I. Allergies vs. Coronavirus: Which One Do I Have?
There is some overlap, but allergies usually have telltale symptoms.
By Vanessa Caceres and Melissa Shin April 17, 2020
AH-CHOO! IT'S THE SOUND of allergy season.
More than 50 million Americans experience allergies each year, according to the American College of Allergy, Asthma and Immunology. That includes seasonal allergies provoked by tree pollen, grasses and weeds, as well as year-round allergy triggers like dust, mold and animal dander.
With spring blossoming around the U.S. right now, you or someone you know is probably experiencing allergies. However, with the new coronavirus pandemic happening at the same time, you may sometimes wonder if those sneezes, coughs or other related symptoms are actually allergies or a sign of a COVID-19 infection.
Here's how to tell the difference.
Symptoms of Allergies vs. COVID-19
There are a few key ways that allergies are different than COVID-19. Most importantly, allergies aren't associated with having a fever, even though an allergy is sometimes called hay fever, says Dr. J. Allen Meadows, an allergist with the Alabama Allergy and Asthma Clinic in Montgomery, Alabama.
Here are some of the common symptoms of allergies:
- Nasal congestion.
- Throat clearing.
- Itchy, watery eyes.
- An itchy or runny nose.
- Dry cough.
- Feeling run-down, although you're still able to get out of bed and do your daily routine.
- A loss of smell for severe allergies.
- If you have asthma, then allergies could trigger your asthma symptoms, like wheezing and shortness of breath.
Here are some of the common symptoms of a COVID-19 infection:
- A fever.
- Difficulty breathing.
- Dry cough.
- A loss of smell or taste.
- Muscle aches.
- Fatigue to the point where you can't get out of bed.
- Digestive symptoms, such as nausea, vomiting and diarrhea.
COVID-19 isn't typically associated with sniffles or sneezing. In contrast, they're a hallmark of allergies.
Second, allergy symptoms usually come at the same time each year. So if you suffered last spring with sniffles and sneezes, and it's happening again, that's more indicative of allergy problems. Itchy symptoms also are a sign of allergies, not a respiratory infection, says Dr. Purvi Parikh, an adult and pediatric allergist and immunologist and member of Physicians for Patient Protection, an advocacy group focused on physician-led health care.
Plus, those with allergies don't have muscle aches or digestive issues, says Dr. Andrew Murphy, an allergist at Suburban Allergy Consultants, which has various locations around Philadelphia.
Another difference between allergies and COVID-19 are eye symptoms. Environmental-related allergies – caused by pollen, dust and related substances – can cause itchy, watery and burning eyes.
In some patients with a COVID-19 infection, pink eye may occur, according to the American Academy of Ophthalmology. The symptoms of pink eye are burning and red eyes, along with a watery discharge. However, a doctor may suspect a COVID-19 infection for pink eye only if you have other symptoms, such as a fever, shortness of breath and extreme fatigue. Having only pink eye is not associated with COVID-19.
There is some overlap with seasonal or year-round allergies and COVID-19 infection symptoms: cough and trouble breathing.
"The real challenging symptoms to differentiate are cough and shortness of breath, especially in patients with asthma," Murphy says. A cough from allergies usually occurs with other allergy symptoms, such as an itchy nose and eyes. If you have a cough from COVID-19, you likely have the infection's other common symptoms, such as a fever, digestive problems and trouble breathing.
Treatment for Allergies
If you have seasonal or year-round allergies, there are a few ways you can treat them, including medications, avoidance and lessening your exposure and allergy shots.
Many effective allergy drugs are available over the counter. These include oral antihistamines such as:
There also are nasal steroids. These aren't the type of steroids that athletes might use, Meadows says. Instead, this is a type of medication that you squirt up your nose. Some examples include fluticasone and triamcinolone nasal spray.
Check with your primary doctor before using allergy drugs such as nasal steroids, Parikh says. This is to make sure they won't affect other medications that you use. Sometimes, nasal steroids should be avoided if you have certain health conditions, such as glaucoma.
For itchy eyes, there are several over-the-counter eye drops, such as ketotifen and olopatadine.
