It is possible to have COVID-19 without developing the typical symptoms of fever and cough. Some people infected with the virus are asymptomatic, meaning they do not develop any symptoms at all. Others may only have mild symptoms that are not the classic ones we associate with COVID-19. Let’s explore in more detail if you can have COVID but no fever or cough.
What are the typical symptoms of COVID-19?
The most common symptoms of COVID-19 are:
- Fever or chills
- Cough
- Shortness of breath or difficulty breathing
- Fatigue
- Muscle or body aches
- Headache
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Nausea or vomiting
- Diarrhea
Fever and cough are considered the classic symptoms of COVID-19, present in the majority of cases. The other symptoms can manifest in varying combinations and levels of severity.
Is it possible to have COVID-19 without fever or cough?
Yes, it is certainly possible to have COVID-19 without developing a fever or cough. Here’s why:
- Asymptomatic infections: Some people who test positive for COVID-19 never develop any symptoms at all. Estimates vary on how common asymptomatic cases are, ranging from 20-50% of infections.
- Mild symptoms: Some people only get mild symptoms that don’t include fever or cough, such as headache, sore throat, or runny nose.
- Pre-symptomatic: People infected with COVID-19 may be contagious 1-3 days before symptoms start. So they can transmit the virus before fever or cough set in.
- Post-viral: Lingering symptoms after the acute illness has resolved, which may not include fever or cough.
Let’s explore these situations further:
Asymptomatic COVID-19 infections
Some people infected with SARS-CoV-2, the virus that causes COVID-19, never develop noticeable symptoms. However, asymptomatic cases can still transmit the virus to others.
One study published in JAMA Network Open found that 30% of infections were asymptomatic. Another study found that among those testing positive, 104 out of 128 (81%) remained asymptomatic.
People who are vaccinated are more likely to develop asymptomatic infection if exposed to the virus. One study found that unvaccinated people were twice as likely to develop symptoms compared to vaccinated people.
So while the risk is reduced, asymptomatic transmission remains possible in vaccinated individuals. This demonstrates how COVID-19 can occur without classic fever or cough symptoms.
Mild COVID-19 symptoms
Many people with COVID-19 only experience mild to moderate symptoms that don’t require hospitalization. Symptoms may include:
- Headache
- Fatigue
- Sore throat
- Congestion
- Muscle pain
- Loss of taste/smell
In these milder cases, people may never develop a fever, cough, or shortness of breath. But they can still spread the virus to others.
Pre-symptomatic transmission
Pre-symptomatic refers to the time between exposure to the virus and onset of symptoms. People infected with COVID-19 may be contagious during this period, even without symptoms.
On average, symptoms develop within 5 days of infection:
- Day 1: Exposure to the virus
- Day 2-4: Pre-symptomatic period
- Day 5: Symptoms start
So people can be infectious on days 2-4 before fever or cough manifest. This enables asymptomatic transmission early in infection.
Post-viral COVID-19
Some people experience persistent symptoms weeks or months after the acute COVID-19 illness resolves. This is sometimes referred to as “long COVID” or “post-COVID syndrome.”
Common lingering symptoms include:
- Fatigue
- Brain fog
- Headache
- Muscle pain
- Heart palpitations
These post-viral complications may occur even in mild COVID-19 cases that didn’t involve fever or cough initially.
How often does COVID-19 occur without fever or cough?
It’s difficult to give exact statistics on how often COVID-19 occurs without the classic symptoms. Here are some key points:
- 20-50% of COVID-19 cases may be asymptomatic
- 40-50% of transmission may occur pre-symptomatically
- Over 50% of cases are considered mild
- 87.8% of mild cases may not have fever
- 67.8% of mild cases may not have cough
So while fever and cough are the most common symptoms, a significant portion of cases may occur without them. Let’s review some studies on the frequency of atypical presentations:
Study 1 – Symptoms in mild cases
A study published in JAMA Network Open looked at symptoms in mild COVID-19 cases:
- No fever in 87.8% of mild cases
- No cough in 67.8% of mild cases
This suggests the majority of mild infections may occur without fever or cough.
Study 2 – Asymptomatic infection rates
A study in Thorax found 31% of infections were asymptomatic:
| Infection Type | Percentage |
| Asymptomatic | 31% |
| Presymptomatic | 16% |
| Mild symptoms | 40% |
| Moderate symptoms | 10% |
| Severe symptoms | 3% |
This demonstrates nearly 1/3 of infections may be asymptomatic.
