Unlocking COVID Pneumonia: Signs & Care

It’s a feeling I’ve heard described too many times, especially during the height of the pandemic – that sensation of your chest tightening, each breath becoming a conscious, hard-won effort. A patient once shared with me, “Doc, it felt like my lungs were just… heavy. Like I couldn’t get enough air in, no matter how hard I tried.” That alarming struggle, that profound difficulty breathing, often points us towards a serious concern: COVID pneumonia. It’s a complication of COVID-19 that we learned to watch for very carefully.

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What Exactly Is COVID Pneumonia?

So, what are we talking about when we say COVID pneumonia? Essentially, it’s an infection deep in your lungs caused by SARS-CoV-2, the virus responsible for COVID-19. When you get sick with COVID-19, your immune system, bless its heart, rushes in to fight the virus. If that battle happens in your lungs, they can get inflamed. This inflammation can cause the tiny air sacs in your lungs (we call them alveoli) to fill up with fluid. And when that happens? Breathing becomes tough. Really tough.

You might also hear doctors talk about bilateral interstitial pneumonia in connection with COVID-19. “Bilateral” simply means it’s happening in both lungs, which is very common with COVID pneumonia. The “interstitial” part refers to the delicate supporting tissue around your air sacs, blood vessels, and airways. When this tissue gets inflamed and damaged by the pneumonia, it can sometimes lead to scarring. We sometimes see this kind of lung damage even after the initial infection seems to have cleared, particularly in people experiencing what’s often called long COVID.

Think of COVID-19 as the illness caused by the virus. COVID pneumonia is a serious turn that illness can take, specifically targeting your lungs.

How is COVID Pneumonia Different?

Now, you might wonder how COVID pneumonia stacks up against other types of pneumonia. All pneumonias involve inflammation and fluid in the lungs, that’s true. But research suggests the SARS-CoV-2 virus behaves a bit differently.

Many common pneumonias are like a wildfire – the infection can spread very quickly through the lungs, causing symptoms to flare up suddenly. COVID pneumonia, on the other hand, seems to be more like several small bonfires starting in different spots within your lungs. The virus settles in, and then, almost sneakily, it can use your own body’s defense system to gradually spread. This often means it can last longer and potentially cause damage in more areas with a slower, more persistent burn.

Who’s More at Risk for Developing COVID Pneumonia?

While anyone can develop COVID pneumonia, some folks are at a higher risk of getting very sick if they contract COVID-19. It’s something we always keep in mind. You might be at increased risk if you:

Are over 65.
Are pregnant.
Smoke or have a history of smoking.
Have had an organ or blood stem cell transplant.

Or if you’re living with certain ongoing health conditions, such as:

Blood disorders like sickle cell disease or thalassemia.
Cancer.
Cerebrovascular disease, like a previous stroke.
Chronic kidney or liver disease (including hepatitis, cirrhosis, or nonalcoholic fatty liver disease).
Chronic lung diseases like asthma, COPD, pulmonary fibrosis, or pulmonary embolism.
Cystic fibrosis.
Dementia, Alzheimer’s, or other neurological conditions.
Diabetes (Type 1 or Type 2).
Conditions like cerebral palsy or Down syndrome.
Heart conditions such as heart failure, coronary artery disease, or high blood pressure (hypertension).
HIV/AIDS or a weakened immune system for other reasons.
Mental health conditions like depression or schizophrenia spectrum disorders.
Obesity.
Substance use disorders.
Tuberculosis.

It’s a long list, I know. But it helps us identify who needs extra vigilance. About 15% of people who get COVID-19 go on to develop more serious complications, and that includes COVID pneumonia.

Signs to Watch For: Recognizing COVID Pneumonia

The symptoms of COVID pneumonia can overlap quite a bit with the initial COVID-19 infection. That can make it tricky. But if any of these signs are new for you, or if they suddenly get worse, it’s a red flag. You need to seek medical attention right away, or head to the nearest ER. These could mean COVID-19 is progressing to pneumonia:

Shortness of breath (dyspnea) or finding it hard to breathe. This is a big one.
New or worsening confusion.
Extreme tiredness or fatigue that just won’t lift.
A persistent cough.
Fever.
Chest pain or a feeling of tightness.
A bluish tint to your lips, skin, or nails (cyanosis) – this means you’re not getting enough oxygen.

How Do I Know If It’s Turning Into Pneumonia?

