Dismantling at a Single Stroke the Achievements of 20 Years in the Fight Against Pneumonia

[This article has been originally published in Spanish in Planeta Futuro-El País]

When, 300 international experts in the field of pneumonia came together in Barcelona at the end of January last, neither the SARS-CoV-2 virus nor the disease now known as COVID-19 had even been named, and cases of the disease had been reported only in a few specific areas in China. The meeting, was attended by government representatives from countries with a high burden of pneumonia (including a dozen ministers of health from African and Asian countries­), representatives of international and multilateral agencies, funding and nongovernmental organisations, companies, researchers and academic institutions from as many as 55 different countries. It was a celebration of the enormous progress made in recent decades in the fight against pneumonia, the infectious disease that kills more children in the world than any other.

It has been estimated that, in 2019, pneumonia killed more people worldwide than any other infectious disease. The prospect for 2020 is, if possible, even more frightening

Raising the visibility of pneumonia was crucial to making further progress on the prevention and treatment of the disease at a time when it was not garnering front page headlines in the world press or receiving anything like the attention it should, given its huge impact on a global scale. A scant eight months later, the world has radically changed as, stunned, we observe the ravages of COVID-19, a disease responsible for over 50 million documented episodes and 1.25 million deaths, which has not yet been brought under control.

Anyone with half a brain would assume that the irruption in the form of a pandemic of a virus that typically causes pneumonia would at least offer a good opportunity to strengthen the world’s health care systems and to improve the diagnosis, treatment and, above all, prevention of this syndrome. However, in the event, it is now clear that dealing with the crisis will not be easy and the collateral effects may be even worse.  

It has been estimated that, in 2019, pneumonia killed more people worldwide than any other infectious disease. The prospect for 2020 is, if possible, even more frightening. To the almost 2.5 million deaths reported annually (672,000 in children), we must add the deaths directly associated with COVID-19 (although very few of those have occurred in children) and especially those occurring as an indirect consequence of the collapse of the health care system. The most realistic predictions warn that the restrictions on access to primary care, the interruption of basic health services–including vaccination–and the increase in malnutrition rates owing to food scarcity and poverty could give rise to up to 890,000 additional deaths in children, with up to one third of these being attributed to pneumonias.

In a letter published today in The Lancet to mark World Pneumonia Day, Tedros Adhanom Ghebreyesus, the Director General of the World Health Organisation and Henrietta Fore, executive director of UNICEF, together with other opinion leaders call on the world to use the current situation created by COVID-19 to ensure that progress is made in the struggle to end preventable deaths caused by childhood pneumonia, emphasising the needs of the poorest countries with the most fragile health care systems.

In a letter published in The Lancet to mark World Pneumonia Day, Tedros Adhanom Ghebreyesus, the Director General of the WHO and Henrietta Fore, executive director of UNICEF, call on the world to use the current situation created by COVID-19 to ensure that progress is made in the struggle to end preventable deaths caused by childhood pneumonia

Very much aware of the gravity of the current situation, although not without a certain degree of optimism, the authors emphasise that the measures currently recommended for curbing coronavirus (including the use of masks, physical distancing, and improved hygiene) may also be effective in reducing the risk of childhood pneumonia, and that efforts to strengthen health care systems and the training and  reinforcement of front line medical personnel will, no doubt, lead to better care not only for patients with COVID-19 but also for all those who need it.

The greatest opportunities for improvement can be found in the management of hypoxemia or lack of oxygen, one of the most feared symptoms of pneumonia and the leading cause of death among patients with the disease. For the almost 4.2 million children with pneumonia who experience hypoxemia, access to oxygen therapy is a question of life or death, and not having that therapy is a death sentence.

The current worldwide health crisis should, at the very least, make possible mass distribution of pulse oximeters, the technology used to detect hypoxemia, and, above all, guarantee the provision of the necessary equipment and the supply of oxygen. The availability of this very cheap and effective treatment defines better than anything the health inequities in our world.