We’ve learned a lot about COVID-19 over the last few years. The disease, which is spread via respiratory droplets, is highly transmissible. Millions of Americans have been infected by the virus—and billions worldwide. Several variants have been discovered, including Beta, Delta, and Omicron. But the good news is that serious illness can now be avoided. For those eligible, the COVID-19 vaccine can reduce your risk of hospitalization by as much as 95 percent.
That said, there are still numerous unknowns, including why individuals can test positive for the virus weeks after infection and why young children seem to be highly contagious for the disease. According to an August 2021 study published in JAMA Pediatrics, infants and toddlers are more likely to transmit SARS-CoV-2 compared to their older peers, aged 14 to 17. And while some of these findings can explained by behavioral factors—infants and toddlers cannot isolate when sick, for example—the contagion effect is still being researched.
But what does this mean for children and adults? How is COVID-19 spread and, more importantly, how long are children contagious? Read on to learn more.
How Is COVID-19 Spread?
COVID-19 is spread when an infected person releases droplets through coughing, sneezing, or breathing. The droplets can be passed orally, i.e. you can breathe in the infection through your mouth or nose. While rare, COVID-19 can also be spread by coming in contact an infected surface (like a counter or handrail) and then touching your eyes, mouth, or nose.
That said, due to the incubation period of COVID—and the fact that many individuals are contagious days before showing symptoms—it's hard to know if/when you were exposed. Researchers estimate that people who get infected with the coronavirus can spread it to others 2 to 3 days before symptoms start, and are most contagious 1 to 2 days before they feel sick. However, this depends on the variant.
How Long Are You Contagious With COVID-19?
Since COVID-19 was first discovered, experts have been studying the duration of the virus. At first, individuals were told to quarantine for 14 days—or two weeks—if infected. Months later, the number was dropped to 10 days. Currently, the quarantine duration is 5 days—though you should remain masked days 6 through 10 after infection or exposure.
So how long are you actually contagious? According to the Centers for Disease Control and Prevention (CDC), this window of time is contingent on the severity of your infection, and your symptoms.
"You can end isolation [quarantine] after 5 full days if you are fever-free for 24 hours without the use of fever-reducing medication and your other symptoms have improved," the CDC says. "If you continue to have fever or your other symptoms have not improved after 5 days of isolation, you should wait to end your isolation until you are fever-free for 24 hours without the use of fever-reducing medication and your other symptoms have improved."
If you're unsure about your child's contagiousness or symptoms, always speak with their pediatrician. It's better to be safe than sorry when it come to COVID-19.
Can You Get COVID-19 More Than Once?
The short answer is yes. You can get COVID-19 multiple times, and even twice in the same season. While rare within 90 days of recovery, new variants can cause additional infection to occur. What’s more, according to a February 2022 article out of Northeastern University, your antibodies dwindle over time. This means you can can be “reinfected” by the same strain.
"Initially… you would be protected from a second infection," says Mansoor Amiji, professor of pharmaceutical sciences and chemical engineering at Northeastern, said in the article. "But if that decline in antibody levels is rapid from the infection, then you may not necessarily have enough of the antibodies to prevent a second infection."
As for whether or not you can spread COVID during reinfection, the answer is unclear. However, a May 2020 study from the Korean Centers for Disease Control and Prevention suggested that those who test positive for COVID-19 a second time (or even a third) may not be contagious. Viral samples collected from reinfected patients couldn’t be grown in a culture, indicating that these individuals were shedding non-infectious or dead virus particles.
How Do Kids Affect COVID-19 Transmission?
So it's clear kids can catch the coronavirus. But are they spreading it at the same rate as adults, especially when not showing any symptoms? Experts are not so sure.
“The presence of the virus genetic material in swabs the respiratory tract need not equate with transmission, particularly in people who do not have important symptoms such as cough and sneeze,” Calum Semple, Ph.D., professor in child health and outbreak medicine at the University of Liverpool and a consultant respiratory pediatrician at Alder Hey Children’s Hospital in Liverpool, England said in an August 2020 statement.
Other experts say children shouldn’t be disregarded as spreaders no matter what. Even though most infected kids “have mild or unrecognized disease,” they may still “play important epidemiologic roles by potentiating spread of infection through communities,” Roberta L. DeBiasi, M.D., M.S. and Meghan Delaney, D.O., M.P.H. wrote in an editorial about the study, also from August 2020.Infected kids, they later added, “may be more likely to go unnoticed either with or without symptoms and continue on with their usual activities, which may contribute to viral circulation within their community.”
What's more, kids may spread COVID-19 more readily because of various lifestyle factors. For example, they might play closely with other children in daycare. They're constantly in contact with caregivers, and they're not as careful with hygiene. It's unclear how these factors affect current transmission statistics.
What Should You Do If Your Child Tests Positive for COVID-19?
You should reach out to your child's pediatrician if they test positive for COVID-19 or you suspect a COVID-19 infection. Most youth infections are mild, though serious disease can happen on rare occasions. Kids might experience cough, congestion, fatigue, loss of smell or taste, headaches, and/or fever. However, your child's doctor can (and should) advise you. In other words, they will let you know if your child's symptoms are "normal" and what you should be on the lookout for.