This is a question I hear a lot. While many symptoms are similar, the most significant clue that a COVID-19 infection might be worsening into pneumonia is trouble breathing. If you’re feeling short of breath and it’s getting worse, or if you feel like you just can’t get enough air, please don’t wait. Go to the nearest emergency room.

What’s Happening Inside Your Lungs?

The root cause of COVID pneumonia is your body’s immune response to the SARS-CoV-2 virus taking hold in your lungs. When your immune system attacks the virus there, it causes those tiny air sacs (the alveoli) to swell up and leak fluid. That fluid is what makes it so hard to breathe.

Is COVID Pneumonia Contagious?

This is an important distinction. The virus that causes COVID-19 is definitely contagious. It spreads from person to person through droplets when an infected person coughs, sneezes, talks, or even breathes. Pneumonia itself isn’t something you “catch” from someone in the same way. It’s a condition that develops in your lungs.

So, if you have COVID pneumonia, you can spread the COVID-19 virus to others, and they could get sick with COVID-19. Whether they develop pneumonia would depend on their own body’s response and risk factors.

Sometimes, rarely, a person with COVID-19 might also pick up a bacterial infection in their lungs at the same time (we call this a superinfection). If that bacterial pneumonia is present, that specific bacterial infection could potentially be contagious.

Figuring Out What’s Going On: Diagnosis of COVID Pneumonia

If we suspect COVID pneumonia, we’ll start by talking about your symptoms and doing a physical exam. I’ll listen carefully to your lungs with a stethoscope, check your blood pressure, temperature, and very importantly, your oxygen levels. We’ll almost certainly do a nasal swab to test for COVID-19 if it hasn’t been confirmed, or to check for other viruses.

To get a clearer picture, we might suggest some other tests:

Pulse oximetry: This is a small, painless sensor that clips onto your finger. It gives us a quick reading of the oxygen saturation in your blood, telling us how well your lungs are doing their job.
Imaging: A chest X-ray or a CT scan helps us see inside your lungs and look for the tell-tale signs of pneumonia.
Blood tests: These can help us figure out if it’s the COVID-19 virus or perhaps bacteria causing the pneumonia. They also give us clues about how your body is responding.
Sputum test: We might ask you to cough up some phlegm (sputum) into a sterile cup. The lab can then examine this for signs of infection.
Pleural fluid culture: If there’s fluid buildup around your lungs, we might use a thin needle to take a small sample. This can also be sent to the lab.
Arterial blood gas test: This involves taking a blood sample, usually from your wrist, to get a very precise measurement of oxygen and carbon dioxide levels in your blood. It’s a really good indicator of lung function.
Bronchoscopy: In some cases, especially if things are unclear or severe, a specialist might use a bronchoscope – a thin, flexible tube with a light and camera – to look directly inside your airways and lungs. They can also take small tissue or fluid samples this way.

How We Help You Fight Back: Treatment for COVID Pneumonia

If you’re diagnosed with COVID pneumonia, it’s very likely you’ll be admitted to the hospital. This allows us to monitor you closely and provide the support your body needs. Treatment can involve a combination of things:

Antiviral medications: Drugs like remdesivir or Paxlovid™ are designed to target the SARS-CoV-2 virus directly and help your body fight off the infection.
Antibiotics: These are for bacterial pneumonia. If tests show you have a bacterial infection on top of COVID-19, or if we strongly suspect it, you’ll get antibiotics.
Supplemental oxygen: If your oxygen levels are low, we’ll give you extra oxygen through a nasal cannula (small tubes in your nose) or a face mask.
IV fluids: Staying hydrated is key, so you’ll likely get fluids through an intravenous line.
Draining of fluids: If there’s a lot of fluid in or around your lungs, it might need to be drained, sometimes with a catheter or a minor surgical procedure.
Corticosteroids: Medications like dexamethasone can be very helpful in reducing the inflammation in your lungs.
Monoclonal antibodies: Treatments such as tocilizumab can also help calm down or prevent excessive inflammation.
Mechanical ventilation: If you’re struggling significantly to breathe and your oxygen levels are critically low, you might need a ventilator. This machine breathes for you through a tube placed into your windpipe. You’d be sedated (asleep) while on a ventilator.
Extracorporeal membrane oxygenation (ECMO): In the most severe cases, if your lungs (and sometimes heart) are failing, ECMO might be an option. This is a form of life support where a machine takes over the work of your heart and lungs, oxygenating your blood outside your body.

