COVID Pneumonia: Symptoms, Risk Factors, Treatment - Verywell Health

COVID pneumonia is a complication of COVID-19 in which the air sacs of the lungs fill with fluid or pus. Though COVID-19 is mainly restricted to the upper airways in around 80% of cases, 20% involve potentially severe lower respiratory complications, including pneumonia.

Symptoms of COVID pneumonia are the same as other types of pneumonia and typically involve a "wet" productive cough with mucus, fever, extreme fatigue, and difficulty breathing. Severe COVID pneumonia is associated with a high risk of death.

The article describes the causes and symptoms of COVID pneumonia and how the condition is diagnosed, treated, and prevented.

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Can COVID Cause Pneumonia?

Pneumonia is a common and potentially life-threatening complication of COVID-19, a viral infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Pneumonia causes illness by triggering severe inflammation in the lungs, causing them to swell and leak fluids into the airways.

At the end of the airways are tiny air sacs called alveoli where oxygen and carbon dioxide in the blood are exchanged. When alveoli are overwhelmed with fluids, pus, or mucus, oxygen cannot get into the blood, and carbon dioxide cannot be removed from the blood. This is pneumonia.

COVID-19 occurs when the virus gets into the airways and attaches to receptors on the airway walls called ACE2 receptors. In most people, the density of ACE2 is highest in the upper airways, including the trachea (windpipe), pharynx (throat), and nasal passages. Because of this, the infection and symptoms are largely confined to the upper airways.

But in some people, there is a high expression of ACE2 in the lower respiratory tract, including the larger airways known as bronchi and the smaller branches called bronchioles. In these people, the infection can migrate and establish an infection within the lungs, leading to pneumonia.

This is especially true in people with weakened immune systems and certain pre-existing medical conditions.

COVID Pneumonia Symptoms 

Although the symptoms of COVID pneumonia are the same as other types of infectious pneumonia, people with COVID-19 will often experience an easing of upper respiratory tract symptoms as damage to the alveoli and lower respiratory tract gets worse.

At this stage, the primary symptoms are those associated with hypoxemia (low blood oxygen) and hypoxia (low oxygen in tissues).

Symptoms of COVID pneumonia typically include:

• Fever
• Shortness of breath (dyspnea)
• A productive cough with mucus (phlegm)
• Extreme fatigue and weakness
• Chest tightness or pain
• Rapid heartbeats
• Loss of appetite
• Confusion
• Bluish lips, skin, or nails (cyanosis)

Risk Factors for COVID Pneumonia

Some of the risk factors associated with COVID pneumonia cannot be seen, such as the density of ACE2 receptors in the airways. But there are other risk factors that statistically place you at risk of COVID pneumonia, including:

On top of this, there are underlying medical conditions that place you at risk of a variety of COVID-19 complications, including pneumonia:

How Common is COVID Pneumonia?

A study published in the Canadian Medical Association Journal evaluated the medical records of 70,288 people hospitalized with COVID-19 in the United States and reported that pneumonia was the number one complication overall, accounting for 27.6% of cases.

How is COVID Pneumonia Diagnosed?

COVID pneumonia is diagnosed in the same way as other forms of pneumonia.

With that said, many people with COVID pneumonia are not diagnosed with COVID-19 until they seek emergency care. And this can present a diagnostic challenge as the number of viruses in nasal secretions (known as the viral load) characteristically decrease as the number of viruses in the airway increases.

In such cases, a nasal swab test may be negative for COVID-19, and the virus may only be detected in phlegm coughed up from the lungs.

The process of diagnosing pneumonia typically involves:

• A review of your medical history: Including recent symptoms and possible exposures
• A physical exam: Including listening for characteristic lung sounds with a stethoscope
• Chest X-ray: In which areas of the lungs will have a "ground glass" appearance
• Pulse oximetry: Uses a clip-on sensor that measures blood oxygen saturation levels
• Arterial blood gas (ABG): A blood test that checks blood oxygen levels
• Sputum cytology: A lab test that looks for abnormalities in fluids coughed up from the lungs

How COVID Pneumonia Is Treated

The treatment of COVID pneumonia is typically aggressive given the high risk of mortality (death) in hospitalized people.

Treatment options include:

Pneumonia Recovery

After hospitalization from COVID pneumonia, there are things you can do to speed recovery while you are at home:

• Get plenty of rest. Do not return to work until your healthcare provider clears you.
• Control fever with Tylenol (acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or Aleve (naproxen).
• Drink plenty of fluids to help loosen and cough up phlegm.
  
• Drink warm beverages like tea or hot water.
• Use a humidifier, or take steamy baths or showers to open airways and ease breathing.   
• Stop smoking, and avoid second-hand smoke.

How Long Does COVID Pneumonia Last?

According to a 2021 study from Northwestern University, COVID pneumonia lasts longer than many other types of pneumonia. This is because the virus appears to disrupt communications between immune cells and interfere with a coordinated immune response. Rather than days, a person with severe COVID pneumonia can sometimes be hospitalized for weeks.

Complications of Pneumonia Caused by COVID

COVID pneumonia tends to affect both lungs, and it may leave damage that persists for years after the infection. But it is not just the lungs that are affected.

According to a 2019 study published in the journal CMAJ, the three most common complications in people with severe COVID pneumonia include:

Risk of Death from COVID Pneumonia

People who are critically ill with COVID pneumonia and require mechanical ventilation have a mortality rate of roughly 55%, according to a 2021 study in the Journal of Critical Care Medicine.

How to Prevent COVID Pneumonia

The best way to prevent COVID pneumonia is to avoid getting COVID-19. According to the Centers for Disease Control and Prevention (CDC), the best ways to do this are to:

1. Stay up to date with COVID-19 vaccines.
2. Improve room ventilation, such as by opening windows or using high-efficiency particulate air (HEPA) cleaners.
3. Move indoor activities outdoors.
4. Get tested for COVID-19 if needed.
5. Stay home and rest if you have suspected or confirmed COVID-19.
6. Seek treatment if you are considered to be at high risk for complications of COVID-19.

Should I Get the COVID-19 Vaccine?

The CDC recommends that everyone 6 month and older get an updated Pfizer-BioNTech or Moderna COVID-19 vaccine, regardless of whether they've received any original COVID-19 vaccines.

Summary

COVID pneumonia is a potentially life-threatening complication of COVID-19 that is most common in older adults, and people with obesity, high blood pressure, and type 2 diabetes. It tends to last longer than other types of pneumonia and often requires prolonged hospitalization.

The treatment of COVID pneumonia is typically aggressive and may involve antiviral drugs, antibiotics, supplemental oxygen, corticosteroids, and lung aspiration. The best way to prevent COVID pneumonia is to avoid getting COVID-19, which includes getting the COVID vaccines.

14 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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By Emily Brown, MPH
Emily is a health communication consultant, writer, and editor at EVR Creative, specializing in public health research and health promotion. With a scientific background and a passion for creative writing, her work illustrates the value of evidence-based information and creativity in advancing public health.

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