My Personal Experience as a Doctor: The Various Late Lung Complications of COVID-19

Composite scan showing lungs affected by Coronavirus. CREDIT: SPL

I am a UK doctor who has been unwell for 3 weeks with suspected moderate COVID-19.

A few days ago I was getting more short of breath, I had pleuritic chest pain (pain on breathing) and my Oxygen saturations dropped a little. I was seen by a primary care doctor and diagnosed with bacterial superinfection/pneumonia after listening to my chest. This is a well known complication of COVID-19 and guidance for managing it is here, I am currently taking Co-Amoxiclav (Augmentin) and Clarithromycin, although there are many other combinations of antibiotics available.

The lung damage that COVID-19 can cause. Credit: George Washington University, Mashable

Today I am feeling a lot better with energy improving. I still have some chest pain on breathing but it isn’t too bad. The cough and night time problems are still there, and I am sleeping prone to help drainage and aeration.

 
The difference between sleeping supine and sleeping prone. CREDIT: Wikimedia Commons

In a healthy or young person, there are various possible lung complications from COVID-19. Four of these are:

  • Viral Pneumonia
  • Bacterial Pneumonia (Bacterial superinfection of the areas damaged by the virus)
  • Autoimmune Lung Damage following the virus
  • Pulmonary embolism (clot in the lung)

The symptoms for the first three can be very similar, and a CT scan is best for differentiating these. My diagnosis was based on clinical examination, as investigations are resource-limited in the National Health Service at present. The findings of bronchial breathing and consolidation at three weeks following illness were indicative of a possible bacterial consolidation, although viral pneumonia still remains a possibility too. The argument to start antibiotics is based on covering the former just in case.

The last possibility of a Pulmonary Embolism is less likely as I had bronchial breathing (harsh breath sounds suggesting consolidation, which is a feature of the first two). However, this is seems to be getting reported anecdotally and particularly in the context of concurrent pneumonia. In the UK, a good test in the first instance would be an FDP blood test. In my case, I will enquire about this only if I stop improving.

The third possibility of autoimmune lung damage can mimic pneumonia, and can potentially be much more devastating. In these patients, Chest X-ray and Chest CT have shown patchy consolidation, particularly in the backs of the lungs.

Thin-section CT chest showing ground glass opacities without consolidation. This suggests autoimmune disease. Credit: RSNA

The cause of this is a systemic inflammatory dysregulation, which is likely to even follow clearance of the virus. Here is a Nature editorial describing the two-phase immune response which triggers this. There are also online seminars discussing this process at Cambridge University here.

At this stage, we are still not clear about treatment options for this autoimmune complication. Management must address restoration of immune regulation, and current research is looking at Tocilizumabhydroxychloroquine, and IV Steroids, although both the Hydroxychloroquine and Steroids are considered controversial at present. All of these drugs are to be used after the virus is no longer active, as if they are used early on, they will make the infection worse. It is possible that oral steroids may be considered an option in the future, but we still don’t have enough evidence.


 
An image of the lung with ground-glass opacities. Credit: RNAS

COVID-19 is simultaneously a deadly and fascinating disease. In time, we will know more about the many ways it exerts such an influence over the body. We can only hope that we are able to conquer this disease as early as possible to stop it ravaging the world.

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