If you’ve been following the news (which, of course, you have been), you know that the worst cases of coronavirus often end with patients gasping for air as if they’re drowning, their lungs no longer able to supply a sufficient flow of oxygen to their body. And if you don’t have healthy lungs to start out, COVID-19 can be especially dangerous. “If you add another injury on a system which is already behind, that will put that system in a very dire condition,” says Rabih Bechara, M.D., a pulmonologist at the Medical College of Georgia.
In fact, people with chronic obstructive pulmonary disease (COPD) are more than twice as likely to develop severe symptoms from COVID-19, according to an analysis of over 1,000 hospitalized patients in China. Half of the patients in the study with COPD had to be admitted to the intensive care unit, put on ventilators, or ultimately died from COVID-19.
So what is it exactly about this virus that makes people with lung conditions so much more vulnerable?
It’s Harder to Protect Against Infection
It’s unclear the exact percentage of lung disease patients who are getting sick from the coronavirus, but scientists do know that unhealthy lungs are more prone to infection from any virus or bacteria. Here’s why: Airways and lungs are typically lined with cilia—fine, undulating hair-like tendrils that push phlegm and other gunk secreted from your lungs up through the airway and into your throat, where you either spit it out or swallow it. But in many lung diseases, those helpful hairs are damaged or destroyed. Without cilia, secretions from the lungs pile up, narrowing the airways and eventually restricting oxygen exchange—one of the reasons people with COPD struggle to breathe.
For the same reason, the absence of cilia makes it harder for the lungs to clear a viral infection—COVID-19 or otherwise. “These people tend to collect organisms in their lungs that healthy people clear with a good cough,” explains Jill Ohar, M.D., a pulmonologist at Wake Forest Baptist Medical Center in North Carolina.
Your Lungs Have Less Capacity
On top of narrowed airways, people with COPD often have emphysema—damage to the millions of miniscule air sacs called alveoli in your lungs that fill up with oxygen when you inhale and pass it on to the blood to circulate in your body. In cases of emphysema, these air sacs stretch and rupture, essentially reducing the surface area of your lungs and thus diminishing the amount of oxygen your blood receives.
The immune response can further compound the problem: When the body is infected with a virus like COVID-19, it produces white blood cells to fight it off—usually a good thing. But when the infection has taken hold of the lungs, these white blood cells cause your lungs to become inflamed. That inflammation causes fluid from tiny blood vessels to leak into the lungs, wreaking further havoc on their ability to transfer oxygen to the blood. “You flood your lungs with fluid, leading to respiratory distress,” says Dr. Bechara.
Lung disease patients are extra vulnerable to this stress from infection and liable to develop respiratory failure or acute respiratory distress syndrome. “Because of their preexisting condition, the body is not able to repair damage that’s happening,” says Dr. Bechara. So if the coronavirus strikes, these patients are more likely to need oxygen or to be put on a ventilator. And still, they’re not in the clear. “The actual ventilation is more difficult when the lungs are full of pus and water,” says Dr. Ohar.
Even without an official COPD diagnosis, if you’re over 40, have a history of smoking, and get winded easily—say after a 10-minute walk—it’s possible you could have an early state of chronic obstructive pulmonary disease, says Dr. Ohar. Many of her patients don’t seek treatment, “until lung function is about half of what it should be,” she says.
Bottom line: If you have COPD or are breathing-challenged, you’re more vulnerable to serious effects of the coronavirus. It would be ideal if there was a special protocol you could follow to give yourself extra protection. There isn’t, really. So instead, it’s about being hypervigilant to scrupulously wash your hands and staunchly practice social distancing. Limit your number of trips to the store, or get home delivery if you can. Always wear a mask if you do have to go out and/or can't avoid being around other people. Consult your healthcare provider over the phone or by video, if possible. And in case you do get sick, ensure you have enough medication to last at least two weeks.
In other words, stay safe and hang tight. We’ll all breathe easier once this pandemic is over.