COVID-19 pneumonia: a long road to recovery

COVID-19-induced pneumonia can lead to serious and long-term consequences, says a UNSW respiratory expert.

We know by now that COVID-19 wreaks havoc on the body – we’re finding out more and more about how even mild or moderate symptoms can translate to longer-term health issues. And when the virus escalates to the point of requiring oxygen in hospital, some patients develop COVID pneumonia, a particularly problematic development.

Conjoint Professor at UNSW Medicine and respiratory disease expert Christine Jenkins says pneumonia happens when the virus invades the lungs and causes an inflammatory reaction that compromises the function of the lung.

While we don’t yet know what proportion of people who get COVID-19 also end up with pneumonia, Professor Jenkins says it could be up to 20 per cent, but notes we need to see more data to get better numbers.

Young people are not invincible

As Head of the Respiratory Group at the George Institute for Global Health, Prof. Jenkins is an expert in diseases affecting the lung and the respiratory passageways. She says that older age has always been a risk factor for most types of pneumonia – the more advanced your age, the more vulnerable you are to getting pneumonia and having catastrophic outcomes from it.

Young people, on the other hand, are more likely to get asymptomatic COVID-19 – where the virus infects the body but does not show symptoms. And while they have shown to recover quicker from COVID-19, they are not immune to developing COVID-19 pneumonia.

“In a recent study published in the United States, in a group of over 5000 people, they found that 1 per cent of people under 20 were diagnosed with COVID-19 pneumonia,” says Prof Jenkins.

“In addition, no one in that age group who developed pneumonia died.

"So, if you’re a young person, it seems you are much more likely to get an asymptomatic event with COVID-19."

Prof. Jenkins says young people who do develop pneumonia are less likely to require ventilation.

“We still don’t fully understand what determines the age benefits of being 20 as opposed to 70.

“Now, you might think that’s obvious, but let me remind you that with the Spanish flu, it was young people who died.

“We know this virus is not like other respiratory viruses and we can’t make assumptions about it.”

Are you at higher risk?

We already know that there are risk factors for having a bad outcome from COVID-19.

“When you look at large groups of people with COVID-19, people over 50 are at higher risk,” says Professor Jenkins.

“But once you get to 70 and 80, the hazard ratios for having a severe outcome that requires hospital admission go up fivefold.

“So, age seems to be the most important and then there are underlying diseases that are additional factors, like high blood pressure, diabetes and obesity.

“Now, we don’t normally say obesity is a disease, but sadly, it is associated with metabolic dysfunction in many people and has quite a profound effect on the way your lungs work.”

Prof. Jenkins says that the data so far show that being overweight, i.e. having a BMI over 30, is a risk factor for having severe COVID-19.

“Obesity also disadvantages your lungs mechanically, because when you’re obese you don’t expand your lungs as well as a person who has a healthy BMI.”

Road to recovery

Professor Jenkins says we need to wait a little longer before we fully understand the medium to long term consequences when people are on the road to recovery.

“We know how long, on average, it takes for the virus to clear but that doesn’t mean recovery – it just means the virus is no longer detectable in your upper airway secretions.

“So, lung damage is not an overnight recovery and pneumonia can take up to several weeks or months of recovery, especially for those who required significant oxygen supplementation.”

Prof. Jenkins says the lingering symptoms of pneumonia vary a lot depending on the severity of it. If someone is discharged from hospital after contracting pneumonia, she recommends plenty of sleep, eating a nutritious diet and not overdoing it socially.

“I often say to young people, you’ll get 70 to 80 per cent of the way there in the next five days but it’s going to take you a few weeks to recover the last 20 per cent,” she says.

“Apply the common sense things that you know you would do to give your body the best chance to get better quickly.

“You should not be smoking or drinking alcohol and get plenty of sleep to allow the body to rest and recover.”

Prof. Jenkins warns that if a person is persistently symptomatic after they would have expected to have recovered from COVID-19, they should seek advice from a medical professional.

“They will quickly be able to discern whether or not the symptoms are largely related to a bit of post-COVID fatigue, a bit of anxiety or something else such as persisting inflammation in the chest."