COVID-19 can cause lung complications such as pneumonia and, in the most severe cases, acute respiratory distress syndrome, or ARDS. Sepsis, another possible complication of COVID-19, can also cause lasting harm to the lungs and other organs.

1. Respiratory Complications of COVID-19
Dr.

2. • At the end of 2019
• SARS-CoV-2: a positive-stranded RNA virus
• The virus was initially isolated from the Broncho alveolar lavage
• Viable virus is detected in aerosols for up to 3 hours, on plastic and
stainless steel surfaces up to 72 hours

3. Transmission
There are three modes of
transmission of SARS-CoV-2
which include:
1. Droplets transmission
2. Contact transmission
3. Aerosol transmission

4.  China-CDC reports the incubation
period to be 3-7 days.
 The mean incubation period was
reported to be 5.2 days, and
 The 95% percentile of the
distribution was up to 12.5 days.

5. What type of damage can coronavirus cause in
the lungs?
COVID-19, can cause lasting lung damage. Some people (5%) will have
complications, which may be life-threatening. It can cause-
 Pneumonia
 Acute Respiratory Failure
 Acute respiratory distress syndrome (ARDS)
 Sepsis can also cause lasting harm to the lungs
 Superinfection / Secondary infection
 Blood clots
Many of these complications may be caused by
Cytokine release syndrome or cytokine storm

6.  In the majority of the cases i.e.
80% will exhibit mild
symptoms
 14% will have pneumonia
 5% will suffer from septic
shock and organ failure
(mostly respiratory failure)
 2% cases it will be fatal.

7.  The pneumonia tends to take hold in both lungs.
Predominantly basal, peripheral and sub-
pleural region.
 Due to the novelty of the Covid 19 strain, there is no
specific treatment and mostly given supportive
care.
 A spike in pneumonia cases was the first sign of the new coronavirus in
China
 Air sacs become filled with fluid, pus, and cell debris, limiting their ability
to take in oxygen and causing shortness of breath, cough and other
symptoms

8. (a) in a 61-year-old man shows bilateral
patchy, somewhat nodular opacities in
the mid to lower lungs.
(b) in a 33-year-old woman, CT Images
show multiple ground glass opacities
in the periphery of the bilateral lungs. The
bilateral, peripheral patterns of
opacities without subpleural sparing
are common and characteristic CT
findings of the 2019 novel coronavirus
pneumonia.
(c) CT image of a 71-year-old male
shows consolidation in the peripheral
right upper lobe and a patchy area of
ground glass opacity with some
associated consolidation intra- and
interlobular septal thickening within the
left upper lobe.
Chest radiograph

9. (a) Chest CT in a 75-year-old male show
multiple patchy areas of pure ground glass
opacity (GGO) and GGO with reticular and/or
interlobular septal thickening.
(b) Chest CT image of a 38-year-old male
shows multiple patches, grid-like lobule, and
thickening of interlobular septa, typical “paving
stone-like” signs.
(c) An axial CT image obtained in 65-year-old
female shows bilateral ground glass and
consolidative opacities with a striking
peripheral distribution.
(d) CT image of a 65-year-old male shows
large consolidation in the right middle lobe,
patchy consolidation in the posterior and basal
segment of right lower lobe, with air
bronchogram inside.
Typical CT findings of COVID-19

10. CT manifestations of different stages of COVID-19

11.  One of the leading cause of death of COVID-19 is acute hypoxaemic
respiratory failure.
 Diffuse alveolar damage with interstitial thickening leading to compromised
gas exchange.
 The compensatory ventilatory response to hypoxaemia, increased minute
ventilation, may lead to extreme hypocapnia.
 Hypocapnic hypoxia is not usually accompanied by air hunger; instead, a
paradoxical feeling of calm and well-being, impassive, cooperative, and
hemodynamically stable.
 This phenomenon has been coined ‘Silent hypoxia’. Apart from a rapid
respiratory rate clinical presentation can be misleading.

12.  These patients are evaluated by GPs, often by telephone in pre-hospital
context.
 Pulse oximetry readings should be interpreted.
 In COVID-19 patients, a low end-tidal CO2 values (1.4–2.0 kPa) in COVID-
19 patients should alert the physician that respiratory failure is evolving.
 Recent guidance recommends a target oxygen saturation of 92-96% .
 Oxygen delivered through high flow nasal cannulas is beneficial which
provide up to 60 L/min of nearly 100% oxygen.

13. Acute Respiratory Distress Syndrome
(ARDS)
 As COVID-19 pneumonia progresses, more of the air sacs
become filled with fluid which can lead to ARDS.
 With ARDS, the body has trouble getting oxygen into the
bloodstream.
 Patients with ARDS may require ventilator support.

14. Effect of ARDS on lungs
 The virus works by damaging the wall and the lining of the
alveolus and capillaries.
 The debris from the damage, accumulates on the alveolus wall and
thickens the lining.
 More difficult to transfer oxygen to the red blood cells, which
causes difficulty in breathing.
 The lack of oxygen to the internal organs impairs the functioning of
the organs. Then the body fights to increase oxygen intake.

15. Severity
ARDS Severity PaO2/FiO2* Mortality**
Mild 200 – 300 27%
Moderate 100 – 200 32%
Severe < 100 45%
*on PEEP 5+; This value excludes hypoxemia caused by atelectasis.

