Coronavirus Chronicles — The Perhaps Symptomless Disease

In mid-June, the state of knowledge was:

Most of the identified asymptomatic cases are diagnosed by random screening of healthcare workers, and individuals who had been in close contact with COVID-19 cases.

In addition, there is a high number of asymptomatic individuals who have experienced COVID-19-like symptoms in their clinical histories without any diagnostic tests and hospital admission.

The real percentage of asymptomatic individuals and how long they carry the virus is unknown.

Overall, study of the novel coronavirus is in its infancy. Previously we quoted the Centers for Disease Control’s list of recognized possible symptoms. Today’s post picks up on the discussion of back-to-school protocols suggested in late June by the American Academy of Pediatrics (AAP).

According to the AAP document, children, compared to adults, “may be less likely to become infected and to spread infection.” The words “may” and “less likely” are equivocations. It is also possible that, under the right circumstances, children may be quite likely to become infected and to spread infection.

The “less likely” scenario was gleaned from earlier studies which some authorities regard as “small and flawed.” Then, along came a much larger and more rigorous South Korean study that says, according to journalist Apoorva Mandavilli,

Children younger than age 10 transmit to others much less often than adults do, but the risk is not zero.

“Less often” is not great news. Even if a child only transmits to one other person, that individual could could be a “superspreader” who transmits the virus to dozens. That is why for years we have been calling the phenomenon of wildly popular videos a “viral” effect. Maybe nobody pays attention at first, but then an “Internet influencer” — a superspreader — amplifies it.

The thing takes off and explodes, multiplying like crazy and recognizing no limiting authority. The report continues,

And those between the ages of 10-19 can spread the virus at least as well as adults do.

The bottom line here is, to say that children and adolescents are less likely to be symptomatic is meaningless. Studies show that a person’s observable symptoms have little connection with their viral load, or the ease with which they can distribute that viral load to the community. When so many cases of COVID-19 have been transmitted by individuals who appeared, on the surface, to be in peak health, any assurance that a child’s classmates are virtually symptom-free brings no comfort.

Wrapping our heads around it

It is very easy to understand why everybody is confused. If a disease does not have any noticeable effect on a person, how is it even still a disease? If nothing hurts, caves in, or falls off, are you really sick? If an illness does not affect your life in any way, how bad can it be?

The answer is, very bad. For starters, it can make a person unpopular at the Typhoid Mary level. Who wants to be known as the kid who brought in the COVID and wiped out the football team? But mainly, just because someone is asymptomatic today, does not guarantee they will be asymptomatic tomorrow. And that part is hazardously deceptive. A cough is a symptom — but when a child with no cough can simply breathe and be just as contagious as a child with a cough, “asymptomatic” is a distinction without a difference.

Your responses and feedback are welcome!

Source: “A compendium answering 150 questions on COVID‐19 and SARS‐CoV‐2,”, 06/14/20
Source: “COVID-19 Planning Considerations: Guidance for School Re-entry,”, 06/25/20
Source: “Older children spread the coronavirus just as much as adults, study finds,”, 07/18/20
Image by Ministerio da Ciencia/CC BY 2.0

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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