According to coronavirus research from the Centers for Disease Control and Prevention, pneumonia is a complication that tends to indicate a more severe COVID-19 infection, especially among coronavirus-related conditions that require hospitalization.
Pneumococcal infections are typically referred to as cases of community-acquired pneumonia or (CAP); these infections have become an increasingly important point of research as fatal cases of coronavirus typically involve advanced respiratory diseases.
Here’s what you need to know about pneumonia and coronavirus.
Pneumonia Is a Severe Complication of COVID-19
According to an article written by lung disease doctor Paragis Galiatsatos, for Johns Hopkins University, pneumonia occurs when the alveoli (air sacs) of the lungs fill with fluid and swell, decreasing the amount of oxygen the body can process. Symptoms of pneumonia, according to Medline Plus, include shortness of breath, fever, chills, cough (often with phlegm), chest pain, nausea, vomiting and diarrhea.
Pneumonia can be caused by a bacterial, viral or fungal infection, according to Medline Plus. Fungal pneumonia typically appears in people with chronic health issues. Viral pneumonia is usually caused by cold, flu and SARS-CoV-2 (the virus that causes COVID-19); having pneumonia from a viral infection can actually lead to the development of bacterial pneumonia.
According to a June 2020 article published in the Frontiers in Medicine journal “Secondary Bacterial Infections in Patients With Viral Pneumonia,” the mortality rate among 482 people who had viral pneumonia and developed secondary infections was 10.9% while the mortality rate among 268 patients who had pneumonia and developed a from secondary bacterial infection was 15.2%.
Why does pneumonia result from coronavirus?
The answer is that one respiratory infection typically causes a domino effect, weakening the body’s resistance to other respiratory illnesses. In fact, the development of conditions such as pneumonia is very common with pandemics and the article described these type of co-infections (simultaneous infections) and secondary infections (one infection resulting from the weakening of the immune system overall) as “superinfections”:
Co-infections, secondary infections or “superinfections” are common during viral pandemics. The 1918 Spanish Flu pandemic saw around 50 million deaths ascribed to bacterial co-infections and during the 2009 H1N1 Inﬂuenza pandemic up to 34% of all deaths were a result of bacterial co-infections.
While the precise mechanism for susceptibility to secondary infections is poorly understood, it is likely that virus-mediated immunosuppression of the host innate immune enables opportunistic bacteria to colonize the host as it was shown forStreptococcus
Pneumonia is typically diagnosed with a chest x-ray, blood test (to see if the body is showing signs of fighting an infection), or blood culture (to test for the presence of bacteria), according to Medline Plus.
One of the biggest concerns around bacterial pneumonia infections co-occurring with COVID-19 is that the immune system is known to have difficulty simultaneously — and successfully — battling bacterial (pneumonia) and viral (coronavirus) infections. Moreover, the bacterial agents which cause pneumonia are sometimes resistant to antibiotics, which means initial attempts to control it can fail, giving even more severe conditions time to develop.
Pneumonia Can Lead to Acute Respiratory Disease Syndrome (ARDS)
Pneumonia is defined as when fluid fills in the alveoli of the lungs; ARDS occurs when a build-up of fluid in the alveoli causes the surfactant of the lungs — a substance that helps the lungs expand to take in the air — to break down and also causes other areas of the lungs to scar and stiffen, according to the National Heart, Lung and Blood Institute. The Institute noted that “these changes prevent the lungs from filling properly with air and moving enough oxygen into the bloodstream and throughout the body. The lung tissue may scar and become stiff.”
An article published in the journal Critical Care called “Acute respiratory failure in COVID-19: is it “typical” ARDS?” reported that “injury to the alveolar epithelial cells was the main cause of COVID-19-related ARDS.” Their research of patients with the lung disease also found that it was often not diagnosed until 8-12 days after the onset of worsening respiratory symptoms.
The article reported that corticosteroids such as methylprednisolone and ventilation are the most common treatment types.
An article published in the journal, Intensive Care Medicine, examined whether COVID-19-related ARDS presented worse symptoms than non-COVID-19-related ARDS. According to that article, “Physiological and quantitative CT-scan characterization of COVID-19 and typical ARDS: a matched cohort study,” typical treatments did not improve the conditions of those with COVID-19-ARDS.
Moreover, the disease in COVID-19 patients did not affect their ability to take in air, but still caused severe hypoxemia (a low amount of oxygen in the blood). The implications of this difference means that the use of ventilators that use pressure to force air into the lungs may be doing more damage than good, according to an article in MedPage Today.
Here Is How You Can Protect Yourself From Pneumonia
Those more at risk of pneumonia, according to Medline Plus, include children age 2 or under and adults age 65 and older. Other factors include long-term chemical/pollutant exposure, smoking, alcoholism, a weakened immune symptom, recent cold or flu illness, a previous lung disease, a previous disease that caused coughing or made swallowing more difficult.
Getting vaccinated against pneumonia could also help, according to the authors of the Frontiers in Medicine article. “Susceptible individuals within a population can be protected from (the) risk of some common bacterial pathogens that are also capable to cause secondary infections, for example, pneumonia, if vaccines are available,” the authors wrote.
An article in Harvard Health reported that there is a vaccine for children younger than age 2, children over age 2 with pre-existing medical conditions and adults over the age of 65. The PCV13 vaccine for children protects 13 types of bacterial pneumococcal infections while the PPSV23 vaccine for older adults protects against 23 types of bacterial pneumococcal infections.
Reuters reported that the demand for pneumonia vaccines has been incredibly high, leading to shortages in parts of Europe.
The Harvard Health article also noted that over-the-counter medicines can relieve symptoms as well, such as acetaminophen (Tylenol) and ibuprofen (Advil) for pain and high fever and dextromethorphan (DM) for cough and congestion. Prescription drugs for pneumonia that does not require hospitalization typically include amoxicillin and potentially azithromycin or doxycycline; patients who are hospitalized, are typically given antibiotics intravenously.
According to Galiatsatos’ article, treatment can help prevent severe long-term lung damage. “A patient’s recovery and long-term lung health is going to depend on what kind of care they get, and how quickly,” he wrote. Other factors include the severity of the coronavirus disease, the existence of other conditions and age.