Why COVID Can Turn Into Pneumonia — and How to Recognize the Symptoms

COVID-19 doesn’t cause severe lung problems as often as it did earlier in the pandemic. Today, most people have mild symptoms that stay in the nose and throat. But if you develop chest symptoms — like a worsening cough or trouble breathing — it’s natural to wonder if the infection has turned into COVID pneumonia.

COVID pneumonia happens when an infection in the lungs causes inflammation and fluid to build up, making it hard to breathe. Anyone can get it, but it’s more common in adults over age 65 and in people with health conditions like lung disease, heart disease, or diabetes.

In this article, we explain how COVID pneumonia develops, the symptoms to watch for, and how to treat it.

Can COVID turn into pneumonia?

Yes. Some people with COVID can develop pneumonia. Pneumonia is a serious infection that affects the lower part of the lungs. In pneumonia, the tiny air sacs in the lungs fill with inflammatory fluid. This makes it harder for the lungs to do their job of absorbing oxygen and getting rid of carbon dioxide. 

COVID usually starts in the nose and throat, where the virus first enters the body. For most people, it stays there. But in some cases, the virus travels farther down the respiratory tract and reaches the lungs. This can cause symptoms like a deep cough or shortness of breath.

If the infection goes even deeper, it can lead to COVID pneumonia. At that point, the lungs can become filled with fluid or pus, and breathing becomes more difficult. Symptoms typically worsen, and some people may need medical care.

What are the symptoms of COVID pneumonia?

It’s not always easy to tell when COVID is turning into pneumonia based on symptoms alone. Early symptoms often look the same as a mild COVID infection or even a cold or the flu.

Common early symptoms (not specific to COVID pneumonia) include:

• Fever

• Cough (usually dry)

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These symptoms are common in many respiratory infections, so they don’t necessarily mean the lungs are involved.

But here are symptoms that raise concern for COVID pneumonia:

• Persistent or returning fever: Fever that lasts for several days, or comes back after improving. 

• Productive cough: A cough that shifts from dry to coughing up phlegm (sputum).

• Worsening shortness of breath: Feeling like you can’t catch your breath, getting winded easily, or having trouble taking a deep breath.

• Pale or bluish skin or lips: This could be a sign that you’re not getting enough oxygen from your lungs. 

• Fast heart rate: A resting heart rate above 100 can signal a worsening infection.

• Chest pain: Pain that gets worse with breathing can happen when fluid builds up in the lungs. Chest pain can also happen when the heart doesn’t get enough oxygen.

• Serious fatigue, lethargy, or confusion: These are all signs of a serious illness that needs urgent care.

How to diagnose pneumonia

Symptoms alone can’t diagnose COVID pneumonia. A chest X-ray is the easiest and safest test to look for fluid or inflammation in the lungs. Depending on what the chest X-ray shows, you might also need a CT scan to look at the lungs in more detail. 

Who is at risk of developing COVID pneumonia?

Anyone can develop COVID pneumonia, but it’s more likely in people whose lungs or immune systems are less able to fight infection. 

Your risk is higher if you:

• Are 65 or older

• Have a longstanding lung condition like asthma, chronic obstructive pulmonary disease (COPD), or pulmonary fibrosis

• Have heart disease, high blood pressure, or diabetes

• Have a weakened immune system from an illness or medication

• Are unvaccinated or not up-to-date on COVID vaccines

These factors don’t mean pneumonia will happen. Most people with COVID never develop pneumonia. But they do increase the risks of more serious lung involvement.

Quiz: Do I have pneumonia?

What are the stages of COVID pneumonia?

COVID pneumonia doesn’t follow strict medical “stages,” but it does tend to develop in recognizable patterns. Here’s what researchers and clinicians see most often:

• Early infection (days 1 to 4): Symptoms are usually limited to the nose, throat, or upper airways. Fever, fatigue, and a dry cough are common.

