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| About 14% develop COVID pneumonia. |
My answer: Great question. Without giving statistics or citing articles, I will attempt an answer here. My answer comes from an interview I had with a doctor. Although, I have been working with COVID patients since the pandemic started. So, I am probably a credible source on my own. Although, I will quote a doctor here who works in a COVID unit. He said:
"Most people with Covid will not develop pulmonary fibrosis. And, generally, only those COVID patients who develop COVID pneumonia will be at risk for pulmonary fibrosis. And, even there, only those who require 100% oxygen for a long time develop it. So, basically, only those on high-flow nasal cannulas for a long time develop it.
"At the beginning of the pandemic, we were keeping people on high-flow nasal cannulas and nonrebreathers to keep their oxygen saturation 88% or above. And we were keeping these patients on this for weeks. Back then, we heard there was a 100% death rate for those who required ventilators. Or perhaps the death rate was 80% or higher. So, the medical board decided to make it a protocol to try not to intubate COVID patients. So, we gave them as much oxygen as needed with the goal of keeping their oxygen saturation 88% or higher. Although, in some cases, we tolerated oxygen saturations hand in the mid to low 80s, and this was all in an effort to prevent them from being intubated, of which their was a high death rate.
"There was one patient in particular I remember. He was on a high-flow nasal cannula for several weeks. And his sats were dipping into the mid to low 80s. And it got to the point he decided he did not want to go on a ventilator. And so we were tolerating saturations in the high 70s. Eventually, he decided to go on a ventilator. And he ended up dying a few weeks later.
"By the time he was intubated, he had already developed pulmonary fibrosis. His lungs had become stiff because all of the inflammatory markers meant to attack the virus had been present so long they had caused scar tissue. And this scar tissue makes your lungs (alveoli) stiff. And this scarring, therefore, makes the lungs stiff. And this is pulmonary fibrosis. So, he is a good example of a person who develops pulmonary fibrosis. By the time he was intubated, it was really too late to save him.
"So, to answer your question, people who require high amounts of oxygen for a long time ultimately develop pulmonary fibrosis. Generally, your COVID patients who do not require a hospital do not develop it. And those who are hospitalized on low amounts of oxygen (such as 6 liters nasal cannula) are at low risk for developing it. Those at the highest risk are those on high flow nasal cannulas. Although, not even all of them will develop pulmonary fibrosis.
"We have another patient who was. on a high-flow nasal cannula for three weeks. She was receiving 100% oxygen. And she could not be vented because she had small pneumothoraxes (leaks in her lungs). And after three weeks of this, a cat scan was done. And it showed no signs of pulmonary fibrosis. So, not all patients on high levels of oxygen with COVID will develop pulmonary fibrosis.
"Today, we have changed our policy. We have found that if someone needs a high-flow nasal cannula and a nonrebreather, we will intubate them earlier as opposed to later. We no longer allow them to stay on a high flow if their sats are less than 88%. And we intubate as soon as we see signs of respiratory failure, such as a high respiratory rate. And, as noted above with the patient with pneumos, there are still some exceptions. We find that incubating earlier changes the dynamics in the lungs. And, especially with our updated treatments, I think we now have a 50% chance of getting someone off a ventilator. So, things have improved as far as that is concerned."
So, there is your answer. It may not be the best answer, mainly because we are limited on data as COVID is still a relatively new disease.
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