A significant percentage of the population — 45% or even higher, according to recent research — could have coronavirus but show mild or no symptoms.

They may not look sick, but they can still spread COVID-19.

It is important to distinguish asymptomatic — which refers to people who are infected but have no symptoms — from the term pre-symptomatic, used to describe people infected with the virus but not yet showing symptoms. Recent research has suggested that pre-symptomatic people may commonly spread the virus and are most contagious up to two days before the onset of symptoms, while getting infected from a person who truly has no symptoms is comparatively less likely. More research in this area is needed.

Many massage therapists have told MASSAGE Magazine, in an informal survey, that they will be using personal protective equipment (PPE) such as face masks in their return to work. Some areas require this of both therapists and clients. In addition to PPE and increased sanitation, many practitioners noted they will screen clients for coronavirus during the intake, taking temperatures and asking if clients have recently travelled internationally; been knowingly exposed to someone with COVID-19; or have symptoms of the virus, which include cough, fever and loss of taste or smell. But what about clients who appear healthy?

How Is Asymptomatic Transmission Possible?

It is possible for a client to be infected with COVID-19 and show very mild, or no, symptoms. A person with a mild or asymptomatic case is likely to be shedding smaller amounts of viral particles and so poses somewhat less of a risk — that is, for a healthy adult, said Ric Ford, Epidemic Intelligence Officer for Eurofins Scientific LLC, a laboratory testing company. Smaller amounts of virus that may not succeed in infecting a healthy adult can still be deadly to people in high-risk groups.

“Asymptomatic carriers and people that have developed or are developing a mild case of the infection should be a low to moderate risk to anyone working in inter-personal services,” said Ford. “However, from a professional perspective those risks still have to be moderated in a diligent and transparent process.”

To understand how it’s possible for COVID-19 to be transmitted by an asymptomatic person, it helps to understand how viruses in general spread and what’s different about the coronavirus. (The full name of coronavirus is severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2, which spreads the coronavirus disease, or COVID-19).

What is a Virus?

Viruses, according to the textbook “Molecular Cell Biology,” are infectious agents that cannot reproduce on their own; a virus must infect a living host cell, which is then forced to produce copies of the virus, which then emerge and seek out other cells to infect. As this process continues, the number of virus particles in the body increases exponentially and at some point will trigger the immune system to respond. The immune response to a virus is what causes symptoms such as fever or coughing.

As the body’s immune response clears the virus, symptoms subside. However, it is important to note that even in the stages before the immune response is triggered and after the person starts to feel better, the virus is present in the body. Depending on the virus type and amount of virus present, this means a person could expose others to the virus before they know they have it, and possibly after their symptoms have begun improving.

This is what makes it difficult to control the spread of COVID-19 and other viral illnesses.

How Does COVID-19 Spread?

According to the U.S. Centers for Disease Control and Prevention, coronavirus is believed to spread primarily through the tiny droplets produced and released into the air when a person breathes, speaks, coughs or sneezes. The closer you are to an infected person, the more likely you are to inhale some of those droplets. If you are exposed to enough of them, you can become infected. The virus can also live in droplets that land on a surface, such as a door handle or countertop.

It is important to note — and this is where the asymptomatic transmission element comes into play — that simply talking can generate coronavirus droplets that can remain suspended in the air for between eight and 14 minutes, according to research published in May in the Proceedings of the National Academy of Sciences.

According to Ford, exposure to very small amounts of virus is less likely to cause infection in a healthy adult. He went on to note that 62 to 68% of people who test positive for COVID-19 are found to have had cumulative exposure to the illness over the course of hours or days.

What If You Have a Pre-Existing Condition?

Apart from the level of exposure to the virus you have, your health makes a big difference in whether you get sick, or how sick you get. If you are a “healthy adult” — meaning you have no existing serious medical conditions — you are less at risk of serious complications of coronavirus than an elderly person or someone with a chronic disease like diabetes. (This article is not a replacement for medical or legal advice; check your local and state regulations before practicing.)

Keep Taking Precautions to Avoid Asymptomatic Transmission

To summarize, your chances of catching COVID-19 are lower if you have been social distancing, staying at home and wearing appropriate PPE, including a face mask in public. Within your session room, you should continue to wear a face mask; you may also want to wear gloves if it makes you or your client more comfortable.

While social distancing isn’t possible during a massage or spa treatment, you should practice it whenever you can inside your establishment, said Carol Winner, public health expert and founder of givespace, an organization established to help people communicate their personal space needs. (Winner founded the organization several years prior to the pandemic.)

In addition to taking payments electronically, washing your hands often, wearing a mask and frequently disinfecting surfaces, she recommends taking measures such as maintaining a six-foot distance between yourself and any co-workers, and only allowing one client at a time in your waiting area. She suggests that both you and the client wear masks during the session — advice that mirrors many state and location regulations.

“It is always best to assume that each client, and possibly an unknowing co-worker, is infected,” Winner said.

About the Author

Allison M. Payne is MASSAGE Magazine’s associate editor. Her recent articles include “Questions About Paying Student Loans During the Pandemic? Here’s Where to Find Answers” and “MTs Push Back on San Francisco Ordinance That Targets Human Traffickers” (both, massagemag.com).

“You Asked” provides answers to questions asked by our community of massage therapists. Join our closed massage therapists’ Facebook group at facebook.com/groups/massagemagazine to participate in polls and for the opportunity to tell us what you’d like to learn.