Carl Hennigan

Day five, day seven, you start to deteriorate.

It's a disease that often doesn't give you a high temperature, but actually gives you the shortest breath and can lead to the respiratory distress that requires hospitalisation.

Versus what happens with viruses is you've also got to be aware and look out for secondary bacterial complications.

And that's really important because the evidence from systematic review shows that if you have community-acquired pneumonia and you have viral pneumonia at the same time a viral pathogen on board, your risk of death is doubled.

Now, how did you tell the two and what should you do about it?

Well, bacterial pneumonia might have a higher temperature, can be unilateral, can also come on much more sudden.

It's hard to detect from viral pneumonia because the deterioration can happen sudden as well.

Very difficult, very difficult to do that.

And I think one of the keys is that one of the discussions which I'm having with my colleagues is as soon as you're going to come into a hospital, because it's so difficult to tell, they're going to give you a single or a double dose of antibiotics to cover common pathogens and atypical pathogens.

The question there is, if you consider somebody has bacterial complications, I think it's common sense to lower the threshold for giving them the antibiotics and see if they have an initial response to that in the next 24 hours.

But it's very difficult to determine viral from bacterial pneumonia in the absence of radiology, in the absence of blood tests.

So it's an incredibly difficult job in the community for GPs.

Yeah, and I think that's interesting.

But one of the things about viral pneumonia is to remember it's insidious.

It carries on and on and it's slow.

And with some of the symptoms of COVID, loss of appetite and nausea and gastrointestinal diarrhoea, that type of symptoms, you can get dehydrated.

You can stop eating.

So it's really important to keep your nutrition up because the problems start to occur about day five, seven.

And there's some perception that what's happening there, either you're immunosuppressed or you're running out of physiological reserves.

And so if you haven't been looking after yourself, you'll run into trouble.