How to Tell If Your Case of Cold, Flu, or COVID-19 Has Progressed to Pneumonia
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This article was medically reviewed on December 15, 2020 by Raj Dasgupta, M.D., Assistant Professor of Clinical Medicine at USC's Keck School of Medicine and a member of the Prevention Medical Review Board.
Before COVID-19, we heard blissfully little about pneumonia - maybe you knew about an elderly relative who had it in the hospital, or someone told you after everyone got better that her cold was actually a case of "walking pneumonia" . That said, their symptoms were mild enough that they didn't even know they had them and were on their way.
Well, pneumonia currently has a moment as it can be a dangerous complication of the novel coronavirus. About 20% of COVID patients develop COVID-19 pneumonia, although that number may be low, says pulmonologist and intensive care doctor Raj Dasgupta, M.D., associate professor of medicine at the University of Southern California.
This is because if you have minor symptoms, you are unlikely to go to the hospital for imaging and formal diagnosis. This is a good thing given the COVID risks and the current taxed healthcare workers. "There is no benefit in being in intensive care with a mild case," says Dr. Dasgupta, as knowing you have a mild case probably wouldn't change your doctor's advice. "Either way, you are advised to stay home, take it easy, sleep on your stomach, and stay hydrated."
A more severe case of pneumonia is an entirely different matter. During normal times, pneumonia (along with childbirth) is the leading cause of adult hospitalization in the United States. According to the American Thoracic Society, about 1 million adults are hospitalized for this condition each year.
But how do you tell the difference between pneumonia and the virus that can cause it - like the flu, COVID-19, or a really bad cold? Here is everything you need to know about how to identify, treat, and prevent pneumonia.
What exactly is pneumonia?
"Pneumonia is an infection in the gas exchange units (called the alveoli) of the lungs," says Michael Niederman, M.D., clinical director of pulmonary and intensive care medicine at Weill Cornell Medical College in New York. Translation: The air sacs in your lungs become inflamed or even fill with fluid or pus, which affects your body's ability to deliver oxygen to your blood.
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"About half the time it is due to bacteria," says Dr. Edelman. "Viruses account for the other half of the time." The most common type of pneumonia is caused by the bacteria Streptococcus pneumoniae, in the same family of bacteria that causes strep throat. Influenza is also a key virus that can cause pneumonia, and fungi can also be a culprit. The novel coronavirus can of course also cause pneumonia, albeit with a longer incubation period than, for example, the flu, says Dr. Dasgupta.
"Pneumonia occurs when the organism overwhelms the patient's defenses," says Dr. Niederman. This basically means that an alien bug is taking over your immune system, even if you are generally healthy. This is because certain organisms, like those associated with the flu, can be particularly hostile or enter your body in large numbers.
How do you get pneumonia?
Pneumonia can occur in any number of ways, from inhaling fumes to living in a moldy building. Overall, it's broken into two distinct categories: community-acquired pneumonia and hospital-acquired pneumonia, says Norman Edelman, M.D., senior scientific advisor to the American Lung Association.
Community-acquired pneumonia can be acquired anywhere, anytime. Bacterial and viral pneumonia are contagious, so you can catch them from stray coughs or sneezes by sharing cups or not washing your hands as often as you should.
Then there is hospital-acquired pneumonia that you get during your stay in the hospital or in a chronic care facility like a nursing home or rehab center. "We make this distinction because the errors that cause these two types of pneumonia are different and are treated differently," says Dr. Edelman.
That brings us back to the pandemic: Hospital-acquired pneumonia is a concern for people with ventilators being treated for COVID-19, says Dr. Dasgupta. "It's a huge risk factor and that's why we want to remove patients from the ventilator as soon as possible," he adds. If your immune system is weakened (due to the coronavirus, the flu or some other infection), you are more prone to "superimposed" pneumonia, for example from bacteria that have been admitted to the hospital or your community. COVID-19 can also lead to acute respiratory distress syndrome (ARDS), a life-threatening lung injury that can cause fluid to enter the lungs. Because breathing becomes difficult and oxygen cannot get into the body, a patient is often put on a ventilator. ARDS and pneumonia are closely related in critically ill patients, says Dr. Dasgupta.
