When Do You Need to Go to the Hospital for COVID?

Most people with COVID-19 infection never have to see a healthcare professional throughout the course of their illness. But in a world of self-testing and telehealth appointments, it’s totally normal to wonder if you’re OK at home. And it can be scary to know that COVID can still lead to severe health problems. We’re here to help you know when it’s time to get help.

What are the symptoms of severe COVID-19?

A COVID infection can make you feel very sick, even when you’re OK and not in any real danger. But it can be hard to know when it’s time to get medical attention. 

It’s important to remember that COVID can cause severe symptoms, like difficulty breathing. It can also cause oxygen levels in your body to be dangerously low. If this happens, you need medical attention and supplemental oxygen right away. 

Your oxygen level might be low if you:

• Feel like you’re working very hard to breathe

• Feel like you can’t catch your breath

• Experience chest pain or tightness

• Notice a bluish or dusky discoloration of your skin, lips, or nail beds 

• Seem confused or disoriented

• Have difficulty staying awake

If you’re used to feeling short of breath from an underlying condition, like asthma or chronic obstructive pulmonary disease (COPD), it's important to be extra cautious if you get a COVID infection. Pay attention to any symptoms that seem different or worse than your baseline. 

What are the risk factors for severe COVID?

Certain conditions put you at greater risk for developing severe COVID infections compared to the average population. Some of the more common risk factors include: 

• Age over 50 years old

• Diabetes

• Higher body weight or body fat

• Chronic lung disease

• Heart disease

• Cancer

• HIV (human immunodeficiency virus)

You’re also at greater risk for severe COVID if you have:

• Received an organ transplant 

• Had an illness that required steroids or immunosuppressive medications

• Not been vaccinated against COVID

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What to do if you have a higher risk of severe COVID

If any of the above risk factors apply to you, there are a few extra things you can do to look out for signs or symptoms of a more severe disease:

• Stay in tune with your body. Take note of how you feel day to day so you can sense if your symptoms are worsening. 

• When in doubt, see a healthcare professional. Don’t wait until you feel really sick. If you’re unsure if you’re OK, reach out to your primary care provider to discuss your symptoms. They can also help you decide if you need to be seen right away in an ER. 

• Consider getting a pulse oximeter. This little device, which you put on your finger, measures your oxygen levels. In normal conditions, most people have a reading over 95%. If that reading consistently drops below this, it’s time to go to the ER.

What happens if you go to the ER for COVID-19?

When you go to the ER for COVID, one of the most important parts of your evaluation will be checking your vital signs. These include your: 

• Oxygen level (sometimes called “pulse ox”)

• Breathing rate

• Heart rate

• Blood pressure

Depending on your vital signs and physical exam, your care team may also run some additional tests to see how the virus is affecting your body. These tests may include:

• X-ray of your lungs to look for signs of pneumonia or fluid

• CT scan of your chest to look at the lungs in greater detail or to check for blood clots

• Electrocardiogram (ECG) of your heart to look for signs of stress or strain on your heart

• Blood tests to check your blood counts, kidney function, and electrolytes

After these tests, you’ll discuss if you’re safe to continue recovering at home or if you should stay in the hospital for closer monitoring.

What happens when you are admitted to the hospital?

Your care team in the ER will probably recommend you stay in the hospital if:

• You’re struggling to breathe.

• Your oxygen levels are low.

• You’re struggling to stay hydrated or keep fluids down.

• You have any changes in how alert or sleepy you are, or how coherent you seem.

• You have a medical condition that makes it more likely that your infection will worsen. 

In the hospital, a healthcare professional can monitor you and your symptoms more closely.

Treatments for COVID

In addition to close monitoring, you can get helpful COVID treatments in the hospital. Every person is different and has different needs. But some treatment options include: 

• Oxygen, given through nasal prongs or a mask

• Intravenous (IV) fluids to keep you well hydrated

• Steroids, if you have underlying lung conditions

• Antiviral medications, like remdesivir

• Biologic medications, like vilobelimab or tocilizumab

• Anti-inflammatory medications, like baricitinib or anakinra 

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

Keep in mind that getting admitted to the hospital doesn’t mean that you’ll definitely have COVID-related complications. Hospitalization is often done to prevent that from happening. And if issues come up, your care team can treat them right away.

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Written by:

Jill L. Jaimes, MD

Jill L. Jaimes, MD, is a board-certified pediatric emergency medicine physician with over 20 years of clinical experience. She received her medical degree from Baylor College of Medicine and completed her residency and fellowship training at Texas Children’s Hospital.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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