Despite Vatican updates confirming daily improvement in Pope Francis' condition following his most recent health woes, the seriousness of the now 88-year-old pontiff’s condition continues to make the future unpredictable.

Such danger exists in the continued presence of double pneumonia, a condition Jessica Sit, a Toronto-based certified respiratory educator and respiratory therapist, notes as particularly hazardous.

“While  initial infection may not always lead to pneumonia, bronchitis or a respiratory infection that lasts a long time can spread to your lower airways and infect your lungs,” she said. “We don't always see a bilateral infection so if that infection does spread to both lungs, it is definitely a sign of a more severe case.”

Pope Francis' initial diagnosis of bronchitis was later updated to bilateral pneumonia following signs of a viral, bacterial and fungal respiratory infection before the onset of pneumonia in both of his lungs. Catholics worldwide have been praying for the Pope's recovery as he remains in stable condition at Rome's Gemelli Hospital.

Sit, manager, evidence to practice at Toronto’s Lung Health Foundation, said when both lungs are compromised, respiratory symptoms are likely to increase, leading to laboured breathing and decreases in oxygenation.

Pope Francis currently remains on high-flow oxygen therapy, likely stemming from such issues related to bilateral pneumonia. 

Sit says there is a greater risk for additional complications and longer recovery times, something Pope Francis has experienced with his thrombocytopenia, a condition where the platelet count in the blood is too low. It's a concerning comorbidity, with excessive bleeding, clotting and even strokes increasing in risk, according to Canadian Blood Services.  

The Vatican has confirmed the Pope's thrombocytopenia has since stabilized after blood tests showed early, mild renal insufficiency, which has since been under control.  

In his 20s, Pope Francis had part of one lung removed in a procedure known as a lobectomy. The procedure not only left him prone to respiratory illnesses later in life, but also increased the severity at which they are likely to affect him and reduce his lung function altogether.

His age and coinciding conditions also play a role in both his short-term health and long-term recovery. 

“Our bodies are not as strong as they were before as we age and that includes a weaker immune system. Pope Francis had some kidney and blood issues as well, and those comorbidities can compound and seriously affect recovery more than it may in younger people,” Sit said. 

According to the latest Statistics Canada report on influenza and pneumonia, approximately nine in 10 Canadians who died of influenza and pneumonia in 2022 were aged 65 and older. Over half of those deaths occurred among those aged 85 and older. 

Pope Francis continues to be treated in hospital, albeit in stable condition. While limited information is available about his exact treatment plan apart from oxygen therapy, his polymicrobial infection as a result of asthmatic bronchitis required the use of corticosteroid and antibiotics, a common treatment option. 

“One of the first things we do whenever somebody is diagnosed with pneumonia is to get them on antibiotics. Many cover an array of different bugs that may be present in your body. Oftentimes with pneumonia, the bronchial tubes, which are the tubes in our airway, become inflamed, which can add to the difficulty in breathing. The corticosteroid is going to reduce the overall inflammation and help the breathing,” Sit explained. 

As treatment continues and Pope Francis alternates between rest and prayer, the Vatican will look for signs of improvement or decline. Sit said doctors will constantly monitor his  vital signs such as heart rate, blood pressure and respiratory drive. Medical professionals may also take more chest X-rays to monitor infection as well as keeping an eye on his overall well-being, energy levels and fatigue. 

Despite his exact prognosis remaining guarded, fewer asthma-like respiratory episodes combined with continued respiratory physiotherapy are signs of improvement for the head of the Catholic Church. Sit indicates that although a multitude of factors may play against him, his condition remains remediable. 

“ (Pneumonia) is treatable and as long as it is treated early people can have a good prognosis. Age and those other comorbidities can play a factor in recovery, but I think if you are able to treat it early with the right medications and the right supportive measures for health, you can get better,” she said. 

Her advice to the public, especially those who may be medically compromised, is to think about getting vaccinated for pneumonia, as there have been close to three times as many walking pneumonia cases in Ontario compared to pre-pandemic.  

Statistics Canada reported that from 2019 to 2020, just over half of Canadians aged 65 and older had received the pneumococcal vaccine. 

“It is something that is going to play a really important part, especially in the elderly population, to help protect your lungs during the flu and cold season.  People can talk to their primary care provider about their options towards getting protected,” Sit said.