What happens to patient's lungs when they get Coronavirus?
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Covid-19 started in late 2019 as a cluster of pneumonia cases, cause found to be a new virus – severe acute respiratory syndrome coronavirus 2, or Sars-CoV-2.

Prof John Wilson, president-elect of the Royal Australasian College of Physicians and a respiratory physician on a few questions about pneumonia & COVID-19.

#Q. How is the virus affecting people?

People who catch Covid-19 can be placed into four broad categories.

- The least serious are those people who are “sub-clinical” and who have the virus but have no symptoms.
- Next are those who get an infection in the upper respiratory tract, which means a person has a fever and a cough and maybe milder symptoms like headache or conjunctivitis.
- The largest group of those who would be positive for Covid-19, and the people most likely to present to hospitals and surgeries, are those who develop the same flu-like symptoms that would usually keep them off work.
- A fourth group will develop severe illness that features pneumonia. In Wuhan, it worked out that from those who had tested positive and had sought medical help, roughly 6% had a severe illness.

#Q. How does the pneumonia develop?

When people with Covid-19 develop a cough and fever; this is a result of the infection reaching respiratory tree – the air passages that conduct air between the lungs and the outside.

The lining of the respiratory tree becomes injured, causing inflammation. This, in turn, irritates the nerves in the lining of the airway. Just a speck of dust can stimulate a cough. But if this gets worse, it goes past just the lining of the airway and goes to the gas exchange units, which are at the end of the air passages. If they become infected they respond by pouring out inflammatory material into the air sacs that are at the bottom of our lungs. If the air sacs then become inflamed, an outpouring of inflammatory material [fluid and inflammatory cells] into the lungs and we end up with pneumonia. Lungs that become filled with inflammatory material are unable to get enough oxygen to the bloodstream, reducing the body’s ability to take on oxygen and get rid of carbon dioxide.

That’s the usual cause of death with severe pneumonia.

#Q. How can the pneumonia be treated?

Unfortunately, so far we don’t have anything that can stop people getting Covid-19 pneumonia.

People are already trialing all sorts of medications and we’re hopeful that we might discover that there are various combinations of viral and anti-viral medications that could be effective. At the moment there isn’t any established treatment apart from supportive treatment, which is what we give people in intensive care. We ventilate them and maintain high oxygen levels until their lungs are able to function in a normal way again as they recover.

Patients with viral pneumonia are also at risk of developing secondary infections, so they would also be treated with anti-viral medication and antibiotics. In some situations that isn’t enough. The pneumonia went unabated and the patients did not survive.

#Q. Is Covid-19 pneumonia different?

Covid-19 pneumonia is different from the most common cases that people are admitted to hospitals for. Most types of pneumonia that we know of and that we admit people to hospital for are bacterial and they respond to an antibiotic.

Cases of coronavirus pneumonia tend to affect all of the lungs, instead of just small parts. Once we have an infection in the lung and, if it involves the air sacs, then the body’s response is first to try and destroy [the virus] and limit its replication. This “first responder mechanism” can be impaired in some groups, including people with underlying heart and lung conditions, diabetes and the elderly. Generally, people aged 65 and over are at risk of getting pneumonia, as well as people with medical conditions such as diabetes, cancer or a chronic disease affecting the lungs, heart, kidney or liver, smokers, and infants aged 12 months and under.

It’s important to remember that no matter how healthy and active you are, your risk for getting pneumonia increases with age. This is because our immune system naturally weakens with age, making it harder for our bodies to fight off infections and diseases.

Source: https://www.theguardian.com/world/2020/apr/01/what-happens-to-peoples-lungs-when-they-get-coronavirus-acute-respiratory-covid-19
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