Author: Barton Schmitt, MD, FAAP
Copyright 2021. Updated 3/25/2021
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
COVID-19 Infection: What You Should Know
- You or your child have symptoms of COVID-19 (fever, cough or shortness of breath or others) AND:
- Diagnosis was confirmed by positive lab test OR
- Suspected diagnosis was made by a doctor OR
- You suspect COVID-19 based on symptoms consistent with COVID-19 AND it is widespread in your community.
- COVID-19 Symptoms: the most common symptoms are cough and fever. Some patients progress to shortness of breath (trouble breathing). Other common symptoms are chills, shivering (shaking), runny nose, sore throat, muscle pains or body aches, headache and loss of smell and taste. The CDC also includes the following less-common symptoms: fatigue (tiredness), nausea, vomiting and diarrhea.
- Incubation Period: average 5 days (range 2 to 14 days) after coming in contact with the secretions of a person who has COVID-19.
- No Symptoms but Infected: over 30% of infected patients have no symptoms.
- Mild Infections: 80% of those with symptoms have a mild illness, much like normal flu or a bad cold. The symptoms usually last 2 weeks.
- Severe Infections: 20% of people with symptoms develop trouble breathing from viral pneumonia. Many of them need to be admitted to the hospital. People with complications generally recover in 3 to 6 weeks.
- Deaths: children generally have a mild illness and recover quickly. Pediatric deaths are very rare. Older adults, especially those with chronic lung disease, heart disease, diabetes or weak immune systems, have the highest death rates. The overall death rate is around 6 per 1,000.
- Vaccine: safe and effective vaccines are now approved for those 16 and older. Some vaccines are 2 doses, given 3-4 weeks apart. Others are a single dose. Similar to flu shots, they will probably provide protection for 6-9 months. Vaccine research on younger children is in progress. Age 12 to 16 approval is expected in Fall 2021. Age 11 and younger approval is expected in Spring 2022.
- Treatment: new treatments for severe COVID-19 are becoming available. They are mainly used on hospitalized patients and are given in a vein (IV).
- MIS-C is a very rare and severe complication of COVID-19. In general, COVID-19 continues to be a mild disease in children.
- Symptoms: the most common symptoms are fever with red eyes, red lips, red palms and soles. Abdominal pain, vomiting and diarrhea also occur. Half of the patients develop trouble breathing. MIS-C always has more than two symptoms.
- Onset of symptoms: usually about 4 weeks after COVID-19 infection and apparent recovery.
- Peak Age: 8 years. Age range: 6 months to 21 years.
- Treatment: MIS-C is treatable with medications, including IV immune serum globulin.
- If a child gets this rare complication, a parent will know that their child needs to see a doctor. Patients with MIS-C need to be admitted to the hospital.
- Prevention: MIS-C cannot be prevented nor predicted. When approved for this age group, the COVID-19 vaccine will prevent MIS-C.
Treatment of Symptoms:
- The treatment is the same whether you have COVID-19, influenza or some other respiratory virus.
- The only difference for COVID-19 is you need to stay on home isolation until you recover. Reason: you want to protect other people from getting it.
- Treat the symptoms that are bothering you or your child the most.
- There is no anti-viral medicine for treating COVID-19 at home.
- Antibiotics are not helpful for viral infections.
- You don’t need to call or see your doctor unless you or your child develop trouble breathing or become worse in any other way.
- For fever above 102 F (39 C), you may use acetaminophen or ibuprofen if the patient is uncomfortable.
- For fevers 100-102 F (37.8 to 39 C), fever medicines are not needed. Reason: fever turns on your body’s immune system. Fever helps fight the infection.
- Exception: if the patient also has pain, treat it.
- Fluids: offer cool fluids in unlimited amounts. Reason: prevent dehydration. For children younger than 6 months, only give formula or breastmilk. Staying well-hydrated helps the body sweat and give off heat.
- Age 3 Months to 1 Year:
- Give warm clear fluids (e.g., apple juice or lemonade) to thin the mucus and relax the airway. Dosage: 1-3 teaspoons (5-15 ml) four times per day.
- If nothing else helps: give a small amount of corn syrup. Dosage: ¼ teaspoon (1 ml). Can give up to 4 times a day when coughing. Caution: avoid honey until 1 year old. Reason: risk for botulism.
- Age 1 Year and Older:
- Use honey, ½ to 1 teaspoon (2 to 5 ml) as needed, as a homemade cough medicine. It can thin the secretions and loosen the cough. If honey is not available, can use corn syrup.
- OTC cough syrups containing honey are also available. They are not more effective than plain honey and cost much more per dose.
- Age 6 Years and Older:
- Use cough drops (throat drops) to decrease the tickle in the throat. If not available, can use hard candy.
- Avoid cough drops before 6 years. Reason: risk of choking.
- Over the Counter (OTC) cough medicines are not recommended. Reason: no proven benefit for children. Honey has been shown to work better.
- Don’t use OTC cough medicines under 6 years of age. Reason: cough is a protective reflex.
- Over-the-Counter (OTC) Cough Syrups: some people find that cough syrups help decrease coughing. Dextromethorphan is the most common cough suppressant in OTC cough syrups. Often the letters ‘DM’ appear in the name.
- OTC Cough Drops: cough drops can help a lot. They work best for mild coughs. They soothe the tickling feeling in the back of the throat. Cough drops are easy to carry with you.
