COVID-19 Pneumonia

What Is COVID-19?

COVID-19 is a respiratory viral disease caused by the coronavirus (SARS-CoV-2). This virus is transmitted directly through inhaling infected respiratory droplets expelled by an infected person or indirectly by touching contaminated surfaces or objects. Infected patients commonly develop symptoms of influenza-like illnesses, such as cough, fever, loss of smell or taste, runny nose, chills, etc. When this virus affects the lungs and results in pneumonia, the patient develops shortness of breath. There have also been reports of concomitant gastrointestinal symptoms like nausea, vomiting, and diarrhea in 5 to 10 % of patients. However, the majority of patients (81 %) do not exhibit any symptoms of the illness (asymptomatic) or show very mild symptoms (paucisymptomatic). Such patients are treated with isolation and drugs like Paracetamol (Acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve symptoms.

Other patients (19 %) show significant symptoms due to pneumonia and need hospitalization. Such patients can develop acute respiratory distress syndrome (ARDS), which requires mechanical ventilation.

Several vaccines have been developed against COVID-19, which are approved and are in use. Also, medications like antiviral drugs, monoclonal antibodies, corticosteroids, and other drugs have been developed to treat COVID-19. In addition, COVID-19 patients are given symptomatic (relieving specific symptoms) treatment. Patients with severe symptoms are treated with oxygen therapy, intravenous fluids, broad-spectrum antibiotics, anti-inflammatory drugs, and antiviral agents (Remdesivir, Ritonavir, or Lopinavir). Those who develop acute respiratory distress syndrome (ARDS), which is the most common cause of mortality, require mechanical ventilation.

What Is Pneumonia?

Inflammation of the air sacs in the lungs due to infection caused by various viruses, bacteria, and fungi is called pneumonia. Fluid or pus gets collected in these air sacs, resulting in the patient coughing up phlegm. Fever, chills, and shortness of breath are other common symptoms.

Pneumonia is a potentially fatal condition, as it can lead to life-threatening complications in infants, older adults (65 years and older), people with pre-existing chronic illnesses, and immunocompromised individuals. It is the leading cause of death worldwide due to infection in children younger than five years of age.

What Is the Relation Between SARS-CoV-2 and Pneumonia?

Large respiratory droplets containing the coronavirus (SARS-CoV-2) enter the upper respiratory tract through the nose or mouth. The virus in these droplets then multiplies and moves through the bronchus and bronchioles (the tubes that branch out from the windpipe) into the lungs. When the virus reaches the lower respiratory tract, it can result in pneumonia.

When a person breathes in, oxygen in the air travels through the bronchus and bronchioles and reaches the alveoli (small sacs of air in the lungs). The exchange of oxygen in the air that is inhaled with the carbon dioxide present in the blood takes place in these alveoli. SARS-CoV-2 can damage these alveoli and the surrounding structures, interfering with oxygen-carbon dioxide exchange. The virus damages the wall and lining of the alveolus, and the debris (plasma protein) from the damage gets on the wall causing the thickening of the walls. This makes breathing more difficult and leads to oxygen shortage in the body and impaired functioning of body organs.

As the body tries to fight off these viruses, resulting in an immune response and collection of inflammatory cells, fluid, and dead cells in the lungs leading to pneumonia. All these together result in breathing difficulties or shortness of breath seen in critically ill COVID-19 patients. Moreover, there is no immediate cure for pneumonia in Covid-19 patients, so they mostly have to give supportive care to control the condition.

What Are the Stages or Categories of COVID-19 Infection?

Based on the severity of the infection and the symptoms, the stages or categories of COVID-19 infection are:

1. Category 1 - The patient might not show any symptoms but might be contagious. Such patients carry a high risk of spreading the virus.

2. Category 2 - The patient exhibits mild fever and cough, and sometimes headache and diarrhea. The symptoms are due to viruses present in the upper respiratory tract.

3. Category 3 - The symptoms are more obvious, and the patient might need to be hospitalized. Prompt and proper management at this stage can prevent death.

4. Category 4 - The infection has led to pneumonia or ARDS. Such patients have a higher chance of fatality.

How Is COVID-19 Pneumonia Different Than Regular Pneumonia?

The symptoms seen in COVID-19 pneumonia and other viral pneumonia might be similar, making it difficult to differentiate the cause. A person showing symptoms of pneumonia has to be tested for COVID-19 or other infections to find the cause. Scientists tried to find out the difference between COVID pneumonia and other types of pneumonia. This new information will immensely help with diagnosis and help doctors understand how the coronavirus affects the lungs.