Study 3 – Pre-symptomatic transmission
A modeling study published in Science estimated the pre-symptomatic infectious period represents over 50% of transmission:
| Period | Transmission Percentage |
| Pre-symptomatic | 48% |
| Asymptomatic | 6% |
| Symptomatic | 46% |
Nearly half of transmission happens before symptoms like fever and cough develop.
Can you transmit COVID-19 without symptoms?
Yes, people infected with SARS-CoV-2 can transmit the virus even without developing symptoms. This occurs through:
- Asymptomatic cases
- Pre-symptomatic phase
- Mild illnesses without classic symptoms
Asymptomatic people carry similar viral loads to symptomatic patients, making transmission possible. Exactly how contagious they are compared to symptomatic cases is still under investigation.
One study found household transmission rates from:
- Asymptomatic cases: 0.7%
- Pre-symptomatic cases: 6.2%
- Symptomatic cases: 18%
While lower, asymptomatic transmission remains a risk. Proper masking, distancing, and testing are essential to reduce spread from those not exhibiting fever or cough.
Vaccination also reduces transmission risk by decreasing the likelihood of developing symptoms and generating virus-containing respiratory droplets. But breakthrough infections remain possible, underscoring the need for continued vigilance.
How to tell if you have COVID without classic symptoms?
It can be challenging to determine if you have COVID-19 without textbook fever or cough symptoms. Here are some strategies:
- Take a COVID test – Molecular or antigen tests can detect infection in mild/asymptomatic cases.
- Monitor for any symptoms – Isolate and test if you experience headache, sore throat, or other signs of illness.
- Consider your exposures – Have you had close contact with anyone diagnosed with COVID-19? Have you attended gatherings where transmission may have occurred?
- Isolate if ill – Stay home from work and avoid others if you feel unwell, even without major symptoms.
The only way to know for sure is to get tested, especially after exposures or if symptoms are suspicious for COVID-19. False negative results are possible, so repeat testing may be warranted if illness persists or exposure risk was substantial.
Can you get COVID-19 without an exposure?
For someone to get infected with SARS-CoV-2, they need to have contact with the virus through exposure to an infected person. COVID-19 cannot arise spontaneously without transmission occurring.
There are two ways exposure happens:
- Symptomatic cases – Exposure to respiratory droplets from an infected person coughing or sneezing. Being within 6 feet facilitates transmission.
- Asymptomatic cases – Inhaling small respiratory droplets or aerosols from someone with no symptoms. Requires prolonged indoor contact.
So COVID-19 cannot develop without viral exposure at some point. However, the exposure may have been very mild or via an asymptomatic contact. The absence of a known close contact does not rule out COVID-19 infection.
Testing is still warranted with any suggestive symptoms, even if the person lacks a clear exposure history. Isolate from others while awaiting results to limit spread in case it does turn out to be COVID-19.
Prevention tips if you have COVID without symptoms
Here are some tips to avoid transmitting COVID-19 if you lack symptoms:
- Get tested if you’ve had an exposure or feel unwell in any way.
- Isolate from others while awaiting test results.
- Wear a well-fitting mask around others if infected.
- Inform close contacts if you test positive so they can monitor for symptoms.
- Stay home as much as possible if infected, and avoidcontact with high-risk individuals.
- Practice good hand hygiene by washing regularly with soap and water.
Vaccination and boosters remain vital to limiting community spread. Even mild illnesses can be contagious, so stay vigilant about possible exposures and isolate at the first sign of symptoms.
The Bottom Line
It is certainly possible to contract and transmit COVID-19 in the absence of textbook fever and cough symptoms. Asymptomatic illness, mild symptoms, and pre-symptomatic infection enable spread even without the most common signs.
Estimates suggest 20-50% of cases may be asymptomatic. Over 50% occur pre-symptomatically or only involve mild symptoms.
Testing remains crucial when suspicious exposures or illnesses occur, even without fever or cough. Self-isolation with any possible symptoms can reduce asymptomatic transmission risk.
Ongoing vaccination, masking, distancing, and testing are key tools to control spread from those with non-classic COVID-19 presentations. Remain vigilant about exposures and stay home when feeling ill. With shared efforts, we can work to contain viral transmission even in the absence of obvious symptoms.