The emergence of COVID-19 altered public understanding of infectious diseases, with fever often highlighted as a primary indicator. While a raised body temperature is a common response to many illnesses, including COVID-19, the virus’s presentation is more varied than initially perceived. The spectrum of symptoms has broadened considerably, challenging the notion that fever is a universal or consistently present sign of infection.
Absence of Fever in COVID-19 Cases
It is possible to have COVID-19 without developing a fever. A notable percentage of individuals infected with SARS-CoV-2 do not experience fever at any point during their illness. Some studies indicate that fever is present in about 58% to 80% of cases, suggesting that a significant number of people, potentially one in four, do not develop a fever. This phenomenon can be attributed to several factors, including variations in individual immune responses, the specific viral variant involved, and the age of the infected person.
Asymptomatic and pre-symptomatic infections are relevant here. Asymptomatic individuals are those who test positive for the virus but never develop any symptoms. Research suggests that approximately 15.6% to 40.5% of confirmed COVID-19 cases may be asymptomatic. Pre-symptomatic individuals are infected and can transmit the virus before they develop any symptoms, including fever. The absence of fever does not diminish the likelihood of infection or the capacity for viral transmission.
Other Common Signs of Infection
Since fever is not a universal indicator, recognizing other common signs of COVID-19 is important for identifying potential infections. A persistent cough is frequently reported, often occurring even in the absence of fever. Fatigue and muscle or body aches are also widely experienced symptoms, indicating the body’s systemic response to the viral infection.
Respiratory symptoms beyond cough can include shortness of breath, congestion, or a runny nose. Gastrointestinal issues like nausea, vomiting, or diarrhea may also present, sometimes as the initial or sole symptoms. A distinctive symptom for many individuals has been the new loss of taste or smell, which can serve as an early indicator of the disease. These symptoms can vary in their intensity and combination from one person to another.
What to Do Without a Fever
If you suspect you might have COVID-19 but do not have a fever, proactive steps are necessary to confirm infection and prevent further spread. Testing for the virus is recommended, especially if other symptoms are present or if you have had known exposure to someone with COVID-19. Rapid antigen tests can provide quick results, usually within 15-30 minutes, though they may be less sensitive than molecular tests, particularly when symptoms are absent. For higher accuracy, especially without symptoms, a Nucleic Acid Amplification Test (NAAT), such as a PCR test, is considered the gold standard and can detect the virus’s genetic material.
If you test positive, or if you have symptoms that are not explained by another condition, it is advised to stay home and away from others. You can resume normal activities once your symptoms are improving and you have been fever-free for at least 24 hours without the aid of fever-reducing medication. For the five days after resuming activities, it is recommended to take additional precautions such as wearing a well-fitting mask, maintaining distance from others, and ensuring good hand hygiene to minimize transmission. If symptoms worsen or if a fever returns, you should revert to staying home until symptoms improve and fever subsides for another 24-hour period.