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COVID-19 & Pneumonia

August 21, 2020
Medically reviewed by Susan Kerrigan, MD and Marianne Madsen
Additions/comments provided by Pulmonologist Kelly Fan, MD

COVID-19 affects one’s respiratory system in many different ways. One of the common complications of COVID-19 is pneumonia, where lungs become infected. How does this happen, and what are the chances it will happen to someone when they are infected with COVID-19?

 

Two Primary Types of Pneumonia

 

Pneumonia is a lung infection causing part of the lung alveoli to be filled with an inflammatory fluid, resulting in lowered levels of oxygen in the blood of the lungs. There are two primary types of infectious pneumonia: bacterial and viral. Bacterial pneumonia is often more serious than viral pneumonia. Bacterial pneumonia can develop rapidly over a period of 24 to 48 hours, or the symptoms may come on slowly over several days. Viral pneumonia usually develops gradually over a number of days and can be a complication of COVID-19.

Symptoms

 

Symptoms of pneumonia include coughing, fever, sweating and shivering, shortness of breath, rapid heartbeat, shallow breathing, chest pain, loss of appetite, runny nose and fatigue. Symptoms may also include nausea, vomiting, and confusion (generally in older people), as well as pain in muscles or joints. Some people also experience a loss of taste and smell. Sound familiar? Yes, those are some of the same symptoms experienced by people who are infected with COVID-19, so it’s difficult to tell if pneumonia is a symptom of COVID-19 or if it develops as a complication.

Kelly Fan, MD

Treatment of COVID-19 is an evolving field with active research. At the moment there are no proven outpatient oral therapies. For hospitalized patients, therapeutic options include remdesivir (a direct antiviral medication), dexamethasone (steroid), and convalescent plasma. Other investigational therapies include immune modulators to minimize cytokine storm and inflammatory effect on the body. Anticoagulation medications are given to most patients to minimize the risk of blood clot formation.

Testing and Diagnosis

 

Pneumonia is diagnosed by the doctor performing both a physical examination and tests. During the physical exam, the doctor will listen to your lungs with a stethoscope. If you have pneumonia, your lungs may make crackling or bubbling noises when you breathe in. The doctor may also tap on your chest, known as percussion, and listens for dull thuds, which will confirm either fluid in a lung or signs that part of the lung has collapsed. The doctor will also ask if the pain is worse when breathing in deeply or when coughing; this will help to accurately diagnose pneumonia. Also the color of the lips may be a factor; if the lips are blue, it could be an indication of lower levels of oxygen in the red blood cells (cyanosis). It can be difficult to diagnose pneumonia because its symptoms are so similar to those of flu and asthma.

 

Testing for pneumonia will include blood tests, sputum tests, chest x-rays and pulse oximetry, which tests the oxygen level in the blood. However if one is a high-risk patient, the doctor may also order a CT scan, arterial blood gas test, pleural fluid culture and a bronchoscopy.

 

Treatment

 

Treatment is symptomatic as there is no cure for coronavirus at this time. If suffering from a mild case of COVID-19, the correct path to recovery is to simply stay at home, rest, take medications for symptom relief, and wait it out.

However, a small percentage of the population who are infected with COVID-19 (approximately 15%) will contract viral pneumonia, too. This will result in treatment for the pneumonia, which may involve antiviral medications and may even result in the need to ventilate the patient. This is done to give the person a chance to recover when their lungs have failed. The ventilator replaces the lung’s function during this time and is considered to be a treatment only when other treatments have failed. An arduous process of rehabilitation may be needed afterwards for the patient to function as well as before they contracted COVID-19 and viral pneumonia. There can also be lasting side effects from the ventilation.

 

At this time, treatment for COVID-19 includes Remdesivir and Dexamethasone. Remdesivir is an experimental antiviral drug which might speed up recovery for those suffering from a severe form of COVID-19 and may also help with viral pneumonia infection. Some people’s immune systems overreact to COVID-19, and Dexamethasone may minimize this reaction.

 

To minimize the chances of contracting COVID-19 and its possible complication of viral pneumonia, or of passing it on to others, keep washing your hands, practice social distancing, keeping 6 feet away from other people as often as possible, and be vigilant about wearing your mask.

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