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Stages of Severe COVID-19, Through the Eyes of a Respiratory Therapist

Medically reviewed by Jezreel Esguerra, MD · General Practitioner

Written by Lorraine Bunag, R.N. · Updated Mar 18, 2023

    Stages of Severe COVID-19, Through the Eyes of a Respiratory Therapist

    When we talk about mild COVID-19, we mostly hear about fever and chills, cough, fatigue, or loss of smell and taste. But, what does severe SARS-CoV-2 infection feel like? With more than a year of experience, a respiratory therapist, Karen Gallardo, explains the seven severe stages of COVID. 

    Severe Stages of COVID-19

    Stage 1

    The first stage among the severe stages of COVID-19 doesn’t involve typical flu-like symptoms, although you’ve probably been experiencing them, too, for a couple of days now. Stage 1 starts with the symptom that can turn anyone into panic mode: the difficulty of breathing. 

    It’s so hard to breathe that you decide to go to the hospital. Your blood oxygen levels are so low; you might need 1 to 4 liters of oxygen per minute. On top of that, the doctors will probably give you multiple medications, like steroids and antivirals. 

    You’ll be in the facility for a couple of days. But if doctors can wean you off oxygen, they can discharge you, and you’ll survive. 

    Stage 2 

    The second part in the seven severe stages of COVID-19 marks worsening of breathing troubles. 

    Patients say they feel like they’re drowning. Oxygen requirement increases from 4 to 15 to 40 liters per minute. Bronchodilators, medicines that widen your air passages, give little relief. Little things you do, such as sitting up, can negatively impact your oxygen levels. 

    Stage 2 often ends with you entering an intensive care unit. 

    Stage 3

    Reaching stage 3 of the severe stages of COVID-19 requires even more drastic measures. 

    Since you’re exhausted from hyperventilating (to bring more oxygen into your lungs), the doctor will use “positive pressure ventilation.” It is a non-invasive procedure where you’ll wear a large mask wrapped around your face, so a machine can push pressure into your lungs, opening them up and allowing them to receive more oxygen. 

    Stage 4

    Among all the severe stages of COVID-19, stage 4 is perhaps the most frightening. 

    Your breathing doesn’t improve; in fact, it becomes more labored. Your blood oxygen level becomes critically low, that doctors need to decide whether to intubate you or not. 

    If you cannot tolerate intubation, doctors might call your loved ones. It might be the last time they’ll hear your voice. 

    Successful intubation means you’ll be hooked to a ventilator. That also means you need a rectal tube, catheter, and you’ll eat through a feeding tube. 

    Since you’re limp, nurses will turn your body regularly to prevent bedsores, clean you and bathe you, and flip you over to your tummy so that you can have more oxygen. Lastly, you might need to receive experimental drugs.

    Stage 5

    If you progress into stage 5, that means your breathing didn’t get better. Your lungs need assistance, a machine called Extracorporeal Membrane Oxygenation (ECMO). This machine bypasses the lungs and delivers oxygen directly to your blood. 

    Of course, not all hospitals have ECMO machines. If you’re stable, you might get transferred to a facility that has one. If a transfer is not possible, you’ll continue to receive the same treatment you’ve been receiving. 

    Stage 6

    The severe stages of COVID-19 continue to be unforgiving. 

    Your lungs now require too much pressure to receive oxygen that fluid leaks to your chest. The nurses and doctors have to remove that fluid. 

    Stage 6 might mean your kidneys are failing that your body swells from fluid retention. At this point, you might need to undergo dialysis

    The prolonged hospital stay makes you vulnerable to infection, your lungs may have accumulated fluids, and a blood clot might show up. 

    If your blood pressure drops, doctors can give you medicines. But your heart may stop beating anyway, so several rounds of CPR might be necessary to get a pulse back. 

    Stage 6 means your family might need to make a difficult decision. 

    Stage 7

    Your family decides to withdraw care altogether. The doctors and nurses remove the tube and arrange a way for your family to see you, at least virtually. They hear goodbyes and lots of crying. 

    They hold your hand as you take your last breath. 

    Final Reminders

    Karen says her pandemic stories rarely end well, and they don’t get any easier. But there’s hope. If you’re vaccinated, COVID-19 infection often ends at stage 1.

    Learn more about Coronavirus here


    Hello Health Group does not provide medical advice, diagnosis or treatment.

    Medically reviewed by

    Jezreel Esguerra, MD

    General Practitioner

    Written by Lorraine Bunag, R.N. · Updated Mar 18, 2023

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