Novel coronavirus (COVID-19) pneumonia affects people of all ages. It occurs when a virus, bacteria, or fungi infects the lungs, making breathing difficult. COVID pneumonia can lead to severe illness and complications for those at risk.
Below, we will examine COVID pneumonia symptoms, its causes, prevention methods, what to watch for, and COVID pneumonia treatment.
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COVID pneumonia is a lung infection caused by the same virus that causes COVID-19, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A person can get pneumonia as a result of being ill with COVID-19.
Pneumonia resulting from contracting COVID-19 usually attacks both lungs simultaneously, known as bilateral interstitial pneumonia.
When the body's immune system attempts to fight a respiratory infection, the tiny air sacs (alveoli) inside the lungs fill with fluid or pus. The surrounding tissues that protect the airway, blood vessels, and alveoli become inflamed. The inflammation causes fluid to build up in the lungs as a person struggles to take in oxygen, leading to coughing, shortness of breath, and other symptoms. Scarring or severe lung damage can result.
COVID pneumonia and COVID-19 are basically the same illness at different stages. COVID-19 is a severe respiratory illness caused by the SARS-CoV-2 virus, whereas COVID pneumonia is a complication of COVID-19, causing fluid and inflammation in the lungs.
A SARS-CoV-2 infection begins when the virus enters a person's upper respiratory tract. As the virus spreads, it attacks the lungs, often leading to pneumonia. The fluid buildup and inflammation in the lungs restrict oxygen flow, which causes breathing difficulties.
Since the symptoms of pneumonia and COVID-19 can be similar, it is important to get tested for COVID-19 to see what is causing the illness.
A recent study compared the clinical features of COVID pneumonia to other types of pneumonia and found that those with COVID pneumonia were more likely to show lungs with a "ground-glass" appearance when performing a CT scan. It showed that both lungs, instead of just one, were equally affected by COVID pneumonia, and abnormalities in liver function also appeared through extensive laboratory testing.¹
Individuals who develop COVID pneumonia can also contract acute respiratory distress syndrome (ARDS), a progressive respiratory failure that requires mechanical ventilation to assist with breathing.
When a healthy person breathes in oxygen, it enters the bloodstream and gets pulled into the alveoli in the lungs. When SARS-CoV-2 is present, it is harder to breathe because the surrounding tissues and alveoli are inflamed.
It is possible to contract pneumonia when infected with COVID-19. While the SARS-CoV-2 virus attacks the lungs, bacteria-causing pneumonia can also infect the airways, known as superinfection. It can lead to a weakened immune system, making it more difficult to fight off infection.
As the immune system tries to attack a SARS-CoV-2 infection, the alveoli expand and start leaking fluid, leading to COVID pneumonia.
Most types of pneumonia cause acute disease, although the illness does not typically last as long as COVID pneumonia. COVID pneumonia spreads slowly across the lungs, using the body's own immune system to spread the virus, tending to cause more damage in more places and last longer than standard cases of pneumonia.
COVID pneumonia can be severe, leading to low oxygen levels in the blood. The viral infection usually attacks both lungs, and as it becomes more difficult for oxygen to reach the bloodstream, it becomes harder to breathe.
The most common viral pneumonia in adults is an upper respiratory tract infection caused by the SARS-CoV-2 virus, which also causes COVID-19. Young children can also develop respiratory syncytial virus (RSV) from this virus. Most viral pneumonia does not last as long as bacterial pneumonia and is usually less severe.
The most common strain is pneumococcal pneumonia, a bacterial infection that infects more than 900,000 people in the US annually.²
Bacterial pneumonia can occur on its own or develop after viral infections such as the flu or a cold. It typically only affects one part or lobe of a lung. The people with the highest risk include those recovering from surgery and those with a weakened immune system, a viral infection, or respiratory disease.
Fungal pneumonia is typically seen in people with weakened immune systems or chronic health problems. It commonly affects people taking long-term medicines that suppress the immune system, such as those used to manage organ transplants or treat cancer. Fungal pneumonia is not contagious.
Identifying the cause of pneumonia can be vital to receiving the proper treatment for a rapid recovery.
In most cases of pneumonia, the virus or bacteria spreads quickly throughout one or both lungs. With COVID pneumonia, the virus aggressively infects small areas of both lungs simultaneously. It then uses the body's immune system to spread into other parts of the lungs over time.
Regardless of its intensity or cause, every type of pneumonia causes fluid and inflammation in the lungs. Research suggests the SARS-CoV-2 virus that causes COVID pneumonia moves differently in the lungs compared to other viruses and bacteria that cause pneumonia.
SARS-CoV-2 can infect the airways, sometimes causing significant damage to a person's lungs. While most people do not experience lasting lung damage from pneumonia, COVID pneumonia can be severe. Reportedly, "even after the disease has passed, lung injury may result in breathing difficulties that might take months to improve."³
Several factors that affect the risk of lung damage in COVID-19 infections include:
Disease severity: Mild cases of COVID-19 typically cause less long-lasting scarring in the lung tissue.
Health conditions: Existing health problems such as heart disease or COPD can increase the severity risk of COVID-19. People over 65 are more vulnerable since their immune system weakens as they age and lung tissue becomes less elastic.
