Asymptomatic,
Pre-symptomatic and Mild Signs
and Symptoms of COVID-19
Risk Communication and
Community Engagement
messages
Background
Currently, more than 50% of African countries have reported
community transmission of COVID-19. It has been noted that some of
the infected individuals show symptoms and become ill while others
are infected and do not show symptoms. Evidence has shown that
individuals who do not show symptoms and are not ill can transmit
COVID-19 thus creating concern among public health experts. The
additional challenges at the community level is the belief that only
people who show symptoms can transmit the disease. In order to
address this aspect, it is critical to pay special attention to
asymptomatic and pre-symptomatic cases of COVID-19 to provide
appropriate messaging to avoid and reduce the risk of transmission at
the community level.1
Who is an asymptomatic COVID-19 case?
An asymptomatic COVID-19 case is an individual who is infected with
SARS-COV-2 but does not develop symptoms of COVID-19. These
individuals have tested positive for SARs-CoV-2, but have not developed
symptoms such as fever, cough or difficulty in breathing. Such people
may deny their infection status or doubt the validity of the test
procedures. As a result, they tend to resist or may ignore any advice
regarding observing public health measures to prevent further
transmission to other members of their families, friends and the
community.
1
Zhou P, Yang X-L, Wang X-G, et al. Discovery of a novel coronavirus associated with the recent
pneumonia outbreak in humans and its potential bat origin. bioRxiv 2020.
Who is a pre-symptomatic COVID-19 case?
Pre-symptomatic COVID-19 cases are infected individuals who can
infect others before they develop signs and symptoms of COVID-19.
These people tend to transmit COVID-19 a few days (2-3 days) before
developing signs and symptoms and this period is known as the pre-
symptomatic or latent phase. Pre-symptomatic cases later develop
signs and symptoms of COVID-19 but would have already passed on the
infection unknowingly to other people.
Mild COVID-19 Cases
Some COVID-19 cases may present with mild signs and symptoms, but
they can infect others. The common practice of waiting to get
moderate to severe symptoms before taking preventive actions is
detrimental to the health of others. COVID-19 can be transmitted by
patients with or without symptoms.
Risk Communication and Community Engagement Actions
Asymptomatic, pre-symptomatic and cases with mild signs and
symptoms must be explained to healthcare workers and the public
carefully. The purpose is to advise them to always observe the
recommended public health and social measures. It is likely that the
person next to them could get infected because they are carrying the
virus without knowing. Therefore, there is need to educate them to
protect themselves and others.
Risk communication and community engagement teams must correctly
explain asymptomatic, pre-symptomatic and cases with mild signs and
symptoms in ways that everyone can understand while also building
trust and engaging all stakeholders, including members of the
community. In order to minimize transmission, the following public
health measures are recommended:
Practice hand hygiene
COVID-19 primarily spreads through respiratory droplets from infected
people directly getting in contact with the mouth, nose or eyes or
through touching an infected person and/or contaminated objects or
surfaces. Therefore, your hands can spread the virus onto other
surfaces and/or to your mouth, nose or eyes. Hand Hygiene is one of
the most effective preventive measures you can practice to reduce the
spread of COVID-19. We all can play a critical role in fighting COVID-19
by adopting frequent hand hygiene as a lifestyle. Always wash your
hands with soap and water for at least 40 seconds or clean them with
an alcohol-based hand rub for at least 20 seconds after touching
surfaces or objects used by other people.
Keep physical distance
COVID-19 can spread directly from person to person when someone
coughs, or sneezes and the droplets reach the nose, mouth or eyes of
another person. It is difficult to identify or know who is infected with
COVID-19. Therefore, it is recommended to avoid close contact with
anyone especially people outside your household. Stay at home as
much as possible and go out only when it is essential.
Respiratory etiquette
When coughing or sneezing, always cover your mouth and nose with a
flexed elbow or with a disposable tissue paper Discard the tissue
paper in a covered waste bin immediately after using it and wash your
hands. This action will protect others from getting infected with the
virus.
Use of a face mask
Using a clean face mask prevents respiratory droplets from reaching
your face or someone else’s face if someone coughs, sneezes, talks or
sings. Place the mask carefully, ensuring that it covers your mouth,
nose and chin. Fix it securely to the back of your head with the attached
string to minimize any gaps between the face and the mask. Avoid
touching the surface of the mask while wearing it and replace the mask
with a new clean, dry one as soon as it becomes damp. For effective
protection against COVID-19 infection, you must combine the use of
mask with other protective measures such as hand hygiene and
physical distancing (avoiding crowds). Masks made from Nylon and
polyester materials are more effective than those made from cotton or
gauze materials.
When choosing a non-medical mask, it is recommended that you
choose a mask that you can easily breathe through, with more than one
layer and an inner layer of absorbent material such as cotton.
− When wearing a mask, make sure you can breathe through it
easily,
− Do not use Masks with only have one layer,
− Choose fabrics which can be washed in high temperatures
regularly,
− Fabric masks should have the following layers, type of fabrics and
composition:
• An inner layer of absorbent material, such as cotton,
• A middle layer of non-woven material, such as
polypropylene
• An outer layer of non-absorbent material, such as polyester
or polyester blend
