What happens to the lungs when getting COVID-19 with underlying lung diseases?

By Treven Pyles

Posted on March 20th, 2020

COVID-19 primarily infects the upper respiratory tract. There is evidence that pneumonia caused by Covid-19 may be particularly severe, which is why some patients might have around a drop of 10 to 30 percent in lung function after a full recovery, doctors say.

Based on all cases of COVID-19 confirmed, suspected, and asymptomatic cases in China as of February 11, health officials published in the Chinese Journal of Epidemiology, the first data in the biggest study since the outbreak began:

  • 80.9% of infections are likely to be mild and can recover at home
  • 13.8% developing severe diseases including shortness of breath and pneumonia
  • 4.7% classed as critical and can include respiratory failure, septic shock, and multi-organ failure
  • risk of death increases with age and for those with underlying chronic conditions
  • the current death rate hovers at about 2%

How is COVID-19 diagnosed?

Most coronavirus cases are diagnosed by finding evidence of the virus in respiratory samples such as saliva or mucus, but there is another way to tell whether a person may be infected. Although the American College of Radiology is urging physicians to only deploy computed tomography in very specific circumstances, reports are now showing the importance of computed tomography (CT) in diagnosis and monitoring the infection.

"As COVID-19 continues to evolve on a global scale, it is important for radiologists to be familiar with the imaging appearance of the virus in patients", says a professor of radiology at Michigan Medicine.

Call your doctor or local state healthcare department if you have symptoms to discuss whether you need to be tested. Unless you have a pressing need to be seen by a doctor or provider, put it off, or consider alternative ways of getting that care.

The most serious complication of the new coronavirus infection is a type of pneumonia, called 2019 novel coronavirus-infected pneumonia

Patients with severe cases typically develop excess fluid around their lungs (pleural effusion), similar to those seen in standard pneumonia cases.

A pleural effusion can be detected on a CT scan, where it shows up in the form of white patches that doctors call "ground-glass opacity".

Here is what physicians look for to detect the coronavirus in a scan:

  • normal lungs should appear black on a CT scan; it's normal to have masses of tissue that show up as tiny white dots
  • coronavirus scans tend to have white patches extended to the edges of the patient's lungs; those opacities represent fluid in the lung spaces
  • as the illness tends to worsen quickly in severe cases, the ground-glass patches become more pronounced after a few days

A set of new studies have found patterns in the day-by-day symptoms among patients infected

Most cases are mild, but there have been cases of severe illness and death due to the virus. The first symptoms may not come right after a person has been infected. The coronavirus' average incubation period is about five days.

Here is how symptoms progress:

Day 1

The most common symptom is fever. Patients may also experience fatigue, muscle pain, and dry cough. Pulmonologists and critical care specialists found that the initial fever lasted about 12 days, but cough lasted about 19 days. Digestive symptoms such as diarrhea may be presenting features of COVID-19. In these cases, the index of suspicion may need to be raised earlier rather than waiting for lower respiratory tract infection to emerge.

Day 5

Viral shedding peaked during the first five days after the onset of symptoms. Patients are showing up with breathing problems especially if they are older or have serious medical conditions like chronic respiratory diseases and cancer.

Day 7

Some patients require hospital treatment if clinical signs and symptoms worsen with the progression of the disease. Of severely ill patients dyspnea is the most distressing reported symptom. Hospitals for pulmonology and lung survey found that most patients experienced dyspnea which lasted about 12 to 13 days.

Day 8

At this point, patients with severe cases develop acute respiratory distress syndrome - an illness that occurs when fluid builds up the tiny air sacs in the lungs and that is considered the primary killer among critically ill patients hospitalized with COVID-19

Day 10

Severe cases require supplemental oxygen, or if needed a mechanical ventilator to aid breathing. There can be varying levels of severity of pneumonia all the way through respiratory failure, septic shock, multiple organ dysfunction, and death.

Day 22

According to the study, it took survivors about 3 weeks from contacting COVID-19 to being released from the hospital. Specialists have to take into account whether older patients have families who can take care of them once they leave the ICU because they will need help.

Am I at risk of complications because of COVID-19?

Occupational exposures to asbestos increase a person's risk of developing asbestosis - a type of pulmonary fibrosis caused by the inhalation of asbestos fibers.

Asbestosis patients are vulnerable to any illness that could put a strain on their respiratory system. People who worked in construction, maintenance, heavy industry, were in contact with an extremely high concentration of asbestos.

Because it is a progressive disease, asbestosis typically occurs 30 to 40 years after the first exposure to asbestos.

Shortly after inhalation, the asbestos fibers which attached themselves to lung tissue start producing persistent inflammation and scarring, which will ultimately cause fibrotic lung disease.

The criteria used for the diagnosis of asbestosis are based on clinical, physiological, and radiologic features including diffuse pleural thickening or pleural plaques and the presence of characteristic linear, irregular radiographic opacities. The chest X-ray of a patient diagnosed with interstitial lung disease consistent with asbestosis shows interstitial opacities on both mid and lower lung fields. High-resolution CT also showed that thick, bandlike opacities were common in asbestosis and rare in 2019 novel coronavirus-infected pneumonia, whilst ground-glass opacities were rare in asbestosis and common in 2019 novel coronavirus-infected pneumonia.

Call your doctor immediately if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or shortness of breath.

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