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

Many people are familiar with how COVID-19 affects the lungs: It can cause cough, congestion, and shortness of breath. But if you have these symptoms, does this mean you have COVID pneumonia? The short answer is no, not necessarily. 

COVID pneumonia is a more serious infection of the lungs. Although this can occur in healthy people of any age, pneumonia from COVID is more likely to occur in people above the age of 65. People with underlying medical conditions — like lung disease, high blood pressure, or diabetes — are also at higher risk. Here we will explain the signs of COVID pneumonia and the most effective treatment options.

Can COVID turn into pneumonia?

Yes, some people with a COVID infection go on to develop pneumonia. Pneumonia is an infection in the lungs. It’s a type of lower respiratory tract infection that causes the airways deep inside the lungs to fill up with fluid. 

Pneumonia is different from a common cold. The viruses that cause colds mainly affect the nose, throat, and upper airways. That means colds are a type of upper respiratory tract infection.

The COVID virus starts in the nose and throat, where the virus first enters the body. It then travels down the respiratory tract and into the lungs. That’s where it starts to cause a cough and shortness of breath.

In some people, the virus doesn’t stop there. It can go deeper into the lungs and cause pneumonia. This is when the infection causes a large buildup of inflammatory fluid or even pus. When this happens, the fluid makes it difficult for the oxygen you breathe to get into your blood. And symptoms tend to worsen. 

What are the symptoms of COVID pneumonia?

It can be hard to know if someone is developing COVID pneumonia just based on symptoms. This is because the first signs of COVID pneumonia share similar symptoms as other COVID infections. 

Mild COVID infections can cause fever and cough. These symptoms can happen with the common cold or flu, as well as with pneumonia. More severe COVID infections can also cause shortness of breath, which is one of the more serious symptoms that can also happen with COVID pneumonia. 

Other signs and symptoms that can suggest COVID pneumonia include: 

• Persistent or recurrent fever: Fever that lasts for several days or one that goes away and then comes back can be a sign of pneumonia. 

• Productive cough: Mild to moderate COVID can cause a dry cough. But pneumonia often leads to a cough with a lot of phlegm (sputum).

• Shortness of breath: COVID pneumonia will usually cause worsening shortness of breath. This is a feeling like you can’t catch your breath, or you have trouble taking a deep breath or get winded very easily.

• Pale skin: A lack of oxygen in the blood can cause pale skin. It can also cause a bluish discoloration around the lips or on the hands.

• Fast heart rate: A resting heart rate above 100 is a red flag of a worsening infection.

• Chest pain: Fluid buildup in the lungs can cause pain when breathing. Chest pain can also develop when the heart doesn’t get enough oxygen.

• Lethargy: Excessive fatigue, lethargy, or confusion are signs of serious infection.

EXPERT PICKS: WHAT TO READ NEXT

• Stay up to date on your vaccines. Vaccination can help lower your risk of COVID pneumonia. This can include a flu and COVID shot as well as a pneumococcal vaccine. 

• Signs of severe COVID: Most COVID infections are mild but can still cause serious illness. Here’s when to get help.

• Bronchitis vs. COVID: Bronchitis and COVID can make you feel short of breath, and both can lead to pneumonia. Here’s what to watch out for.

Imaging of the lungs can give healthcare professionals certain clues about a possible diagnosis. CT scans were used in the early stages of the pandemic, but they haven’t proven to be a reliable tool for diagnosis. But X-rays continue to be helpful in managing severe COVID and COVID pneumonia. 

What are the stages of COVID pneumonia?

Pneumonia usually takes some time to develop after the start of a COVID infection. Researchers have noted that shortness of breath from COVID often shows up around days 4 to 8 of symptoms, at which point hospitalization may be needed. 

Some people will actually start to feel better after their initial infection. But then they go on to develop pneumonia and need to be hospitalized for additional treatment. This can happen when COVID leads to a bacterial infection that causes pneumonia. 

In many cases, the immune system is weakened after fighting off the COVID virus. This makes it easier for other viruses and bacteria to come in and cause an infection, like pneumonia. 

In other words, some people develop pneumonia from the COVID infection itself. Other people develop bacterial pneumonia right after their COVID infection.

What is the treatment for COVID pneumonia?

The treatment for COVID pneumonia depends on how severe the infection is and 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

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. One study found that hospital stays from COVID pneumonia can be as long as 19 days.

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, ​​chronic obstructive pulmonary disease (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:

Alex Eastman, PhD, RN

Alex Eastman, PhD, RN, is a California-based registered nurse and staff medical editor at GoodRx, where he focuses on clinical updates and Latino health.

Reviewed by:

Karen Hovav, MD, FAAP

Karen Hovav, MD, FAAP, has more than 15 years of experience as an attending pediatrician in a variety of clinical settings. She has worked in a large academic center in an urban city, a small community hospital, a private practice, and an urgent care clinic.

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