If you have asthma that isn't well-controlled and you have symptoms such as coughing, wheezing, shortness of breath or chest tightness, talk with your doctor, Parikh advises. "We have 10 deaths a day from asthma outside of COVID-19 on a normal basis in the U.S., so any breathing symptom should be taken seriously, no matter what the trigger," she says.
If you already use medications for allergies and asthma, you should continue to use those drugs normally, the American Academy of Allergy, Asthma and Immunology advises. Many of the drugs for both allergy and asthma can be easily used at home.
However, if you have asthma and have been diagnosed with COVID-19 or suspect that you have it and you are using a nebulizer, use your nebulized albuterol in an area of the home that lessens exposure to others in your household, advises the ACAAI. This could be an area like a porch or in a garage where air isn't recirculated into the home. That's because the virus may persist in droplets in the air for one to two hours. Of course, if you have a COVID-19 infection, you should be isolating yourself from family already.
Avoiding and Reducing Exposure
Another effective way to reduce your allergy symptoms is to avoid them the best you can. Here are a few tips:
1. Keep your windows closed when your allergy symptoms are at their worst.
2. If you go outside to take a walk or do yard work, bathe or shower and change your clothes immediately afterward. That's because substances like pollen will stick to your hair and clothes. "Once it's inside, it'll stay active for a long period," Meadows says. That means it could trigger your allergy symptoms even though you're no longer outside.
3. On bad pollen days, consider wearing a mask outside to minimize your exposure, Murphy suggests. You can find a variety of allergy-geared masks online that are similar to masks to lower your COVID-19 exposure.
Allergy shots, also called immunotherapy, are another way to help target your allergies. First, a doctor performs a test to help pinpoint what allergies you have. The shots contain small amounts of your allergen triggers. A series of shots is given over a couple of years to help build up your immunity to those allergens. Allergy shots require a commitment to appointments, but they can help reduce or eliminate allergic reactions.
When to See an Allergist
If you're using over-the-counter medication and your allergy symptoms still aren't controlled, that would be a good time to get in touch with an allergy doctor, Murphy says. Another reason to reach out to an allergist is if you are having complications when you use common allergy medications. Much of the care for allergy patients can be done through telemedicine right now.
If you're interested in starting allergy shots this spring, consider your general health and your local area's shelter-in-place guidelines, Meadows advises. His office still sees a limited number of new patients, although staff members evaluate ahead of time who should or shouldn't be seen in person. "If you're 70 and you have heart disease, I'd say you should stay home. If you're 30 and healthy and you've been furloughed, you may want to risk it. There's no one-size-fits-all guideline," he says. Just always make sure to follow your local ordinances.
If you think allergy shots could help you but don't want to start them now, you could always get back in touch with an allergy doctor in the fall, Meadows says. The shots take a few months to start working, so starting them early on could help you avoid suffering next spring.
Treatment for COVID-19
If you think you have COVID-19, you should call your health care provider for further advice, recommends the Centers for Disease Control and Prevention. Some people are able to recover from it at home by resting, staying hydrated and separating from others in the house. Others may need to seek emergency help if they have the following symptoms:
- Trouble breathing.
- A lingering pain or pressure in the chest.
- Bluish lips or face.
Those seeking medical help for possible COVID-19 should wear a mask.
II. Coronavirus and Pneumonia
Coronavirus and Pneumonia
- What Is Pneumonia?
- COVID-19 Pneumonia Symptoms
- How Many People With COVID-19 Will Get Pneumonia?
- Who’s Most Likely to Get It?
- How Is COVID-19 Pneumonia Diagnosed?
- Are There Treatments for COVID-19 Pneumonia?
Most people who get COVID-19 have mild or moderate symptoms like coughing, a fever, and shortness of breath. But some who catch the new coronavirus get severe pneumonia in both lungs. COVID-19 pneumonia is a serious illness that can be deadly.
What Is Pneumonia?
Pneumonia is a lung infection that causes inflammation in the tiny air sacs inside your lungs. They may fill up with so much fluid and pus that it’s hard to breathe. You may have severe shortness of breath, a cough, a fever, chest pain, chills, or fatigue.
Your doctor might recommend cough medicine and pain relievers that reduce fever. In the most serious cases, you may need to go to the hospital for help breathing with a machine called a ventilator.
