Viral Pneumonia

A number of different viruses cause viral pneumonia, but the most concerning is COVID-19.

• Pneumonia is an infection or inflammation of the lungs. It can be in just one part of the lungs, or it can involve many parts.
• Pneumonia is caused by bacteria, viruses, fungi, and other microorganisms.
• The severity of pneumonia depends on which organism is causing the infection and the immune response of the individual to that infection.
• The deadly pandemic COVID-19 coronavirus causes severe lung symptoms including pneumonia in about 16%-20% of the people who contract it. Five percent of those with severe symptoms need a ventilator to breathe, as of March 2020.
• Viral pneumonias other than the one caused by SARS-CoV-2 virus that causes COVID-19 are usually not very serious, but they can be life-threatening in very old and very young patients and in people whose immune systems are weak.
• Another two of the most publicized viral infections causing pneumonia are SARS and H1N1 swine flu. Severe acute respiratory syndrome (SARS), which is also caused by a virus in the coronavirus family, had a major outbreak in 2003 with an estimated 8,000 cases and 750 deaths. 
• Swine flu (H1N1) was associated with an outbreak of pneumonia in 2009. Early reports came from cases in Mexico, with very high mortality. Many cases were also reported in the U.S. However, early identification and treatment helped reduce the death rate significantly.

About 16%-20% of people who contract the COVID-19 coronavirus will develop severe lung symptoms including pneumonia.

Some of these patients only need extra oxygen and they can recover, but others need ICU beds and breathing support, including 

• high-flow oxygen or
• intubation to use a breathing machine.
• The number of people who will require breathing assistance with a ventilator is about 5% of all infected patients, as of March 2020.

Symptoms of COVID-19 viral pneumonia include the following:

• Oxygen blood saturation falling from normal (95 or above) to below 90 and continuing to drop.
• Severe discomfort 
• Inability to rise from bed.
• On a chest X-ray, radiologists will note round, fluffy areas that are produced by the coronavirus infection called globules blocking oxygenation of lung tissue. 

Viral pneumonia can be caused by influenza virus, respiratory syncytial virus (RSV), and herpes or varicella viruses as well as those that cause the common cold (parainfluenza, coronaviruses, and adenoviruses).

Depending on which virus is involved, the symptoms, severity, and treatment vary.

• Influenza A and B usually occur in the winter and spring. In addition to the respiratory symptoms, you can get headache, fever, and muscle aches. Your chance of catching the flu decreases significantly (but is not totally prevented) if you get immunized (flu shot) every year.
• Respiratory syncytial virus (RSV) is most common in the spring. It usually infects children and can cause outbreaks in day-care centers and hospital nurseries.
• Herpes, or varicella, pneumonia is rare unless you are infected with chickenpox. This tends to be a more common complication in adults who get chickenpox.
• Adenovirus and parainfluenza viral pneumonias are often accompanied by cold symptoms such as runny nose and pinkeye (conjunctivitis).

Most viral pneumonias have the following signs and symptoms in common:

• Low-grade fever (less than 102 F)
• Coughing up small amounts of mucus
• Tiredness
• Muscle aches

Symptoms of pneumonia caused by a virus other than influenza usually go on for several days to a few weeks before you call your doctor. Most people with bacterial pneumonia and influenza get sick very quickly and see a doctor within a few days.

Call your hospital's emergency department or call your doctor if you develop any of these symptoms or signs:

• Persistent cough
• Shortness of breath, either at rest or with just a little exertion
• Severe chest pain
• Severe weakness
• Coughing up blood
• Vomiting so much that you are dehydrated
• Unable to take in food and fluids

If you are unsure whether your symptoms are symptoms of COVID-19 (meaning, you have not been tested for the virus), do not physically go to the doctor's or emergency room until you or a loved one have called ahead. The office will give instructions to admit yourself in a way that reduces transmission risk to other patients and healthcare workers, according to direction from the CDC.

Your doctor will check your temperature, heart rate, and blood pressure. A pulse oximeter (a small clamp-like device, which looks like a clothespin) may be put on your finger to check your blood oxygen level. Your doctor will examine you and specifically listen to your heart and lungs to help determine the cause of your symptoms and the severity of your illness. If it is possible that you have pneumonia, you will probably have a chest X-ray.

