Definition

COVID-19 pneumonia is pneumonia caused by the SARS-CoV-2 virus infection, first identified in 2019, and currently designated by the WHO as a pandemic. The name COVID-19 itself is an abbreviation for coronavirus disease 2019.

Pneumonia is a lung infection that causes inflammation in the small air sacs (alveoli) in the lungs. These air sacs can fill with fluid and pus in large amounts, making it difficult for the patient to breathe; in some severe cases, requiring oxygen therapy or mechanical ventilation (ventilator). The infection can be caused by microbes such as bacteria, viruses, or fungi.

About 15% of COVID-19 cases are severe. This means these cases require oxygen therapy in hospitals. About 5% of cases are critical and require a ventilator. COVID-19 pneumonia often affects not only one but both lungs of humans, thus limiting the patient's ability to take in oxygen.

Most people infected with this virus will experience mild to moderate respiratory disturbances. However, in high-risk groups, the disease can become severe and life-threatening. COVID-19 pneumonia is also associated with lung injuries that can make breathing difficult for patients, even after recovery, and may take months for their condition to improve.

Causes

COVID-19 pneumonia is caused by the SARS-CoV-2 virus infection. This virus has several variants, namely the Alpha, Beta, Delta, and the new Omicron variant. The Delta variant has a high risk of transmission and can reduce the effectiveness of vaccines against the virus.

Meanwhile, the Omicron variant has been found to have many mutations in its genetic material, making it spread faster than other variants. The Omicron variant is also observed to replicate slower in lung cells compared to the Delta variant, resulting in milder COVID-19 severity caused by the Omicron variant compared to the Delta variant. However, it should be noted that the severity of the disease symptoms is not only determined by the virus's replication speed but other factors are also involved, such as the patient's immune response.

The virus spreads through droplets or tiny fluid particles expelled from the mouth/nose of infected individuals when they cough, speak, sneeze, sing, or breathe. COVID-19 pneumonia causes inflammation in the lungs. In severe cases, damage to cells and tissues, including air sacs in the lungs, can occur. These sacs are where oxygen exchange occurs, with inhaled oxygen reaching the sacs and then being distributed to the blood. Damage can lead to the accumulation of debris and fluid that can block the lungs. The sac walls can also thicken, making oxygen exchange more difficult, ultimately leading to difficulty breathing. This condition can be severe enough to be life-threatening.

Risk factor

Anyone can be infected with the SARS-CoV-2 virus, but in cases where the infection develops into COVID-19 pneumonia, it is more often found in people aged 65 years or older. The highest risk is in the elderly aged 85 years and older. Additionally, people living in nursing homes or with certain health problems are also at high risk of developing COVID-19 pneumonia. Health problems that can increase the risk include:

• Lung disease
• High blood pressure
• Heart disease
• Diabetes mellitus
• Liver disease
• Kidney failure
• Severe obesity or body mass index (BMI) > 35
• Cancer

People with weakened immune systems are also more susceptible to severe COVID-19 illness. Factors that can weaken the immune system include:

• Smoking
• Undergoing cancer therapy
• History of organ transplantation
• Uncontrolled HIV/AIDS
• Immune-suppressing medications, such as corticosteroids

Symptoms

The most commonly encountered COVID-19 symptoms and often the initial symptoms are fever, dry cough, and difficulty breathing or shortness of breath. Other symptoms that may occur include:

• Fatigue
• Cold sweats
• Nausea or vomiting
• Diarrhea
• Abdominal pain
• Muscle or joint pain
• Decreased or loss of smell or taste
• Sore throat
• Stuffy nose
• Shivering
• Red eyes
• Skin rash

If COVID-19 infection reaches the lungs and causes pneumonia, symptoms that may occur include:

• Clinical signs such as fever, cough, shortness of breath, and rapid breathing
• Rapid heart rate
• Dizziness
• Excessive sweating

In severe symptoms:

• Visible intense breathing effort
• Chest pain or pressure
• Confusion or decreasing consciousness
• Skin, lips, or nails turning blue
• Oxygen saturation (oxygen level in the blood) below 93% with room air (without respiratory assistance)

Diagnosis

Doctors can diagnose COVID-19 pneumonia based on existing symptoms and clinically visible signs, through physical examinations performed, and from the results of laboratory tests, namely antigen tests or polymerase chain reaction (PCR) tests.

Blood tests can also indicate signs of infection, such as increased white blood cells and C-reactive protein, which are markers of inflammation in the body. Additionally, blood oxygen levels can be low in pneumonia.

Imaging tests such as X-rays and CT scans of the chest area can also be performed. Typically, the lungs will appear slightly "dirty." In areas of the lungs that should appear black due to air filling only, there will be white areas in the lung on the X-ray results. The presence of opacities or dirty areas in the examination results usually indicates lung damage processes.

Management

The administration of therapy to COVID-19 patients depends on the severity of symptoms, age, and the presence of accompanying diseases or comorbidities in patients.

For mild symptoms or asymptomatic cases, patients are usually prescribed multivitamins and medications to relieve their symptoms, such as cough medicine, cold medicine, and fever reducers. Currently, starting from mild symptoms, patients can receive antiviral drugs. However, the administration of antiviral drugs is still adjusted to the availability of drugs in each health facility.

Meanwhile, for moderate to severe symptoms, patients will require monitoring in hospitals with COVID-19 treatment facilities. According to the severity of symptoms and based on the doctor's policy, antiviral drugs and drugs to prevent blood clotting may be given, administered intravenously or through blood vessel routes. Oxygen therapy is also given if the patient's oxygen saturation with room air and without respiratory assistance is less than 93%. Other accompanying diseases or comorbidities present in patients are also treated.

During the recovery period from COVID-19 pneumonia, the body must first repair the damage that occurred in the lungs, then clear the remaining fluid and debris. Lastly, scar formation occurs until the lung tissue heals completely. All of these processes can cause uncomfortable symptoms.

The healing process varies for each individual, depending on:

• Their overall health and immune system
• The presence of other medical conditions
• The severity of the disease

Complications

Pneumonia can cause acute respiratory distress syndrome. This condition is a rapidly occurring disease that causes severe breathing problems, which can lead to respiratory failure.

Furthermore, like other respiratory infections that cause pneumonia, COVID-19 can cause short-term lung damage. In severe cases, the damage can be long-lasting. Data show that a third of COVID-19 pneumonia patients have scarring or lung damage remnants on chest X-rays or other lung examinations one year after infection.

Prevention

If you are around someone with COVID-19, do the following to prevent infection:

• Regularly wash hands with soap for at least 20 seconds
• If unable to wash hands, use hand sanitizer with a minimum of 60% alcohol content. Rub over all surfaces of the hands until dry
• Avoid touching the face, especially the mouth, nose, and eyes, especially if hands have not been washed
• Avoid close contact or physical contact with sick people
• Wear a face mask when leaving home. According to the CDC, respirator masks such as N95 and KN95 provide higher protection than other regular masks
• Regularly clean and disinfect frequently touched surfaces, such as phones
• Get vaccinated for COVID-19 with full doses and boosters

When to see a doctor?

If you experience symptoms of COVID-19 pneumonia, it is best to consult a doctor or healthcare facility immediately to receive appropriate therapy, reducing the severity of symptoms and minimizing lung damage.

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