We’ll always discuss all the options and what’s best for you.

The Road to Recovery from COVID Pneumonia

Recovering from COVID pneumonia takes time, and there’s no one-size-fits-all timeline. You might have good days and bad days. For what we’d call a moderate illness, you might start feeling significantly better in three to six weeks. But if it was a severe case, recovery can stretch out for months. It really depends on:

Your age.
How severe the pneumonia was.
Whether you have other health conditions or developed any complications.

It’s so important to follow up with your doctor after you’re out of the hospital, especially if you have any lingering concerns.

Understanding Potential Complications

COVID pneumonia itself is a serious complication of a COVID-19 infection. It’s helpful to think of COVID-19 severity as a spectrum:

Viral respiratory illness: This is the mildest form, though it can still make you feel pretty unwell with fever, sore throat, and perhaps some shortness of breath. Many can manage at home.
COVID pneumonia: This is when the infection causes significant lung inflammation and fluid, making breathing difficult. Hospital care is usually needed. This is generally considered moderate to severe COVID-19.
Acute Respiratory Distress Syndrome (ARDS): This is a very critical stage where your lungs are failing to get enough oxygen into your body. ARDS requires intensive care, often with a ventilator.

The survival rate for COVID pneumonia has been around 80%, especially when hospitals aren’t overwhelmed. If healthcare systems are strained, sadly, that rate can be lower. Getting medical help as soon as you suspect a problem really does make a difference.

Staying Safe: Prevention Tips for COVID Pneumonia

The best way to avoid COVID pneumonia is, of course, to try and avoid getting COVID-19 in the first place, and to protect your lungs in general. Here’s what we always recommend:

Get vaccinated against COVID-19 and stay up-to-date with boosters as recommended.
Consider getting vaccinated against pneumococcal disease, which causes a common type of bacterial pneumonia.
If you smoke, please consider quitting. We have resources to help. And try to avoid secondhand smoke.
Wash your hands frequently with soap and water. If soap isn’t available, use an alcohol-based hand sanitizer.
Try to avoid close contact and sharing personal items with anyone who is sick.
Manage any other health conditions you have. Keeping them well-controlled can lower your risk of severe COVID-19.

Feeling Better at Home After COVID Pneumonia

Once you’re discharged from the hospital, your recovery continues at home. It’s a gradual process.

Follow your doctor’s instructions carefully regarding any medications or therapies. Finish all prescribed courses!
Get plenty of rest. Your body has been through a lot.
Keep an eye on your symptoms. If you start to feel worse, or if new symptoms pop up, call your doctor right away.

Signs Your COVID Pneumonia is Improving

As you recover, you should notice your breathing becoming easier. If you were on oxygen, your doctor would have been able to gradually reduce it. Back home, feeling like you have more energy and can slowly return to some of your usual activities are good signs. Little by little.

When to Get Help for COVID-Related Concerns

If you have any symptoms of COVID-19 – like loss of taste or smell, sore throat, fever, cough, or shortness of breath – it’s wise to get tested. And always reach out to your doctor if you’re at higher risk for severe illness, or if you just have questions about managing your symptoms.

When to Go to the Emergency Room

This is crucial: If you have COVID-19 and you experience any new or worsening symptoms, especially if you are struggling to breathe, feel confused, can’t seem to stay awake, or if your skin, lips, or nails look bluish, go to the emergency room or call for emergency medical help immediately. Don’t delay.

Take-Home Message: Key Things to Remember About COVID Pneumonia

This has been a lot of information, I know. If you take away just a few things about COVID pneumonia, let it be these:

COVID pneumonia is a serious lung infection that can happen if you get COVID-19, causing inflammation and fluid in your lungs.
Key warning signs include worsening shortness of breath, chest pain, confusion, and bluish lips or skin.
It often affects both lungs and can sometimes cause longer-term lung changes.
Certain groups are at higher risk, including older adults and those with underlying health conditions.
Diagnosis involves exams, oxygen checks, imaging (like X-rays or CT scans), and lab tests.
Hospital treatment may include oxygen, antiviral medications, steroids, and sometimes breathing support like a ventilator.
Prevention is key: Vaccination, good hygiene, and managing other health conditions are your best defenses.
If you have COVID-19 and your breathing gets worse, seek emergency care immediately.

You’re not alone in navigating these concerns. We’re here to help you understand and manage your health, every step of the way.