What are the symptoms of pneumonia?
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Pneumonia can look very similar to the common cold from the outside. The most common symptoms include:
shortness of breath
Chest pain when breathing or coughing
Increased mucus that is green, gray or yellow in color
Nausea, vomiting, or diarrhea
But the common cold usually has other symptoms that pneumonia doesn't cause, like a sore throat or runny nose, ”said Jonathan Puchalski, M.D., director of interventional pulmonology at Yale Medicine. These symptoms - along with any cough or fever you may have - usually go away pretty quickly.
In the case of pneumonia, however, they either stay constant or become more severe. "We all get colds and coughs," says Dr. Edelman. "If it looks like a common cold and has a cough associated with it, and you are otherwise not sick, you can wait a week before seeing your doctor. If it gets worse, see your doctor right away."
"Getting worse" could include symptoms such as a high fever, severe headache, and severe chest pain, says Dr. Edelman, what could mean more serious bacterial pneumonia. If so, you should go to the doctor's office as soon as possible. The same is true if you think you have COVID-19 and your symptoms are getting noticeably worse. "When you have chest pain and you can't breathe and you know something is really wrong, the best place is in a supervised hospital," says Dr. Dasgupta.
How is pneumonia treated?
The type of pneumonia determines what type of treatment you will receive.
? If you have a viral infection ...
"When it's viral, it usually takes care of itself," says Dr. Edelman. Unfortunately, it can take up to a month for your body to really get rid of the viral infection. In the meantime, doctors often try to control the symptoms you are experiencing, such as fever, as opposed to the virus itself. Puchalski.
Leaving it untreated can cause discomfort if you don't control symptoms. However, the infection itself will most likely go away. In the case of a person in hospital with COVID-19, Dr. Dasgupta, symptoms can be treated more aggressively, making you feel good enough to go home, which may lower your risk of accumulated pneumonia.
? If you have a bacterial infection ...
For bacterial pneumonia, prescription treatment becomes very important. For community-acquired pneumonia, your doctor will usually prescribe you an antibiotic, and the infection should go away in a week to 10 days, says Dr. Edelman.
If the hospital is acquired, more intensive medication may be required. "If you have hospital-acquired pneumonia, it is usually a bug that is resistant to the common medication your doctor may use for community-acquired pneumonia," says Dr. Edelman. "You usually get several antibiotics to cover any possible resistant organisms that could cause pneumonia."
However, if you leave bacterial pneumonia untreated, you can put yourself at serious risk. "If it's bacterial, you worry about it spreading to other parts of the lungs or other parts of the body," says Dr. Edelman. "It can go to your heart, it can go to your brain, it can go to all kinds of places."
The worst scenario? The infection can leak from the lungs and cause sepsis, an intense immune system reaction that can be fatal. In fact, pneumonia is the leading cause of death from infectious diseases, says Dr. Niederman. It can also cause ARDS.
How to prevent pneumonia
The final result? See your doctor as soon as symptoms of pneumonia appear, especially if these symptoms worsen.
Even better than treatment is prevention, which takes the form of immunization, says Dr. Niederman. Make sure you get a flu shot every year. If you have a chronic illness or are over 65, ask your doctor about the pneumococcal vaccine, which protects your body from strep bacteria. And as soon as you have a coronavirus vaccine available, get vaccinated.
And the same advice we all took to prevent the spread of COVID works for all types of pneumonia: wear a mask, wash your hands regularly (use soap and scrub for at least 20 seconds, and use hand sanitizer If you can. 't!), sanitize your phone and meters, find time to recover from everyday stress, get adequate sleep, and eat a healthy diet of immunity-boosting foods to keep malicious bugs out of your system.
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