Person checking their blood pressure

July 7, 2022

Some people get COVID-19 and barely notice it. Others land in the ICU fighting for their lives.

Why is that? COVID pneumonia—when the two diseases merge—often may be to blame.

The coronavirus tends to attack airways—leading to coughing, low-grade fever and other minor miseries akin to those of the flu. But for about one in five unlucky people, the virus causes pneumonia—and can be life-threatening.

The earlier you’re treated, the better you tend to do. So, here’s what you need to know. It may save your life:

What’s going on?

Like other forms of pneumonia, the lungs’ air sacs—which look like broccoli when viewed on imaging—can get inflamed and fill with fluid. You also may cough, sweat or have fever, chills, exhaustion or chest pain. But you may not even know you have pneumonia at first.

About a week or two after being diagnosed with COVID-19, you may start gasping for air, as oxygen levels and blood pressure plunge, while your heart rate races to compensate. Infected airway linings may scar or thicken.

If you’re fortunate, you’re able to rely on medicine and oxygen supplementation as you heal at home, while being monitored by your physician. If you’re not, you may need hospitalization and possibly a ventilator or other medical equipment to aid breathing.

Can it get worse?

Yes. COVID pneumonia tends to be harsher than other pneumonia, and both of these diseases can be deadly. COVID pneumonia also can develop into lung failure, called acute respiratory distress syndrome, or ARDS. Such patients need help to breathe.

Sepsis, a possible complication of SARS-CoV-2, also can cause lasting harm to the lungs and other organs.

Who is most vulnerable?

The unvaccinated, immunocompromised and elderly are among those more likely to get COVID pneumonia. It’s more common in people 65 and older, and especially those over 85.

Diabetes, hypertension, obesity and kidney disease all raise your risk. So do smoking and cancer treatment.

Some people are immunocompromised, and their immune system may attack their body instead of the coronavirus.

These include people with lupus or rheumatoid arthritis or those undergoing cancer treatment, all of which make them less able to mount a strong defense against infection. If you already suffer a lung disease, such as asthma or Chronic Obstructive Pulmonary Disease (COPD), you’re also more vulnerable.

At least 15% of these people have a gene flaw: They have genetic errors or autoantibodies to type I interferons, a group of proteins that stave off viruses, reports COVID Human Genetic Effort researchers linked to the National Institutes of Health’s National Institute of Allergy and Infectious Diseases (NIAID).

How can COVID pneumonia be detected?

Blood tests may show low oxygen. Low white blood cell counts (lymphocytes) may mean your body is suffering an infection, while high C-reactive protein (CRP), a protein your liver ships to your blood, may be your body’s effort to cut inflammation.

A pulse oximeter—which you can buy at pharmacies—placed on a fingertip can reveal low oxygen saturation, even in those who seem to breathe normally. This is known as silent hypoxia. A healthy saturation tends to be between 94% and 100%. Pneumonia may cut that in half.

Your health care provider may take X-rays or a chest CT scan, which uses computed tomography to combine many X-ray images for a more revealing 3-D view of fluid or scarring. This is sometimes referred to as “ground glass,” because damage may look like shards.

How can COVID pneumonia be treated?

Your doctor may prescribe an antiviral drug, such as Paxlovid™ (nirmatrelvir or ritonavir tablets), Veklury® (remdesivir) or Lagevrio™ (molnupiravir), to help your body battle COVID-19 or COVID pneumonia. These should be used as early as possible, typically within five days of feeling ill.

About 15% of people will need hospitalization and about 5% will require a ventilator, which moves air in and out of the lungs for those unable to do so on their own. If that’s inadequate, patients may need extracorporeal membrane oxygenation (ECMO), in which blood is pumped outside of your body to a heart-lung machine. It removes carbon dioxide and replenishes blood with oxygen, then returns it to the body.

How long does COVID pneumonia last?

Healing can take weeks to a year. While many recover fully, CT scans can reveal irregularities in over half of patients a year later, especially those who had intensive care, the Radiological Society of North America reports.  

You may need breathing exercises, or pulmonary rehab, to regain full function.

The information in this article is accurate as of July 6, 2022. It was clinically reviewed by Ardath Plauche.

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