You can get pneumonia as a complication of viral infections such as COVID-19 or the flu, or even a common cold. But bacteria, fungi, and other microorganisms can also cause it.
What is novel coronavirus-infected pneumonia?
The illness tied to the new coronavirus was originally called novel coronavirus-infected pneumonia (NCIP). The World Health Organization renamed it COVID-19, which is short for coronavirus disease 2019.
COVID-19 Pneumonia Symptoms
A fever, a dry cough, and fatigue are common early signs of COVID-19. You may also have nausea, diarrhea, muscle aches, and vomiting.
If your COVID-19 infection starts to cause pneumonia, you may notice things like:
- Rapid heartbeat
- Shortness of breath or breathlessness
- Rapid breathing
- Heavy sweating
How Many People With COVID-19 Will Get Pneumonia?
About 15% of COVID-19 cases are severe. That means they may need to be treated with oxygen in a hospital. About 5% of people have critical infections and need a ventilator.
People who get pneumonia may also have a condition called acute respiratory distress syndrome (ARDS). It’s a disease that comes on quickly and causes breathing problems.
The new coronavirus causes severe inflammation in your lungs. It damages the cells and tissue that line the air sacs in your lungs. These sacs are where the oxygen you breathe is processed and delivered to your blood. The damage causes tissue to break off and clog your lungs. The walls of the sacs can thicken, making it very hard for you to breathe.
Who’s Most Likely to Get It?
Anyone can get COVID-19 pneumonia, but it’s more likely in people who are 65 or older. Those who are 85 or older are at the highest risk.
People who live in nursing homes or who have other health problems like these also have higher chances of more severe illness with COVID-19:
- Moderate to severe asthma
- Lung disease
- High blood pressure
- Heart disease
- Liver disease
- Renal failure
- Severe obesity, or a body mass index (BMI) of 40 or higher
Someone who has a weakened immune system may be more likely to get severe COVID-19 illness, too. This includes smokers, people being treated for cancer, people who have had a bone marrow transplant, people who have HIV or AIDS that’s not under control, and anyone who takes medications that slow the immune system, like steroids.
How Is COVID-19 Pneumonia Diagnosed?
Your doctor can diagnose COVID-19 pneumonia based on your symptoms and lab test results.
Blood tests may also show signs of COVID-19 pneumonia. These include low lymphocytes and elevated C-reactive protein (CRP). Your blood may also be low in oxygen. A chest CT scan may show patchy areas of damage in both your lungs. Doctors call this “ground glass.”
Are There Treatments for COVID-19 Pneumonia?
Pneumonia may need treatment in a hospital with oxygen, a ventilator to help you breathe, and intravenous (IV) fluids to prevent dehydration.
Clinical trials are looking into whether some experimental drugs and treatments used for other conditions might treat severe COVID-19 or related pneumonia:
Antivirals, including remdesivir, which the FDA hasn’t approved but which was developed to treat the Ebola virus
The malaria drugs chloroquine and hydroxychloroquine, sometimes along with azithromycin, an antibiotic
COVID-19 Pneumonia Prevention
If you’re in a high-risk group for COVID-19 pneumonia, take these steps to prevent infection:
- Wash your hands often. Scrub with soap and water for at least 20 seconds.
- If you can’t wash your hands, use a hand sanitizer gel that’s at least 60% alcohol. Rub it all over your hands until they’re dry.
- Try not to touch your face, mouth, or eyes until you’ve washed your hands.
- Avoid anyone who’s sick. Stay home and avoid others as much as you can.
- Regularly clean and disinfect surfaces in your home that you touch often, such as countertops and keyboards.
The pneumonia vaccine protects against a kind of bacteria, not the coronavirus. But it can support your overall health, especially if you’re older or have a weak immune system. Talk to your doctor about whether you should get it.
III. What Is Coronavirus Pneumonia?
This swift-moving lung infection is a deadly component of COVID-19.
By Elaine K. Howley, Contributor May 1, 2020
PNEUMONIA IS A COMMON ailment that many Americans have experienced or will experience at some point in their lives. According to the Centers for Disease Control and Prevention, pneumonia sends more than 250,000 people to the hospital each year and kills about 50,000 people in a typical year.