Treatment: Long-term lung health and recovery depend on the medical care an individual receives and how fast they respond to treatment. People with severe COVID-19 will benefit from hospital admission to minimize lung damage.
These factors will determine how likely a person is to regain lung function and recover from the illness.
The symptoms of COVID pneumonia are very similar to those experienced during the initial stages of a COVID-19 infection and can range from mild to severe. These can include:
Difficulty breathing or shortness of breath
Productive cough (expels phlegm, a slimy substance from deep within the lungs)
Persistent chest pain or tightness, especially when coughing or breathing
Nausea, vomiting, diarrhea
The type of germ causing the infection and an individual's age and overall health will affect the severity of COVID pneumonia. Newborns and young children may not appear to have any symptoms, while others may develop a fever or cough or show signs of reduced energy or restlessness.
Older adults or people with weakened immune systems may have milder symptoms or a low temperature, often exhibiting changes in mental awareness.
Difficulty breathing is the biggest indicator of a COVID-19 infection getting worse. If you experience shortness of breath that is not getting better, a visit to the local emergency room may be in order.
Early identification of COVID pneumonia gives individuals a better chance of recovery, preventing complicated hospital admissions.
Worsening or new symptoms can indicate that COVID-19 is progressing into pneumonia. If you are in distress, contact your healthcare provider or seek medical attention at the closest hospital emergency room.
If you are having trouble breathing, experiencing shortness of breath that is getting worse, or feel like you are struggling to breathe in air, call 911 or go to the nearest emergency room immediately.
The virus that causes COVID-19 is very contagious and spreads from person to person through exposure to respiratory droplets. When someone who is infected coughs, talks, or sneezes, they can spread the virus. Those without symptoms can also unknowingly be carriers.
It is rare to get pneumonia by touching a surface or object with a germ on it and then touching your mouth or nose.
Pneumonia is a lung condition that can be a result of a COVID-19 infection. A person infected with COVID pneumonia could give someone else COVID-19, but not necessarily pneumonia.
It is also possible to get a superinfection, which occurs when a person has COVID-19 and then develops a bacterial infection resulting in pneumonia. The bacterial infection can be contagious and spread to others who could get pneumonia.
Not everyone exposed to pneumonia will become ill. There is no designated time for how long a person will be contagious once it's determined they have pneumonia. The contagion period depends on the type of pneumonia.
People with bacterial pneumonia are typically contagious for 48 hours after starting antibiotics, with no sign of fever. People with COVID pneumonia are usually contagious until symptoms, especially fever, resolve.
While anyone can get COVID pneumonia, those most at risk include individuals over 65, as the immune system struggles to fight off infection as people age. Those living in nursing homes and assisted living or long-term care facilities are also at higher risk.
Infants and children under two are also susceptible to infection since their immune system has not yet fully developed. People currently on a ventilator or other assisted-breathing apparatus are at a higher risk of pneumonia.
People can also be at an increased risk of becoming severely ill with COVID pneumonia due to the following:
Chronic lung diseases that make the lungs more vulnerable, such as chronic obstructive pulmonary disorder (COPD), asthma, pulmonary fibrosis, cystic fibrosis, pulmonary embolism, pulmonary hypertension, and others
Heart conditions (heart failure, hypertension, and coronary artery disease)
Chronic kidney or liver disease
Type 1 or type 2 diabetes
Blood disorders (thalassemia or sickle cell disease)
Weakened or compromised immune system due to an organ transplant, HIV/AIDs, long-term steroid use, blood stem cell transplant, or chemotherapy
Congenital conditions such as Down syndrome
Mental health conditions such as schizophrenia spectrum disorders or depression
Pregnancy, due to the stress put on lung functions and suppressed immune system while supporting the baby
Certain lifestyle habits and exposure to environmental factors can also increase the risk of severe illness, some of which include:
Drug and alcohol abuse (increasing the risk of aspiration pneumonia)
Exposure to pollutants, chemicals, toxic fumes
Exposure to secondhand smoke
To date, there have been more than 100 million cases of infection caused by SARS-CoV-2, with over two million reported deaths. Approximately 15% of people with COVID-19 develop COVID pneumonia or other serious complications.
According to recent research, of the individuals that seek medical attention within the first 24 hours of developing symptoms, almost half were admitted to the hospital, and 2.8% were admitted directly to the intensive care unit (ICU). Mortality fell to 2.5% if the person waited to seek medical care until the symptom onset was between one and three days, rising significantly to 3.6% for those waiting between four and seven days.⁴
In 2019, 740,000 children under five died from complications caused by pneumonia. This was more than the deaths caused by infectious diseases, malaria, tuberculosis, or HIV infection.⁵
A medical provider will most likely test for COVID-19 if a person experiences a loss of sense of smell or taste, a sore throat, cough, fever, or shortness of breath. A physical examination will typically include:
Checking vital signs (blood pressure, temperature, and oxygen level)
Listening to the lungs
Taking a nasal swab sample
To rule out or confirm cases of COVID-19 or COVID pneumonia and to look for signs of significant lung infection, a physician may also request imaging and additional testing, such as:
Bloodwork analysis, including a complete blood count (CBC) to see if the immune system is actively fighting an infection
Blood culture to determine if a bacterial infection has spread in the bloodstream
Sputum (spit) test to check for bacteria in the lungs
CT scan, chest X-ray, or other imaging to see how lungs are affected and identify any complications, such as pleural effusions or lung abscesses
Pleural fluid culture to check for bacteria in a sample taken from the space between the lungs and under the chest wall
Arterial blood gas test (ABG) to check for levels of carbon dioxide and oxygen in the blood and the pH balance (The sample is taken from an artery instead of a vein.)
