COVID-19 Lung Damage

What is COVID-19 lung damage?

COVID-19 lung damage can happen when you’re sick with the respiratory illness COVID-19. Severe inflammation can cause lung damage that can make you very sick all at once — with pneumonia or respiratory distress. Or it can linger for a long time after the infection is gone, making you short of breath and tired.

It’s not uncommon for severe respiratory illnesses, like the flu, to lead to lung damage. But when COVID-19 first started spreading, healthcare providers became concerned about how quickly it caused severe illness. Some data suggest that Omicron variants more frequently cause upper respiratory infections than previous versions of COVID. But they’re also still capable of causing lung damage and severe complications.

What are the symptoms of COVID lung damage?

If you’re currently sick with COVID, symptoms of conditions caused by lung damage could include:

• Difficulty breathing/shortness of breath
• Extreme fatigue/tiredness
• Fever
• Bluish or grayish skin, lips or nails (cyanosis)
• Fast, labored breathing
• Chest pain or tightness

Lasting lung damage from COVID — once you’re past the acute infection — might not cause any symptoms. But it could make you short of breath or tired more easily. It also could potentially cause symptoms that get worse over time.

What causes COVID lung damage?

An immune system overreaction can cause lung damage in COVID. Immune cells come to the site of infection to fight it off, which causes inflammation. But out-of-control inflammation can cause damage to healthy tissues.

Damage and weakness in the walls of the small air sacs in your lungs (alveoli) can cause them to fill with fluid. This means air can’t get in and oxygen can’t get to your bloodstream and out to your tissues.

Inflammation can also leave pulmonary nodules or scarring behind, which can take a long time to resolve or could be permanent.

This kind of damage can happen with many kinds of respiratory infections, not just COVID. But COVID seems more likely to cause severe damage. This could be due to it creating immune system overreactions, like cytokine storms, or because of how it uses your immune cells to invade your lungs.

What are the risk factors for lung damage from COVID?

You’re at an increased risk of getting very sick with COVID-19, which could lead to lung damage, if you:

• Are over 65
• Are pregnant
• Smoke or used to smoke
• Are an organ transplant or stem cell transplant recipient
• Aren’t vaccinated
• Have a compromised immune system — this could be due to cancer, medications, HIV or primary immunodeficiency

You might be at increased risk if you have certain health conditions, including:

• Cancer
• Chronic lung disease or a condition that affects your lungs, like asthma, COPD, cystic fibrosis and others
• Conditions that affect your heart, kidneys, liver, blood or brain
• Congenital (present-at-birth) conditions, like cerebral palsy or Down syndrome
• Diabetes
• Mental health disorders
• Obesity
• Substance use disorders

What are the complications of COVID lung damage?

Inflammation caused by COVID and other infections can lead to:

• Pneumonia. This is an infection in your lungs that causes the air sacs to fill with fluid
• Acute respiratory distress syndrome (ARDS). This is a serious condition where much of your alveoli are filled with fluid and oxygen can’t get to your bloodstream.
• Lung nodules. Damage from inflammation can leave behind lung nodules.
• Pulmonary fibrosis (scarring). Areas of lung damage can turn into scarring. Sometimes, scarring can continue to progress, even after you’ve fought off the infection.
• Long COVID. Some people continue to experience symptoms for months or years after having COVID.

How is COVID lung damage diagnosed?

A healthcare provider looks for lung damage using imaging or a bronchoscopy (a lighted tube a provider uses to look inside your airways). They may also use other tests to diagnose infections, like pneumonia.

What tests will be done?

Providers might perform these tests to look for lung conditions and diagnose infections:

• Nasal swab. Your provider may use a thin stick with a soft tip to swab the inside of your nose or throat. A lab will test 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. This gives your provider an idea of how well your lungs are working.
• Imaging. Your provider can use a chest X-ray or CT scan to take pictures of your lungs and look for damage.
• Blood tests. Your provider can use blood tests to help look for infections and check your overall health.
• Sputum test. For a sputum test, you cough and then spit into a container to collect a sample to be tested for infections.
• Pleural fluid culture. During this test, a provider uses a thin needle to take a small amount of fluid from around your lungs to test for infections.
• Arterial blood gas test. This test helps your providers determine how well your lungs are working.
• Bronchoscopy. A bronchoscope can look at your lungs or take tissue or fluid samples for lab testing.

How do you treat COVID lung damage?

There aren’t many ways to treat lung damage after it’s happened. But providers can help you get the oxygen you need. If you have a condition like pneumonia or ARDS due to a COVID infection, your provider might treat you with:

• Supplemental oxygen. If your lungs are working but you’re not getting quite enough oxygen, a provider may give you extra oxygen through a tube in your nose or mask on your face.
• IV fluids. Extra fluid through an IV can keep you from getting dehydrated.
• Mechanical ventilation. If you’re unable to breathe on your own, your provider will put you on a ventilator.
• Proning. Your provider may put you on your belly for several hours a day to help your lungs work more efficiently.
• Extracorporeal membrane oxygenation (ECMO). If your organs aren’t working properly, you may need a type of life support that takes over the work of your heart and lungs.
• Fluid draining. To reduce the fluid in your lungs, a provider may drain the fluid with a catheter or surgery.

Providers may also prescribe medications to help you fight off the infection, including:

• Antiviral medications. Remdesivir or Paxlovid™ can help you fight off a COVID infection.
• Corticosteroids. Providers might use steroids or other anti-inflammatory medications to reduce swelling.
• Monoclonal antibodies. Monoclonal antibody treatments, such as tocilizumab, can help reduce or prevent inflammation.
• Antibiotics. Your provider might prescribe antibiotics if you have a bacterial infection in addition to an infection with COVID.

Rarely, people with lasting, severe lung damage from COVID have received a lung transplant. There are also some medications that might slow down pulmonary fibrosis if it continues to get worse.

Can COVID lung damage be prevented?

The best way to prevent lung damage is to avoid getting an infection. You can help reduce your risk of getting severe COVID-19 by:

• Getting vaccinated (vaccination for COVID and other illnesses, like the flu, might reduce your risk of getting sick or getting severely sick)
• Quitting smoking and avoiding secondhand smoke (smoking damages your lungs, which means you may be more likely to get an infection that leads to pneumonia)
• Washing your hands with soap and water before eating, before handling food and after going to the bathroom (if you don’t have access to soap, use an alcohol-based hand sanitizer)
• Avoiding close contact and sharing items with other people
• Managing other health conditions you have, as they can put you at a higher risk for severe COVID-19

If you do get sick, antiviral medications can help keep you from getting severely ill if you take them within the first five days of your illness.

What can I expect if I have COVID lung damage?

If you have pneumonia or ARDS from COVID, you’ll need to stay in the hospital so providers can help you breathe while your body recovers from the virus.

Lung scarring may last a long time or be permanent. In some cases, fibrosis from infections can continue to get worse over time, even after your other symptoms have gone away.

When should I see my healthcare provider?

If you test positive for COVID-19, ask your provider as soon as possible if you should take an antiviral medication. It’s most effective when taken in the first five days of symptoms.

If you still have shortness of breath, tiredness or other symptoms, talk to your provider. There are designated long COVID clinics that might be able to help you feel better.

When should I go to the ER?

Go to the emergency room or call 911 (or your local emergency services number) if you have COVID-19 and have serious symptoms like:

• Severe shortness of breath or difficulty breathing
• Confusion
• Inability to stay awake
• Bluish skin, lips or nails

What questions should I ask my doctor?

It might be helpful to ask your healthcare provider:

• Are any treatment options available?
• Can this go away on its own?
• How do I take care of myself?