Nuns sit next to a statue of Pope John Paul II in front of the Agostino Gemelli Polyclinic, in Rome, Monday, Feb. 17, 2025, where Pope Francis has been hospitalized to undergo some necessary diagnostic tests and to continue his ongoing treatment for bronchitis. (AP Photo/Andrew Medichini)

ROME (AP) — Pope Francis’ respiratory infection is presenting a “complex clinical picture” that will require further hospitalization, the Vatican said Monday, as concerns grew about the increasingly frail health of the 88-year-old pontiff.

Vatican spokesman Matteo Bruni said the results of tests conducted in recent days and Monday indicate the pope is suffering from a polymicrobial respiratory tract infection that has necessitated a second change in his drug therapy since being hospitalized Friday. Scientists say polymicrobial diseases are caused by a mix of viruses, bacteria, fungi and parasites.

There was no timeframe given for his hospitalization, which at Day 4 has already sidelined Francis for longer than a 2023 hospitalization for pneumonia. Bruni said the complexity of his symptoms “will require an appropriate hospital stay.”

In a late update Monday, Bruni said Francis’ condition was “stationary,” and that he had resumed some work activities and reading.

Francis had part of one lung removed after a pulmonary infection as a young man and is prone to bouts of bronchitis in winter. He was admitted to Rome’s Gemelli hospital in a “fair” condition on Friday after a weeklong bout of bronchitis worsened. Doctors confirmed a respiratory tract infection and prescribed “absolute rest” alongside unspecified drug therapies. Subsequent updates said his slight fever had gone away and that he was in “stationary” condition.

Bruni said Francis ate breakfast, read the newspapers and received the Eucharist on Monday after a third peaceful night. And in a sign Francis was still keeping up with some of the essentials of his routine, the parish priest of the Catholic Church in Gaza, the Rev. Gabriel Romanelli, reported that Francis had maintained his daily video call to the church on Friday and Saturday night. He sent a text message on Sunday.

“We heard his voice. It’s true, it was more tired,” Romanelli told Vatican News. “But we heard his voice clearly and he listened to us,” said the Argentine priest, whom Francis has phoned every day of the Gaza war.

What is bronchitis?

Bronchitis, or an inflammation of the airwaves, can be relatively mild in a healthy person but can become much more severe in someone who is older or has existing lung problems, especially when they are unable to cough up and expel the accumulating mucus. Bacteria and other organisms can colonize, leading to further infection that may be harder to treat.

Dr. Maor Sauler, who specializes in adult pulmonary medicine and critical care at Yale School of Medicine, said it’s not uncommon for people suffering from bronchitis to develop an infection with more than one organism in their lungs. The concern, however, is that antibiotics and other drug therapies don’t work in isolation and require the body to respond, which given Francis’ other problems may make recovery more challenging.

“Being older, wheelchair-bound, all those are risk factors for a situation in which we can’t treat it despite our best efforts,” said Sauler, who is not involved in Francis’ care.

As people get older, their immune systems don’t work as well, making doctors especially concerned when elderly patients develop multiple problems. A decline in lung function and muscle strength can also impair the body’s ability to effectively clear respiratory secretions, increasing susceptibility to infections like pneumonia, a deeper and far more serious infection of the lungs’ air sacs.

“It’s in the public record that he’s had chest problems in the past, he’s been admitted to hospital with pneumonia (in 2023), he’s had part of one lung removed,” noted Dr. Nick Hopkinson, medical director of the Asthma + Lung UK foundation, who is not involved in Francis’ treatment. “All of that makes him a little bit more vulnerable potentially, but we just have to wait and see.”

He said that after doctors have identified clinically what is wrong, they can start treating the underlying infection with the correct therapies.

Pope’s frail health

The Argentine pope is a known workaholic who keeps up a grueling pace despite his increasingly precarious health.

In addition to his frequent bouts of respiratory infections in winter, he uses a wheelchair, walker or cane because of bad knees and suffers from sciatica nerve pain. In 2021 he had 33 centimeters (13 inches) of his colon removed because of a narrowing, and then had a further surgery in 2023 to remove intestinal scar tissue and repair an abdominal hernia.

When he had a bad case of pneumonia in 2023, he left the hospital after three days and only acknowledged after the fact that he had been admitted urgently after feeling faint and having a sharp pain in his chest. This time around, Francis insisted on finishing his morning audiences Friday before leaving the Vatican, even though he was having trouble speaking at length because he was so short of breath.

Some appearances have been scrapped

Francis’ continued hospitalization has already forced the cancellation of some events connected to the Vatican’s Holy Year and put others in question. The official Vatican calendar online has no more papal appointments or activities for February, and picks up only on March 5, Ash Wednesday. This week’s weekly general audience was canceled.

Outside the Gemelli hospital, people were praying for the pope, including Nigerian nuns in front of a giant statue of St. John Paul II. He had so many hospitalizations at Gemelli that the main entry way is decorated with a permanent photo exhibition of his ailments over the course of his quarter-century pontificate.

Sister Mary Beatrice Nnenji said prayers were necessary “because no one is strong enough on their own.”

“With age also you feel your health and especially with his workload and all the efforts he makes,” she said. “So if God wants he will go on. Let’s hope in God, we cannot go against it, whatever comes.”