Bronchoscopy to see inside the airways of the lungs
Pulse oximetry to check the levels of oxygen in the blood
Most people diagnosed with COVID pneumonia get admitted to the hospital for further observation and treatment, which can include:
Antiviral medications (redeliver or Paxlovid) to target COVID-19 infection
Antibiotics (only if a bacterial infection is present)
Supplemental oxygen for assistance in breathing
Intravenous (IV) fluids to prevent dehydration
Draining of lung fluids
Corticosteroids (dexamethasone) to reduce inflammation
Monoclonal antibodies (tocilizumab) to help prevent inflammation
Mechanical ventilation for patients that cannot breathe on their own
Extracorporeal membrane oxygenation (ECMO) life support to take over for the heart and lungs
The survival rate for COVID pneumonia is about 80% if hospitals are not overwhelmed with an influx of cases.
When there is a surge in cases and hospitals become overwhelmed, there can be double the deaths (mortality) from COVID pneumonia. Getting immediate medical treatment increases the chance of survival and will allow for a quicker recovery.
While there is no set time for COVID pneumonia recovery, how you feel will depend on your age, the severity of the illness, and any other health conditions that could cause complications.
With a moderate case of COVID pneumonia, you may start feeling better in 3–6 weeks.
However, a more severe illness could take months for a full recovery. It can sometimes take three months to a year with continual treatment and therapy for lung function to return to pre-COVID-19 levels.
Pneumonia is reportedly the leading cause of hospitalization in children and adults, with tens of thousands of people in the US dying yearly, most of them over 65.
While most people with COVID pneumonia are treated successfully, recovery can be lengthy.
Managing symptoms and following your physician's orders is the best way to start feeling better fast. Finish all medications as prescribed, follow all therapy routines, get plenty of rest, and continue to monitor symptoms.
Contact your healthcare provider if you start to feel worse or experience new symptoms.
When it is no longer a struggle to breathe, you will be on your way to feeling better. A medical provider can reduce the types of COVID pneumonia treatments you are receiving and eliminate or reduce the equipment used to help you breathe, possibly taking you off oxygen when deemed appropriate.
Wanting to return to normal activities is a good indicator that you are well on your way to recovery from COVID pneumonia.
Good hygiene is the best way to prevent respiratory infections, particularly pneumonia. Getting vaccinated will reduce your chances of contracting COVID pneumonia. Eating well-balanced meals, living a healthy lifestyle, and not smoking can also help to prevent COVID pneumonia.
COVID-19 can damage the lungs and weaken the immune system, increasing a person's risk of developing pneumonia. There are approved vaccines available for COVID-19 to significantly reduce the risk of hospitalization and serious illness associated with the infection.
Pneumococcal vaccines, such as Pneumovax23® and Prevnart13®, help protect people in at-risk age groups from bacterial pneumonia.
The immunity received from vaccines can help in the healing process as well. An unvaccinated person will typically survive the infection but has a greater risk of scarring that can cause permanent lung damage.
Getting vaccinated and following the booster regimen will reduce your risk of getting seriously ill from a COVID pneumonia infection.
Practicing healthy lifestyle changes can help reduce a person's risk of getting severe COVID-19 or COVID pneumonia. The following changes may help:
Avoid secondhand smoke
Wash hands with soap and hot water before using the bathroom or handling food
Use an alcohol-based hand sanitizer if soap and water are not available
Avoid sharing items and close contact with people you suspect of having COVID-19Eat a healthy diet
Seek medical attention for any chronic conditions that may put you at a higher risk for COVID pneumonia
COVID pneumonia is a serious condition brought on by COVID-19. While some people will only get a mild case of the illness, others, especially those in high-risk categories, can get very sick from COVID pneumonia.
People with an ongoing medical condition or who are 65 or older should exercise caution and be aware of the warning signs associated with COVID pneumonia.
The virus can be debilitating and cause serious illness, so it is essential to contact your healthcare provider with any questions or concerns. If you are having trouble breathing and experiencing shortness of breath, go to the nearest emergency room immediately.
Following your doctor's orders and COVID pneumonia treatment plan will provide a possible increased chance of full recovery.
What causes pneumonia? | American Lung Association
COVID-19 lung damage | Johns Hopkins Medicine
Pneumonia can be prevented—Vaccines can help | Centers for Disease Control and Prevention
What is pneumonia? | American Lung Association
Preventing pneumonia | American Lung Association
Pneumococcal vaccination: What everyone should know | Centers for Disease Control and Prevention