16. Differences from ARDS caused by other factors
The reported onset of COVID-19-related ARDS was similar in different studies
 Huang et al. first reported 41 cases of COVID-19 in which the median time from
onset of symptoms to ARDS was 9.0 days (8.0–14.0).
 Subsequently, Wang et al. reported 138 cases of COVID-19 in which the median
time from the first symptom to ARDS was 8.0 days (6.0–12.0).
 Zhou et al. reported the median time from illness onset to ARDS was 12.0 days
(8.0–15.0).
 As the onset time of COVID-19-related ARDS was 8–12 days, it suggested that
the 1-week onset limit defined by ARDS Berlin criteria did not apply to COVID-19-
related ARDS.

17.  ARDS resulting in reduced lung compliance and severe hypoxemia.
 Lung compliance might be relatively normal in some COVID-19-related ARDS
patients. This was obviously inconsistent with ARDS caused by other factors.
 CT findings of COVID-19 showed consolidation and exudation, it was not a
“typical” ARDS image.
Differences from ARDS caused by other factors

18. Figure 1: Early and late-stage X-ray findings in patients with COVID-19

19. How do doctors’ ascertain the onset of ARDS
in Covid 19 infected individuals?
Key indicators to judge the onset and severity of
ARDS in infected individuals:
• Hypoxia – due to damage to the alveolus
• Breathing difficulties and shortness of breath
• Chest X-rays- exhibit an opaque and glassy look
against the black background
• Worsening symptoms over the course of time

20. Sepsis
 Another complication of a severe
case of COVID-19.
 It occurs when an infection reaches
and spreads through the
bloodstream, causing tissue damage.
 Sepsis, even when survived, can
leave a patient with lasting damage
to the lungs and other organs.

21. Superinfection / Secondary infection
A review of several studies found that secondary infection is a
possible but not common complication.
Strep and Staph are common culprits.
This can be serious enough to raise the risk of death.

22. Blood Clots
• Disseminated intravascular coagulation (DIC) causes Unusual
clots form, which can lead to internal bleeding or organ failure.
• Abnormally aggressive coagulation has been noted with COVID-
19, which is called COVID-19-associated coagulopathy (CAC).
• D-dimer level >1 μg/mL has been identified as a risk factor for poor
outcome.

23. • D-dimer over 2,660 µg/L had 100% sensitivity and 67%
specificity for PE on CT angiography
• Contrast-enhanced CT or CTPA should be performed to rule out
PE if supplementary oxygen is needed.
• prophylactic anticoagulation (enoxaparin 40 mg once daily in
ward patients, or twice daily in obese and ICU patients).
Blood Clots

24. COVID-19: Anticoagulation Recommended
Even After Discharge
 ISTH had recommended prophylactic-dose low molecular weight heparin
(LMWH) for all hospitalized COVID-19 patients, unless they have
contraindications such as active bleeding or low platelet count (<25×109/L).
 Up to 45 days of prophylaxis could be considered for low-bleeding-risk
patients but elevated VTE risk due to reduced mobility or comorbidities.
 Elevated D-dimer more than twice the upper normal limit was also
suggested as a high-risk group to get post-discharge extended prophylaxis
 UNC's algorithm calls for 30 days of direct oral anticoagulants (DOAC)
use after discharge with COVID-19.

25. Formation of blood clots in different organs raises the
chance of fatality

26. (a,b) Axial CT images (lung windows)
show peripheral ground-glass opacities
(arrow) associated with areas of
consolidation in dependent portions of
the lung (arrowheads). Interlobular
reticulations, bronchiectasis (black
arrow) and lung architectural distortion
are present. Involvement of the lung
volume was estimated to be between 25%
and 50%.
(c,d) Coronal CT reformations
(mediastinum windows) show bilateral
lobar and segmental pulmonary
embolism (black arrows).
Figure: Pulmonary CT angiography of a 68 year old male. The CT scan was obtained 10 days after the onset
of COVID-19 symptoms and on the day the patient was transferred to the intensive care unit.

27. Three Factors in Coronavirus Lung Damage
• Disease severity - Milder cases are less likely to
cause lasting scars in the lung tissue.
• Health conditions- The weaker immunity is
unable to stop the virus and aggravates the crisis.
Existing health problems- such as DM, COPD,
Heart disease and on immune-suppressing
medications can raise the risk for severe disease.
• Age- Older people are also more vulnerable for a
severe case of COVID-19.

28. Can coronavirus patients lessen the chance of lung damage?
People living with Diabetes, Heart disease and Respiratory issues
(COPD/Asthma) should be especially careful to manage those
conditions with monitoring and taking their medications as directed.
Proper nutrition and hydration
can also help patients avoid complications of COVID-19.

29. is COVID-19 lung damage reversible?
 After a serious case of COVID-19, recovery from lung damage
takes time.
 Over time, the tissue heals, but it can take three months to a year
or more for a person’s lung function to return to pre-COVID-19
levels.
 So, doctors and patients alike should be prepared for continuing
treatment and therapy.

30. Conclusion
 While a vaccine for Covid 19 is still under work and might take a while before it is
tested and certified for usage, our best bet right now is to stay safe, stay indoors
and avoid crowds.
 A few simple precautions like maintaining hygiene and sanitizing our
environment will go a long way in countering the spread of Covid 19 infection.

32. Thank You