As a doctor, I know the coronavirus, COVID-19, has revealed itself to be a master of disguise. Whereas some people can have it and have no idea they are infected, others end up in the Intensive Care Unit, unable to breathe and on a ventilator, since the virus targets the lungs. So what should we look out for? What are the signs our lung function is deteriorating?
Here are some points of relevance—however, if you are concerned about your clinical condition, I would urge you to seek professional help sooner rather than later, because all respiratory infections can get worse with frightening speed. You need to get help promptly before things progress too far.
First, Take Stock of the Severity of Your Infection
If you are unlucky enough to become infected with COVID-19, the episode may last up to two weeks in mild cases, or three to six weeks in severe or critical cases. The severity of COVID-19 infection has been divided into 5 groups:
- Mild disease
- Moderate disease
- Severe disease
- Critical—Acute Respiratory Distress Syndrome (ARDS)
Experience from Wuhan, where the virus originated, showed 81% of COVID-19 patients had mild disease, 14% of those infected developed severe pneumonia and around 5% required critical care.
When we consider if the lungs are failing, we are specifically interested in people passing from mild and moderate disease, to severe or critical. Mild to moderate disease can be managed at home. People with severe or critical disease need hospitalization.
The following are 5 symptoms/clinical signs to look out for, which will help decide if your infection is passing from moderate to critical severity, and if so, needs urgent help.
Your Cough is Getting Worse
Up to 82% of patients infected with COVID-19 have a cough. This is typically dry and irritating. Experts describe the cough in the early stages of the disease as coughing episodes which can last up to an hour, and with 3 or more coughing bouts in 24 hours.
Coughing is due to inflammation in your airways. A cough is a reflex designed to protect your body from invasion with foreign particles such as bacteria and viruses. If your lungs are inflamed, a cough also expels mucus and cellular debris.
In a way, a cough is a good thing! However too much coughing is exhausting, it further interrupts the supply of oxygen to your lungs and can—although rare—cause serious problems such as fractured ribs, or even small hemorrhages in the brain.
If your cough is worsening, this can be a warning sign the infection is progressing to cause a more severe, full-blown pneumonia.
You’re Finding it Hard to Breathe
Breathlessness was reported by 31% of patients from the initial experience in Wuhan. It is very frightening not being able to breathe. The degree of breathlessness is probably the most important clinical indicator of the severity of your condition.
- Respiratory rate – Normally adults breathe in and out 12 -18 times per minute.
More than 20 breaths per minute is faster breathing—called tachypnoea.
- Inability to breathe interferes with normal daily activities – As the COVID-19 infection progresses, you may feel more breathless. If this is starting to interfere with daily activities, for example, you can’t finish a sentence without taking a breath, or it’s hard to eat or drink, this is a bad sign. In addition, you may also find it harder and harder to walk around, manage the stairs, or do your daily activities.
- Strain from breathing – If you watch someone with severe breathing difficulties, you will notice them using their neck muscles to draw up the chest and suck air into the lungs, and sometimes flaring of the nostrils. People with severe breathing difficulties often complain that their chest, tummy, or back hurts, due to the mechanical strain of breathing.
If you have these clinical signs, you need to be getting urgent medical help as these are signs COVID-19 has passed from a moderate to a severe infection.
Fatigue was one of the most common symptoms reported from the first experience of COVID-19 in China and was reported in around 70% of patients. It’s normal to feel tired when you are unwell. However, if the tiredness becomes total fatigue, such that you can’t manage a shower, don’t want to get out of bed or get dressed, lose your appetite, or start not wanting to drink, these are signs of exhaustion.
This extreme fatigue is due to a high viral load in your body. Your body is generating a huge immune response. This then results in a fever, sweating, coughing, and can lead to dehydration. Fatigue is also due to the physical exertion of trying to breathe.
As the fatigue worsens, you may become listless, unable to watch TV or concentrate or communicate effectively.
Other medical complications can also occur, including possible secondary bacterial infection. In the most critical cases, there may be overwhelming infection with sepsis and septic shock.
If your tiredness is progressing and becoming extreme, this is a sign the coronavirus infection is becoming severe, and your pneumonia is worsening. You need to seek urgent help.
Your Lips are Blue
If your lips, fingers and toes are looking blue, this is called cyanosis—this is a serious sign of poor lung function and you must get urgent medical help.
When you breathe in, your lungs deliver oxygen to the heart and the rest of the body. The lungs also excrete carbon dioxide, in the air you breathe out.
When you have severe pneumonia, such as with COVID-19 infection, your body can be lacking in oxygen, and are also unable to get rid of carbon dioxide.
Well-oxygenated blood is a cherry-red color, giving your skin a nice reddish/pink tinge. However deoxygenated blood has a darker red color, and when light reflects off the skin, it now appears a dark navy blue. This bluish tinge is seen on the lips and on the tips of the fingers and toes, and in the nail beds.
You’re Having Chest Pain
This is not being widely reported as a major symptom of COVID-19, however, pneumonia of any cause can cause chest pain.
- If pneumonia affects the lining of the lung tissue – the pleura – it can cause pleurisy. Pleuritic chest pain is a typical pain felt in the chest when you breathe in. It is sometimes also felt in the abdomen, the neck or the shoulder. Pneumonia can also cause fluid to build up in the chest – this is called a pleural effusion.
- Coughing and straining the intercostal muscles (between the ribs) can cause pain. Severe coughing can cause a fractured rib, or a pneumothorax – a lung collapse.
- Patients do report chest tightening with COVID-19—which may be due to bronchospasm, especially in people who are known asthmatics or have a tendency to wheeze when they get a respiratory infection.
There’s the Additional Threat of Underlying Medical Conditions
COVID-19 pneumonia presents an additional threat for people who already have underlying medical conditions:
- Cardiovascular disease – Severe COVID-19 infection increases the strain on your heart, as it beats harder and faster due to infection, in an effort to help with oxygenation, and thwarted by dehydration and increasing resistance from trying to pump blood into diseased lung tissue. This increases the likelihood of angina, and/or a heart attack.
- Diabetes – Diabetic control is always disrupted in any severe acute infection and becomes difficult to manage.
- Chronic respiratory disease – Underlying chronic obstructive airways disease, often from smoking, means airways are already damaged and clogged with mucus and debris.
- Hypertension – High blood pressure is correlated with cardiovascular disease, and further puts the heart under strain.
Complications can arise from COVID-19 exacerbated by any of these conditions. For example, a heart attack, secondary bacterial pneumonia or a pulmonary embolus (blood clot). All of these can cause chest pain—although they can also be silent.
If you are getting worsening chest pain, this would suggest your COVID-19 is becoming more severe and you need urgent medical attention.
Final Thoughts From the Doctor
If you think you have COVID-19 infection, the advice is to stay at home. However, this is a serious viral infection which causes pneumonia. If you feel your condition is deteriorating, you must seek help.
It can be hard to judge how well or badly your lungs are coping with a COVID-19 infection. Never worry about wasting anyone’s time! Lung function can deteriorate rapidly and it is always best to act earlier rather than later. If you can identify with any of the five symptoms listed here, it’ s time to be calling your doctor.
And to get through this pandemic at your healthiest, don’t miss these 50 Things You Should Never Do During the Coronavirus Pandemic.
Dr. Deborah Lee is a medical writer at Dr Fox Online Pharmacy.