A study conducted to compare the clinical features of other types of pneumonia to COVID-19 pneumonia found that COVID-19 pneumonia patients showed:

1. Both the lungs are affected by pneumonia.

2. CT scan of the lungs had a characteristic “ground-glass” appearance with peripheral areas of consolidation.

3. Liver function and other lab tests showed abnormalities.

4. Chest X-ray shows faint opacities with bilateral and peripheral distribution.

What Are the Symptoms of COVID-19 Pneumonia?

The following are the symptoms of COVID-19 pneumonia:

1. Fever.

2. Productive or dry cough.

3. Chills.

4. Dyspnea (shortness of breath).

5. Coughing and deep breathing result in chest pain.

6. Fatigue.

Emergency medical care is required for patients exhibiting the following symptoms:

1. Breathing difficulties.

2. Shallow and rapid breathing.

3. Feeling of pressure or discomfort in the chest.

4. Rapid heartbeat.

5. Confusion.

6. Difficulty walking.

7. Dizziness.

8. Bluish discoloration of the face or lips.

A study conducted in China found that 14 % of cases were severe, and only 5 % were critical. The illness in severely and critically infected COVID-19 patients can also lead to COVID-19 ARDS.

What Is COVID-19 Acute Respiratory Distress Syndrome (COVID-19 ARDS)?

ARDS is when fluid builds up in the alveoli present in the lungs. The collected fluid prevents the lungs from filling with sufficient air, which leads to a lack of oxygen in the blood. This lack of oxygen prevents the internal organs from functioning properly.

COVID-19 patients who develop pneumonia can also develop acute respiratory distress syndrome. This makes the patient gasp for air and the need for assisted ventilation to help them breathe. A large number of patients who develop ARDS do not survive. The rate of fatality increases with age and the severity of illness. Patients who do recover from ARDS usually suffer from permanent or long-lasting lung damage.

Who Is at Risk of Developing COVID-19 Pneumonia?

The people who are at a higher risk for developing COVID-19 pneumonia and other serious complications due to COVID-19 are:

1. Older adults (65 years and above).

2. Individuals living in a nursing home or assisted living facilities.

3. Individuals with underlying health conditions, such as chronic lung diseases, diabetes, asthma, heart diseases, liver disease, and obesity.

4. Individuals with a weakened immune system like those undergoing cancer treatment, taking steroids, and those infected with HIV.

How Does a Doctor Diagnose COVID-19 Pneumonia?

The presence of the SARS-CoV-2 in the sample collected from the nasal and oral cavity is tested using PCR (polymerase chain reaction). The respiratory sample is collected using a cotton swab. To confirm the presence of pneumonia, the doctor takes a chest X-ray or CT scan to see the changes in the lungs of patients suffering from symptoms of pneumonia.

How Is COVID-19 Pneumonia Treated?

No specific drug is approved by the FDA to be used for COVID-19 pneumonia. Various drugs are under clinical trials as potential therapies. For now, COVID-19 pneumonia treatment aims at managing the symptoms and maintaining proper oxygen levels in the body with the help of oxygen therapy. Ventilators are required for severe cases.

Can Pneumonia Vaccine Prevent COVID-19 Pneumonia?

Vaccines that are available for certain types of pneumonia do not protect against the coronavirus. The risk of developing COVID pneumonia can be reduced by getting COVID-19 vaccines that have either been approved or authorizednsuch as the Moderna vaccine, now called Spikevax.

The best ways to prevent getting infected with the coronavirus are:

• Do get your vaccination at your turn.The CDC (Centers for Disease Control and Prevention) recommends getting the additional primary shot and the booster dose at least after two months after getting the second dose.

• Social distancing try to avoid contact with people in public places as much as possible. Maintain a safe distance (six feet) from others.

• Do not shake hands with others.

• Do not forget to wash your hands frequently with soap and warm water for a minimum of 20 seconds.

• In case you are sick, stay home, and avoid going to public places.

• Wear a face mask when in public.

Conclusion:

The mild form of COVID-19 does not require hospitalization; however, patients with COVID-19 pneumonia and other severe medical conditions need immediate medical attention. If you develop breathing difficulties, go to the nearest emergency room. Prompt treatment with oxygen therapy will help you breathe until your body fights off the deadly virus.