Get vaccination, but wear face mask!

‘COVID Pneumonia’ is a term that can strike fear in the hearts of many though the term itself is barely a year old. This is because as we have learned a significant percentage of the deaths caused by COVID-19 are due to pneumonia. In addition, even some of the patients who survive COVID pneumonia go on to develop long-term complications. Therefore, in order to arm ourselves with information about this lethal condition we consulted Dr.Bodhika Samarasekera, Consultant Chest Physician, District General Hospital Gampaha and Joint secretary of Sri Lanka College of pulmonologists, in this week’s Health Capsule.

About Pneumonia
Pneumonia is a condition caused by microbial infection within the lung tissues. Even though it is commonly caused by bacterial infections, viral infections such as influenza and corona can also cause pneumonia.

COVID 19 and Pneumonia
SARS COV 2 virus mainly affects the respiratory system and most of the affected patients (80%) recover without serious illnesses. About 15% of COVID-19 patients develop severe illness and may need hospitalization and oxygen therapy. Only about 5% of patients have critical infections and need ventilator treatment, according to Dr.Samarasekera. 

Complications usually develop after 7 days of the onset of symptoms. Pneumonia is a common serious complication of SARS COV 2 infection.

In Sri Lanka, all the patients diagnosed to be positive for COVID 19 are admitted to an institution for monitoring and treatment. “We are fortunate to have much less complications and low death rates when compared to the western world” the doctor reassures. 

Pathophysiology of Covid Pneumonia
SARS COV2 infection begins when respiratory droplets containing the virus enter the upper respiratory tract. As virus multiplies, infection can progress into lungs and cause pneumonia. 

The oxygen that we breathe in crosses into our blood streams through the small air sacs (alveoli) in our lungs. Infection with SARS COV 2 damage these alveoli and surrounding tissues. As the immune system fights against the virus, the resultant inflammation can lead to build up of fluid and dead cells in our lungs. All these act as barriers in the transfer of oxygen, leading to coughing and shortness of breath. 

Complications 
The symptoms of COVID-19 pneumonia are similar to those of other types of pneumonia. 
These include fever, cough (with or without sputum), shortness of breath, chest pain (typically occurring on deep inhalation or coughing) and fatigue.

Patients with severe disease may go on to develop more serious bouts of pneumonia. Their symptoms might include severe breathing difficulty and low oxygen levels in the blood. In critical cases, pneumonia can progress to a life threatening condition called acute respiratory distress syndrome (ARDS). Many people with ARDS need mechanical ventilation.

At Risk Population
Anyone infected with COVID-19 can develop pneumonia. However, people older than 65 years and patients who are having prior medical conditions such as chronic lung disease (COPD, Uncontrolled Asthma, Bronchiectasis and lung fibrosis), diabetes, kidney disease, heart disease, liver disease and severe obesity are found to be more at risk of developing COVID pneumonia. People with weakened immune system due to cancer, long-term steroids and HIV are also more susceptible.

Treatment
All patients suspected to have COVID Peumonia need a good diagnostic work up, including basic blood counts, a PCR test for SARS COV 2, chest x ray and a CT chest in severe cases. It can be distinguished from other types of pneumonias from a sign called ‘ground glass appearance’ on CT.

All COVID patients with pneumonia need in hospital treatment with oxygen, to deal with breathing difficulty. Ventilator support may be needed to assist breathing in severe cases. Non invasive ventilators can be used as initial breathing support. 

“A steroid called dexamethasone is used to treat patients who need oxygen and shows some promising results. In addition, some countries use FDA Approved anti viral drug called Remdesivir for treatment of COVID-19. Antibiotics are used if there is evidence of secondary bacterial pneumonia”, explains Dr. Samarasekera.

“Even though many unproven local remedies claiming to cure COVID-19, have been distributed here in Sri Lanka, it is very important to do proper studies before giving it to patients to avoid many unwanted consequences of such medicine,” emphasises the doctor. 

Long-term complications
Studies have shown that lung functions and oxygen transfer capacity of the patients recovered from COVID pneumonia have been affected in the long run. Some patients who recovered experience shortness of breath on exertion and fatigue for many months after recovery.

Prevention better than cure
When it comes to prevention of COVID-19, several vaccines with different mechanism of actions have been approved for use throughout the world. The ChAdOx1 (oxford) vaccine currently administered here in Sri Lanka shows an efficacy of around 70% after 2 doses. Out of all the participants who received the vaccine in the oxford clinical trial, no hospital admissions or deaths due to COVID-19 were reported. Only minimal side effects such as pain at the injection site, fever, chills, muscle pain, joint pain and fatigue were reported amongst the participants.

Even if you are lucky enough to get the vaccine it is very important to wear a face mask, practice social distancing and good hand hygiene even after receiving the vaccination. This is in order to prevent the infection spreading from you to others as there is still a chance of you being a carrier of the disease, explains Dr. Samarasekera. “There is no proven prophylactic ‘immune boosting’ medicine or Local remedies to prevent COVID-19 or COVID pneumonia as of yet. Therefore our best and so far, the only, defence against the COVID-19 pandemic is getting the vaccine and practising respiratory etiquette to prevent this disease”, concludes the doctor. 

Seek emergency care if you are experiencing;

• Difficulty in breathing 
• Rapid shallow breathing 
• A bluish color of the lips, face or finger tips 
• A rapid heartbeat 
• Confusion 
• Difficulty in staying awake
• Oxygen saturation levels less than 96% if you have a finger pulse oxymetre at home.