- Home Remedy – Hard Candy: hard candy works just as well as OTC cough drops. People who have diabetes should use sugar-free candy.
- Home Remedy – Honey: honey has been shown to help decrease coughing at night. The adult dose is 2 teaspoons (10 mL) at bedtime.
Sore Throat Treatment
- COVID-19 often causes a sore throat. Here are some tips on treating it:
- Age over 1 year: can sip warm fluids such as chicken broth or apple juice. Some children prefer cold foods such as popsicles or ice cream.
- Age over 6 years: can also suck on hard candy or lollipops. Butterscotch seems to help.
- Age over 8 years: can also gargle. Use warm water with a little table salt added. A liquid antacid can be added instead of salt. Use Mylanta or the store brand. No prescription is needed.
- Pain medicine: use if pain interferes with swallowing. Not needed for mild pain.
- Sip warm chicken broth or apple juice.
- Suck on hard candy or a throat lozenge.
- Gargle with warm salt water four times a day.
- Avoid smoking.
- Pain medicine, such as acetaminophen (Tylenol), ibuprofen (Motrin, Advil) or naproxen (Aleve): use if pain interferes with swallowing. Not needed for mild pain.
Muscle Pain Treatment
- COVID-19 can normally cause muscle pains and body aches.
- Massage: gently massage any sore muscles.
- Stretching: gently stretch any sore muscles.
- Apply Heat: use a heat pack, heating pad or warm, wet washcloth. Do this for 10 minutes 3 times per day.
- per day.
- Warm bath: for widespread muscle pains, consider a warm bath for 20 minutes, 2 times a day. Gently exercise the sore muscles under water.
- Pain medicine: for widespread body aches, give acetaminophen every 4 hours OR ibuprofen every 6 hours as needed. (See Dosage table.) Not needed for mild aches.
Fluids – Stay Well-hydrated
- Drink lots of fluids. Water is best.
- Goal: keep the patient well-hydrated.
- It loosens up any phlegm in the lungs. Then it’s easier to cough up.
- It helps the body sweat and give off heat.
Home Isolation is Needed:
- Isolation means separating sick people with a contagious disease from people who are not sick (CDC). That means stay at home for at least 10 days after symptoms started.
- Living with a suspected COVID-19 patient implies close contact has occurred.
- Both patient and family members should stay home on isolation and quarantine.
- Exceptions: essential workers who have COVID-19 exposure but do not have any symptoms. Talk to your employer.
- The sick person does not need to be confined to a single room. Reason: preventing spread of respiratory infections within a home is nearly impossible.
- The sick person should try to avoid very close contact with other family members. That includes hugging, kissing, sitting next to or sleeping in the same bed. None of this is realistic for young children.
- Older children and adults with symptoms may consider wearing a mask in common household areas.
- Isolation Questions for Your Doctor: home isolation can be complicated. A parent may need to return to work. Someone in the household may be elderly or have a serious medical problem. If you have additional questions, call your doctor during office hours. Your doctor is the best resource for up-to-date information on COVID-19.
COVID-19 Testing – Talk with your Doctor:
- Who can benefit from testing is complicated.
- The availability of testing and where to get it can be different for every community.
- Your doctor is the best resource for up-to-date information on testing. Call during office hours.
- Here are some facts that may answer some of your questions:
- Diagnostic Tests: these are performed on nasal or mouth secretions. The test can tell us if you have a COVID-19 infection now. Timing is important on when to do this test:
- With Symptoms. Get a test within 3 days of onset of symptoms.
- Without Symptoms with a COVID-19 close contact. Get a test on day 5-7 after exposure. Reason: testing done during the first 5 days after exposure will usually be negative.
- Tests for COVID-19 are mainly done on people who are sick (have symptoms of COVID-19).
- Serious symptoms. Testing is routinely done on patients who have serious symptoms or are admitted to the hospital.
- Mild symptoms. Testing is not always done on patients with mild symptoms who don’t need to be seen.
- No symptoms. Tests are usually not done on people who have no symptoms, unless they have a close contact with COVID-19.
- Repeat diagnostic tests: after a positive test, repeat tests are not recommended. Even after it is safe to stop isolation (usually 10 days), tests may stay positive for up to 90 days. A positive test does not mean the patient can spread the infection once the required isolation period is completed.
- Antibody Tests: these are performed on blood. They can sometimes tell us if you have antibodies from a previous infection. They are not done until at least 2 to 3 weeks have passed from the start of the infection. Talk with your doctor if you have questions about this test.
How to Protect Others – When You or Your Child are Sick:
- Stay home. Don’t go to school or work if you are sick. Don’t go to stores, restaurants, places of worship or other public places. Avoid public transportation or ride sharing. Leave the house only if you need to seek medical care. Your doctor or local health department will tell you when it is safe to return.
- No visitors. Do not allow any visitors, even friends.
- Cover the cough. Cough and sneeze into your shirt sleeve or inner elbow. Don’t cough into your hand or the air. If available, sneeze into a tissue and throw it into a trash can.
- Wash hands often with soap and water. After coughing or sneezing are important times.
- Don’t share glasses, plates or eating utensils.
- Wear a face mask when around others or you have go to a medical facility.
Call or Contact Your Doctor If:
- Trouble breathing occurs
- You think you or your child need to be seen
- Symptoms become worse