COVID Pneumonia

COVID pneumonia is a complication of a COVID-19 infection. It happens when the SARS-CoV-2 virus infects your lungs, causing them to get inflamed and fill with fluid. This makes it hard to breathe.

Newer variants of COVID seem to be less likely to damage your lungs. But it can still cause life-threatening illness, including pneumonia. It can last longer and cause damage in more places than other types of pneumonia.

Symptoms of COVID pneumonia

The symptoms of COVID pneumonia can be similar to the ones you get with a COVID-19 infection. If any of these symptoms are new or get worse, seek medical attention or go to the nearest ER. They may be signs of progression to pneumonia. Symptoms include:

• Shortness of breath or trouble breathing
• Confusion
• Extreme fatigue/tiredness
• Cough
• Fever
• Chest pain or tightness
• Bluish lips, skin or nails (cyanosis)

COVID pneumonia causes

An infection with the SARS-CoV-2 virus in your lungs causes COVID pneumonia. When your immune system attacks the infection, it can make the small sacs in your lungs (alveoli) swell and leak fluid. This causes pneumonia and trouble breathing.

Research on the original variants suggested that COVID pneumonia uses your own immune system to spread through your lungs. This means it might cause more damage, make you sicker and last longer than other forms of pneumonia. Research on the most recent major variant, Omicron, suggests that circulatory or kidney issues may contribute to developing COVID pneumonia.

Risk factors

People over 65 are at the highest risk of developing pneumonia from a COVID infection. Health conditions that put you at a higher risk include:

• Blood disorders
• Cancer
• Conditions that affect your lungs, heart, kidneys or liver
• Current pregnancy
• Stroke or other conditions that affect blood vessels in your brain
• Dementia, Alzheimer’s disease or other neurological conditions
• Diabetes (Type 1 or Type 2)
• Cerebral palsy, Down syndrome or other conditions you’re born with
• HIV or a compromised (weakened) immune system
• Mental health conditions
• Obesity
• Receiving an organ or blood stem cell transplant
• Smoking (current or past)
• Substance use disorders

Complications of this condition

COVID pneumonia can lead to:

• Acute respiratory distress syndrome (ARDS)
• Blood clot in your lungs
• Lung scarring

How doctors diagnose COVID pneumonia

To diagnose COVID pneumonia, your healthcare provider will ask about your symptoms and examine you. They’ll test you for infections and get images of your lungs to look for pneumonia. They may also test how well your lungs are working.

Tests could include:

• Nasal swab: Your provider uses a thin stick with a soft tip to swab the inside of your nose or throat. A lab tests the sample for COVID-19 and other viruses.
• Pulse oximetry: A sensor slips over your finger and measures the amount of oxygen in your blood.
• Imaging: Your provider can use chest X-ray or CT scan to take pictures of your lungs and look for signs of pneumonia.
• Blood tests: Your provider can use a blood test to help find the cause of pneumonia.
• Sputum test: You cough and then spit into a container to collect a sample. A lab will look for signs of an infection and try to determine the cause.
• Pleural fluid culture: A provider uses a thin needle to take a small amount of fluid from between your ribs and lungs. They send the sample to a lab to help diagnose the cause of pneumonia.
• Arterial blood gas test: Your provider takes a blood sample from your wrist, arm or groin to measure levels of oxygen and carbon dioxide in your blood.
• Bronchoscopy: Your provider may use a thin, lighted tube to look at the inside of your lungs. They can also use the bronchoscope to take tissue or fluid samples for testing.

How is COVID pneumonia treated?

If you’re diagnosed with COVID pneumonia, you’ll likely be admitted to the hospital. Treatments you might receive include:

• Antiviral medications: These include remdesivir or Paxlovid™.
• Antibiotics: You’ll only get antibiotics if you’ve been diagnosed with a bacterial infection or your doctor thinks you’re at risk for one.
• Supplemental oxygen: Your provider may give you extra oxygen through a tube in your nose or a mask on your face.
• IV fluids: Extra fluid through an IV can keep you from getting dehydrated.
• Draining of fluids: A provider may drain fluid from your lungs with a catheter or surgery.
• Corticosteroids: Medications like dexamethasone can reduce inflammation in your lungs.
• Anticoagulants: Blood-thinning medications can reduce your risk of blood clots.
• Monoclonal antibodies: Monoclonal antibody treatments, like tocilizumab, can help reduce or prevent inflammation.
• Mechanical ventilation: If you’re unable to breathe properly on your own, your provider will put you on a respirator. This involves a breathing tube that goes in the back of your mouth and throat, then into your windpipe.
• Extracorporeal membrane oxygenation (ECMO): If your lungs or heart aren’t working properly, you might be put on an ECMO machine. This is a type of life support that takes over the work of your heart and lungs.

When should I see my healthcare provider?

Contact your healthcare provider if you’re at risk for severe COVID-19 or if you have questions about managing your symptoms. They may prescribe antiviral medications for you to take within the first five days of symptoms.

Go to the emergency room or call 911 (or your local emergency service number) if you or someone you’re with has these symptoms:

• Difficulty breathing
• Confusion
• Difficulty waking up or staying awake
• Skin, lips or nails that appear blue

How long does it take to recover from COVID pneumonia?

You’ll probably need to stay in the hospital for a week or longer to recover. How soon you’ll feel better depends on:

• Your age (if you’re older than 65, it may take longer to resolve)
• The severity of pneumonia and how much of your lungs are involved
• If you have other health conditions or complications

You might still be more tired than usual or have other symptoms for weeks or months after you go home from the hospital. Follow up with your healthcare provider if you have ongoing health concerns after being treated for COVID pneumonia. Some healthcare systems now have special clinics for long-term health issues after a COVID infection.

What’s the survival rate for COVID pneumonia?

Age is usually the biggest factor in surviving COVID pneumonia. As you get older, your risk of getting seriously ill or dying goes up.

Mortality also depends on how sick you are. COVID pneumonia mortality rates range from 3% to 5% for people who are in the hospital but not in intensive care, 30% to 40% for people in the ICU and 50% to 80% for those on a respirator.

Can you prevent COVID pneumonia?

There are steps you can take to reduce your risk of getting COVID-19 and other conditions that can damage your lungs. Ways to reduce your risk include:

• Getting vaccinated against COVID-19 and the flu
• Getting vaccinated against pneumococcal disease, which can cause bacterial pneumonia
• Quitting smoking and avoiding secondhand smoke
• Washing your hands with soap and water frequently (or using hand sanitizer, if soap and water aren’t available)
• Avoiding close contact and sharing items with other people if either of you has COVID
• Wearing a mask around other people when COVID is spreading
• Getting treated for other health conditions you have that can put you at a higher risk for severe COVID