• Worsening respiratory symptoms (days 4 to 8): As the COVID infection starts to move deeper into the lungs, a viral pneumonia starts to develop, with worsening symptoms. Hospitalization may be required. 

• Initial improvement followed by new symptoms: Some people get sick again, after feeling like they started to recover. Their fever returns, cough starts up again, and they may have worsening shortness of breath. This happens when someone develops a secondary bacterial pneumonia after being weakened by the initial COVID infection. 

These patterns can help you identify if your COVID infection could be turning into pneumonia. But keep in mind that the exact timing can vary from person to person (and that most people don’t get pneumonia from COVID).

What is the treatment for COVID pneumonia?

The treatment for COVID pneumonia depends on how severe the infection is and if you have any underlying health conditions. 

Some people with COVID pneumonia are well enough to treat it at home. At-home COVID treatments can include:

• Prescription COVID medications, like Paxlovid (nirmatrelvir / ritonavir) or Veklury (remdesivir)

• Acetaminophen (Tylenol) for fever

• Cough medicine, like dextromethorphan or benzonatate

• Hydration with lots of fluids

• Plenty of rest

People with a more severe infection need to be hospitalized for treatment. Treatments in a hospital may include:

• Antibiotics, if there’s a concern about a bacterial infection

• Oxygen, depending on how low blood oxygen levels are

• Dexamethasone, a steroid that reduces inflammation

• Blood-thinning medications, like aspirin or enoxaparin (Lovenox), to reduce the chance of blood clots

Can COVID pneumonia go away on its own?

Sometimes, but not always. Mild cases of COVID pneumonia can improve with rest, fluids, and time, especially in people who are otherwise healthy. But pneumonia can worsen quickly, so it’s best to get evaluated for treatment if you think you could have pneumonia. Some people need oxygen, medications, or other hospital care to recover safely. And, if you’re eligible for treatments like Paxlovid or other COVID antivirals, it’s best to start them early to help lower the risk of severe illness.

If you’re having trouble breathing, persistent fever, or symptoms that are getting worse instead of better, don’t delay getting medical care.

How long does it take to recover from COVID pneumonia?

Most mild cases of COVID last about 2 weeks. But recovery from COVID pneumonia usually takes longer, usually 3 weeks or longer. 

Most people with a moderate case of COVID pneumonia recover fully. But about 1 in 3 might still have some trouble breathing with exercise a year later. People with a very severe infection — one that requires treatment in the intensive care unit (ICU) — are more likely to have persistent symptoms.

How do you prevent COVID from turning into pneumonia?

Just like there’s no way to completely avoid COVID infection, there’s no way to have total protection against COVID pneumonia. But you can take steps to prevent COVID from turning into pneumonia. Here’s how to lower your risk of pneumonia:

• Stay up-to-date on your vaccines. There are several vaccines that can help protect you from pneumonia. A yearly flu shot, COVID vaccination, and pneumococcal vaccines can all help lower your chances of COVID pneumonia. 

• Manage any medical conditions you have. Older adults are more at risk for both COVID and pneumonia. You’re also more at risk if you have long-term health conditions, like asthma, ​​COPD, or diabetes. Working with your healthcare team to manage these conditions can help you prevent infections.

• Keep up with basic precautions. There are some simple steps you can take every day to help prevent infections. This includes washing your hands, wearing a mask in crowded areas, and limiting contact with people who are sick. 

• Don’t smoke, or try to quit. Smoking cigarettes puts you at risk for many health problems, including COVID pneumonia. Quitting smoking isn’t easy, but there’s help.

If you notice symptoms of COVID infection, get help sooner rather than later, especially if you have a higher risk. A healthcare professional can recommend medications and other treatments to help prevent more serious illness. 

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Written by:

Nicole Andonian, MD

Nicole Andonian, MD, is a private practice anesthesiologist in Orange County, California. Her focus is in general anesthesia, regional anesthesia, and acute pain management.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. A pulmonologist and hospitalist, she practiced and taught clinical medicine at hospitals in London for a decade before entering a career in health education and technology.

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