Pneumonia with coronavirus in adults

Coronavirus pneumonia is one of the most insidious complications of the infection caused by the ill-fated Wuhan virus.

What is pneumonia

Pneumonia is an inflammation of the lungs. It can be caused by various reasons, including the coronavirus. With COVID-19, severe, life-threatening complications can develop in 2-5% of cases. This is due to the fact that with pneumonia, inflammation affects the air sacs (alveoli), where gas exchange occurs – the blood gives off carbon dioxide, receiving oxygen from the atmosphere in return. When the alveoli become inflamed, they swell, causing the body to lack oxygen. Hypoxia and respiratory failure develop, oxygen saturation falls (normally it should be above 95%).

With a coronavirus infection, pneumonia does not proceed according to the classical scenario, as is the case with typical microbial inflammations. Therefore, such pneumonia is called atypical. Both lungs usually suffer, and the percentage of tissue damage can be from 5 – 10 to 90%, and the course of the disease will depend on the degree of damage.

Causes of pneumonia in coronavirus in adults

With coronavirus infection, pneumonia can be in two versions – primary or secondary.

Primary pneumonia provoked by the virus itself – SARS-CoV-2, which penetrates the lung tissue, damages it and causes an inflammatory process. Such pneumonia has an atypical course, which is difficult to predict and treat.

secondary pneumonia may be viral-bacterial or purely bacterial in nature. Pathogenic bacteria can enter the lungs in the wake of the virus, causing additional complications.

The bacterial flora most often worsens the course of the infection and provokes the development of pneumonia approximately 5-7 days after the onset of symptoms of coronavirus. Later complications are also possible, which occur after 14 to 20 days, when the virus itself has already disappeared from the blood and tissues.

In addition to SARS-CoV-2 itself, other viruses can also cause pneumonia – influenza, measles, adenovirus, metapneumovirus. If a person with coronavirus has contracted these infections at the same time, they can also provoke pneumonia.

Symptoms of pneumonia in coronavirus in adults

The insidiousness of the coronavirus is that it can not make itself felt for a long time, destroying lung tissue and changing metabolic processes. As a result, the condition can worsen dramatically in just a couple of days. But more often, the development of pneumonia with coronavirus is gradual, the first signs may be:

• temperature within 37,3-37,5ºС;
• weakness, fatigue;
• sore throat;
• redness of the eyes, lacrimation;
• slight runny nose or congestion, decreased sense of smell (not always).

More serious signs of pneumonia occur 8-10 days after the onset of the disease. But sometimes changes in the lungs, according to CT data, are even in those people who do not feel almost any unpleasant symptoms or suffer from a mild form of the coronavirus, similar to SARS.

In some patients, especially from risk groups, serious lung damage, reaching 30% or more, occurs already 4-5 days after the onset of fever.

Often, severe pneumonia can be accompanied by:

• nausea, diarrhea and vomiting on the first or second day of illness;
• rash on the skin;
• dry painful cough, in which sputum does not go away, and pain in the chest;
• severe malaise, severe weakness with a complete lack of appetite;
• high temperature up to 39 – 40 ° C, which is poorly knocked down by conventional antipyretics, and after a few hours it rises again to high rates;
• shortness of breath, which increases with any, even the slightest activity;
• cyanosis of the lips, fingertips;
• low blood pressure and high heart rate (tachycardia);
• loss of consciousness due to cerebral hypoxia.

If the oxygen saturation is measured (which is usually done by emergency doctors when making a house call), the oxygen saturation of the blood will be less than 95%, and in severe cases it drops to 85% or less.

Treatment of pneumonia in coronavirus in adults

Pneumonia in coronavirus is an extremely dangerous complication. It is difficult to predict the course of the disease, therefore, it is important to immediately consult a doctor to determine a treatment plan.

With a mild course or minor lung damage (up to 20 – 30% in relatively healthy people), it is possible to treat at home under the supervision of a local doctor or a specialist in a private clinic. If the condition does not improve, signs of deterioration appear, and patients at risk are shown hospitalization in an infectious (covid) hospital.

Diagnostics

The initial stages of diagnosis are the same for all types of pneumonia, including covid. A polyclinic or ambulance doctor carefully records all complaints, measures oxygen saturation with a pulse oximeter (a device that is put on a finger), listens to the lungs, measures blood pressure and pulse.

Then a rapid test is performed to detect the virus, or a PCR test is prescribed. Also needed:

• a blood test to detect an inflammatory response;
• blood clotting to determine the tendency to thrombosis;
• blood for antibodies to coronavirus (if the patient has been sick for more than a week or two);
• blood biochemistry with the mandatory determination of C-reactive protein (it is an important indicator of a dangerous condition – a cytokine storm);
• CT scan of the lungs to determine the extent of the lesion.

Modern treatments

A mild form of infection with a small percentage of lung involvement according to the latest protocols can be treated at home, but strictly under medical supervision. The patient should be isolated from all family members. Bed rest, light meals and plenty of fluids are indicated.

Of the drugs prescribed:

• antiviral drugs (selected by a doctor);
• antipyretics (Paracetamol, Nurofen, Ibuklin, Teraflu, Coldact Flu Plus, Rinza);

• antitussives (Bromhexine, Lazolvan, ACC, Ambroxol);
• vitamin C (at a dose of 500 mg per day).

If, according to the blood test, there is no confirmation that the pneumonia is microbial, antibiotics are not prescribed. If home treatment is ineffective, the condition worsens, the patient is hospitalized. The hospital uses:

• intravenous solutions for detoxification (glucose, saline, rheopolyglucins);
• corticosteroid drugs (suppress inflammation, protect the alveoli of the lungs from damage);
• drugs against blood clots (anticoagulants);
• oxygen therapy;
• drugs against cytokine storm (they suppress the activity of the immune system).

If pneumonia progresses, the patient may be put on a ventilator or ECMO (extracorporeal membrane oxygenation) may be performed while continuing intensive treatment.

Antibiotics are added only if there is a proven presence of secondary microbial flora, which occurs in no more than 3-5% of patients.

Prevention of pneumonia in coronavirus in adults at home

The basis of the prevention of coronavirus pneumonia is protection from infection. People who have not been ill are recommended to be vaccinated with the registered vaccines Gam-COVID-Vac and EpiVacCorona. In addition, it is important to follow all recommendations for the prevention of infection:

• wearing a protective mask and gloves in public places;
• thorough hand washing;
• self-isolation for risk groups;
• avoiding contact with sick people;
• maintaining a healthy lifestyle, rational nutrition, giving up bad habits.

Popular questions and answers

Coronavirus pneumonia is a dangerous, unpredictable complication of the infection. It is important to know what the development of this type of pneumonia can turn out to be for a person, how long these complications will last and whether it is possible to reduce the risk of their occurrence. We talked about this with an expert – therapist, general practitioner Zhanna Dorosh.