Clearly, pneumonia can be a serious problem. But this year, amid the coronavirus pandemic, pneumonia has become an even greater concern because it's a common and potentially deadly complication of infection with the novel coronavirus that leads to COVID-19.
What Is Pneumonia?
Dr. Jonathan Parsons, associate director of clinical services in the division of pulmonary, allergy, critical care and sleep medicine and director of the asthma center at the Ohio State University Wexner Medical Center, explains that the term pneumonia means "inflammation of the airway cells. It can be caused by a bunch of different infections."
Rates of infection tend to spike in the winter time when there are lots of seasonal viruses circulating that can trigger lung infections.
Dr. Albert A. Rizzo, chief medical officer of the American Lung Association and chief of the section of pulmonary and critical care medicine at Christiana Care Health System in Newark, Delaware, says pneumonia can be "caused by viruses like this coronavirus, the influenza virus and a host of other bacteria. Any infectious organism can cause pneumonia."
Rizzo adds that the body may have a more or less severe response to pneumonia depending on several factors, including:
- Preexisting comorbidities and general state of overall health.
- How virulent the organism is.
- How heavily exposed someone is to the infectious agent. For example, notes Rizzo, "if they came into close proximity with someone who was spewing out a lot of viral load and they inhaled a lot of droplets, that would increase their risk of more severe illness."
What Makes COVID-19 Pneumonia Different?
Pneumonia can be dangerous no matter what causes it because the lungs become inflamed and fill with fluid, which reduces their ability to extract oxygen from the air we breathe and send it onward to other parts of the body.
In the context of COVID-19, pneumonia becomes even more challenging because this particular coronavirus is "very virulent," Parsons says. "Although other viruses cause pneumonia, with this virus, we're seeing pneumonia more frequently and more severely."
How sick you get when you get any kind of infection depends in large part on how your immune system responds.
Symptoms signal that the body is ramping up its immune response to fight a invading pathogen. "When you start getting a fever and a cough and mucus, that's (signs of) the body fighting the virus," Rizzo says.
What might be less obvious from the outside is the cascade of chemical signaling taking place within the body to cause the immune system to mount that response and produce those symptoms. In some people, this response is too intense.
"What we're seeing in some patients with COVID-19 is that the inflammatory response by the body tends to be hyper-aggressive and over-reactive," Rizzo says.
It's not 100% clear why this virus seems to trigger such a robust response, but one working theory is that "the virus has a strong affinity to attach to the ACE2 receptors that are found in the lungs," Parsons says. Cell receptors are proteins typically located on the surface of cells that aid in sending messages within the cells. When a molecule connects with the receptor, that initiates a response within the cell. It could cause the cell to begin growing, for example, or the cell could launch another biochemical reaction.
ACE2 receptors are found in abundance in lung cells. The coronavirus can enter lung cells via these receptors and begin replicating itself. But that act of attachment also triggers the cell to respond. "When the virus attaches to these receptors, it causes an inflammatory reaction that causes more damage than the virus itself," Parsons explains.
An Overreactive Immune System
This inflammatory response leads to a higher potential for fluid to build up in the lungs, leading to damage to the airways and the air sacs, Rizzo says. The immune system sends out chemicals intended to fight the virus. But if it sends too many, that can cause collateral damage. "Normally, the body tries not to hurt our own cells, but when there's a significant enough infection and the inflammatory process is overreactive," damage can result.
Using an analogy, Parsons says, "it's almost like if you were going into urban warfare," with the body's immune system bombing a city until the threat is extinguished. "When the combat is over, the buildings are destroyed and smoking. That's sort of what's happening in the lungs" of some people who contract COVID-19.
The issue is that the immune system goes overboard in trying to protect the body from the invading threat of the virus, and ends up leaving a trail of destruction in its wake that leads to a severe form of pneumonia that tends to progress quickly.
Parsons says what makes this type of pneumonia so dangerous is that it's coming from a completely new virus that humans haven't encountered before, meaning that we have no immunity. It's also a "very contagious and aggressive. We're seeing a lot of patients who are sick but not critically," arriving at the emergency department, but then their condition deteriorates rapidly. "They go from needing low levels of support to needing mechanical ventilation in a short amount of time," Parsons says.