• Influenza A and B are usually diagnosed clinically, which means the symptoms give the diagnosis. Often screening lab tests can help with the diagnosis. These tests are usually taken from secretions from your nose to help identify the organism.
• Varicella pneumonia is usually diagnosed clinically because it usually happens during an outbreak of the chickenpox. The chest X-ray is often characteristic after the infection has resolved (small round white dots seen in both lung fields).
• If your doctor suspects respiratory syncytial virus (RSV), a swab of your nose secretions can be sent for testing by a laboratory. Children and infants are more likely to be tested for RSV, because this virus can be more serious in them.
• Adenovirus and parainfluenza virus are not likely to cause life-threatening illnesses. Tests are rarely done if these viruses are suspected to be the cause of pneumonia.

• If you've been diagnosed with viral pneumonia, you need to rest and drink plenty of fluids.
• If you overexert yourself when you are sick, even with a virus, you can prevent your immune system from fighting off the illness, and possibly get even sicker.
• You can use over-the-counter medicines to reduce fever, body aches, and cough. Although some medicines can help you feel better, you still need rest. These medicines won't cure you, and your body still needs rest to have the energy to fight the infection and to heal itself.

If you are diagnosed with a viral pneumonia, an antibiotic will not help you get better faster. Antibiotics work only on illnesses caused by bacteria. Your best treatment is to rest and keep yourself hydrated. But there are some bacteria that do not behave like standard bacteria when they cause pneumonia. These are referred to as atypical infections with organisms like Mycoplasma, Legionella, and Chlamydia. These infections do respond to antibiotics. So if your physician is not certain if your infection is viral or due to one of these atypical bacteria, an antibiotic may be prescribed to cover these atypical organisms.

• If your doctor suspects your pneumonia is caused by an influenza virus, you may get a prescription for an anti-flu medicine. It must be started within 36 hours of the beginning of symptoms to be effective. Four drugs are available: Amantadine (Symadine, Symmetrel), rimantadine (Flumadine), and oseltamivir (Tamiflu) are pills or capsules. Zanamivir (Relenza) is a powder that you inhale directly into your lungs.
• Varicella pneumonia is almost always serious enough to need treatment with acyclovir (Zovirax) or a similar antibiotic. You can take this drug by mouth or, if you are severely ill and in the hospital, by IV.
• Respiratory syncytial virus usually needs treatment for symptoms only. If you are sick enough to be in the hospital, you might be treated with ribavirin (Rebetol).
• Treatment of adenovirus and parainfluenza virus pneumonia is also just to relieve symptoms.
• There are no approved drug treatments for COVID-19 coronavirus, other than supportive care and symptom relief.
• Several medications that may or may not have some benefit are authorized by the FDA under emergency use designation against the COVID-19 coronavirus.

• If you are treated at home, your doctor will probably ask you to return in 1-4 weeks to be checked.
• You may need a repeat chest X-ray when your symptoms have improved. Because some types of pneumonia can look like cancer, a second X-ray will prove that it is not.

Germs are spread both by aerosolized droplets that you breathe in (such as from a sneeze) and through body fluids left on surfaces like countertops and door handles. If you avoid people who are coughing or sneezing, and wash your hands frequently, you can reduce your chances of catching a virus.

Fluids and rest during bouts of the common cold can help prevent progression to pneumonia.

• If you get a flu shot every fall, you reduce your chances of getting influenza pneumonia.
• If you have never had chickenpox, you can get a vaccine to prevent it. You should discuss with your health care professional if the vaccine is indicated for you.

Most people get well quickly with no damage to the lungs. You are at a greater risk for developing complications if you are very old or very young, or if you have a weakened immune system, or if you have chronic heart or lung disease.

This seems to hold true for COVID-19 patients as well, however, children and young adults don't seem to be affected severely, in general. Though a tiny fraction of people infected with coronavirus dies of the disease, the virus is so contagious that the small percentage includes hundreds of thousands of deaths worldwide as of late April 2020.