In some cases, COVID-related pneumonia can result from the coronavirus infection itself, or can result from a secondary infection from another virus or bacteria after infection with the coronavirus. "Some patients get a superimposed bacterial infection" because they're immunocompromised, Rizzo says.
Some patients are also turning up with a condition called silent hypoxia, which means that their blood oxygen levels are dangerously low, but they aren't showing the typical symptom of low oxygen, which is breathlessness. Blood oxygen saturation levels usually hover around 94% to 100% for most healthy adults at sea level. Once your levels dip below 80%, damage to brain tissue and vital organs can occur.
However, some COVID-19 patients are showing up in emergency departments with dangerously low blood oxygen levels, some as low as 50%. It's not clear how prevalent silent hypoxia is among COVID-19 patients, but it seems to be connected to the body's run-away inflammatory response. Silent hypoxia can cause lasting damage to the brain or other internal organs.
Treatment of COVID Pneumonia
Currently, there's no approved curative treatment for people with COVID-19. However, there are ways to support their care if they need to be admitted to a hospital.
Parsons says that people who are admitted to the hospital with COVID-related pneumonia are offered supportive care that seeks to reduce the severity of symptoms, such as supplemental oxygen to help boost a patient's ability to get oxygen to the rest of the body. In some cases, a bronchodilator medication can help open up the airways to improve a patient's ability to breathe.
In some cases, patients may be turned onto their stomachs for part of each day to help facilitate better oxygenation. This practice, called proning, makes a difference and "goes back a number of years," Rizzo says. It was first developed as a means of helping patients recover from another lung condition called ARDS, or acute respiratory distress syndrome, which can produce similar symptoms and complications to COVID pneumonia.
The reason it helps, he says, is "because of the anatomy of the lungs." When there's an acute infection, fluid floods into the lungs. Most of the blood and oxygen exchange occurs via blood vessels that are more concentrated along the back of the lungs. When you're lying on your back, fluid will collect and can pool there, making it much more difficult for the lungs to extract the oxygen the rest of the body needs. Rolling people over onto their stomachs helps drain the fluid off the back of the lung, improving the lung's ability to provide oxygenation to the rest of the body.
Intubation and mechanical ventilation may also be required for some patients with COVID pneumonia. This may be helpful in cases where the patient is really struggling to breathe because their breathing muscles get too fatigued by fighting against the fluid that's built up in the lungs.
But intubating a COVID-19 patient is considered a measure of last resort, Rizzo says. "The act of intubation requires multiple caregivers to be in close proximity" to the patient and in the danger zone in terms of contracting the virus. There's a high risk of transmission during that process, and thus caregivers need to wear personal protective equipment, which we know is in short supply across the country.
Once that patient is on mechanical ventilation, getting them off again has proven very difficult because it signals that the infection is very severe and that there's likely additional damage that's occurred in the lungs and possibly other internal organs.
"If you're at the point where you need a ventilator, the severity of the illness has jumped and your likelihood of mortality has also increased," Rizzo says, noting that some locations are "recording only 15% of patients are (successfully) getting off of it."
In addition, when the machine is doing the work of breathing for you, your respiratory muscles – which have already been weakened and fatigued by the worsening pneumonia – may need a long while to regain adequate strength to support you breathing on your own.
For patients who have been able to come off mechanical ventilation, it's unclear what sort of lasting injury or disability they may be dealing with in the future.
"Some individuals may never get back to baseline if COVID-19 did cause some scaring," Rizzo says. But we won't know that for a while yet. As with so many other aspects of this disease, we just don't have enough information to say for sure.
Jonathan Parsons, MD, Parsons is associate director of clinical services in the division of pulmonary, allergy, critical care & sleep medicine and director of the asthma center at the Ohio State University Wexner Medical Center. He is also a professor of internal medicine.
Albert Rizzo, MD, FACP, FCCP, Rizzo is chief medical officer of the American Lung Association and chief of the section of pulmonary and critical care medicine at the Christiana Care Health System in Newark, Delaware.
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