Why pneumonia deserves more attention
While it may seem common place – pneumonia is more of a risk than most people think. Combined with influenza, it is one of the leading causes of death in Canada.
The cause of a considerable number of emergency department visits, hospitalizations and mortality, especially among older adults, pneumonia infects lungs, impacts oxygen exchange, makes it harder for a person to breathe. It is caused by bacteria, viruses or – in rare cases – fungi.
Not taken seriously enough
Pneumonia is often overlooked given common misperceptions around its severity. Many see it an easily treatable illness that only affects older adults, rather than a life-threatening condition. This has led to a lack of awareness of the ways its spread and the availability of vaccines with both the public and the healthcare provider community.
As a result, only 54.7% of Canadians had their Pneumococcal vaccinations in 2023—a far cry from the 80% target set by Public Health Agency of Canada.
Pneumonia often occurs alongside or as a complication of other diseases (e.g., influenza or, most recently, COVID-19), which can cause it to be overshadowed. Public Health priorities often focus on other diseases like cancer, heart disease or COVID-19, which has resulted in “dismal policy uniformity from province to province” according to experts.
Who is at risk?
While anyone can catch it, more vulnerable individuals who have a higher risk factor to contracting pneumonia include those with chronic illnesses such as diabetes, asthma or COPD. Also those with weakened immune systems due to a variety of other factors such as medication, chronic illness, frailty, cancer, or HIV are more susceptible. Infants, younger children, and older adults are also at a higher risk, as are those who participate in substance abuse or regularly smoke.
Symptoms of pneumonia
Often diagnosed along with other conditions, things to watch for include:
•Cough – potentially producing mucus
•Fever, chills, and sweating
• A lower than normal body temperature
• Shortness of breath or difficulty breathing
• Fatigue and weakness
• Chest pain (worsens with breathing or coughing)
• Delirium or confusion, especially in older adults
• Nausea, vomiting, and potentially diarrhea
There are different types
While most of us use just one name, there are various strains of this disease, often named for the method of contraction. Community-Acquired Pneumonia (CAP) is contracted commonly during daily activities, and outside of healthcare settings. Hospital-Acquired Pneumonia (HAP) can often be more severe due to antibiotic-resistant strains, and is contracted during hospital stays. Walking Pneumonia is a milder strain, where symptoms are less severe, allowing individuals to continue daily activities. Invasive Pneumococcal Disease (IPD) is caused by the bacteria Streptococcus pneumoniae entering the body leading to complications like meningitis or bacteremia.
Economic impact
According to a recently updated report from The National Institute on Ageing, the economic effect of pneumonia in Canada is considerable and includes direct and indirect healthcare costs relating to productivity losses and caregiving. Healthcare costs include hospitalizations, physician visits, and medications. In 2010, pneumonia-related hospital care costs in Canada amounted to almost $622 million – equivalent to over $850 million today when adjusted for inflation. While the average cost of treating pneumonia varies from province to province due to regional differences in healthcare delivery and pricing, Ontario reported an average cost of $8,510 per case for treatment.
As mentioned, there are also a number of indirect costs which stem from the broader societal and economic impacts the condition. Survivors of severe pneumonia can face long-term health care issues, ongoing medical expenses and a reduced quality of life. Another, sometimes invisible cost, is the impact on caregivers and family due to the need for unpaid caregiving duties, and employment productivity loss that stems from increased illness or infection.
Prevention saves lives
Vaccines are the cornerstone of prevention. In a ten-year span from 2005 to 2015, pneumococcal vaccination programs in Canada are estimated to have saved $1.76 billion – largely by preventing hospitalizations, outpatient visits, and deaths. Recent vaccines (e.g., PCV20 and PCV21) offer greater protection and are more cost-effective, especially when paired with childhood immunization programs.
The influenza vaccine can also be greatly effective by reducing risk against caused by the flu. Vaccines such as those in Childhood Immunization Programs and the COVID-19 vaccine also can help prevent the contraction of the disease.
Healthy lifestyles also make a difference. Cessation of smoking and reducing alcohol intake is important as they weaken the body’s ability to fight off infections. Maintaining a balanced diet and participating in regular physical activity also strengthens the immune system. Good respiratory hygiene plus proper handwashing and occasional mask use in crowded or high-risk environments can also reduce the risk of contraction. For vulnerable groups, regular check-ups and vaccination schedules tailored to their needs can reduce the risk of infection.
Facility based prevention controls should also reduce the risk of attracting long-term care or Hospital Acquired Pneumonia. This includes regular sterilization, hand hygiene and proper use of ventilators. To prevent the spread of Community-Acquired Pneumonia practicing habits that reduce respiratory infections, such as staying home when sick can help.
Taking charge
Making pneumonia prevention a healthcare priority is key with a call for stronger public education needed in the area of symptom recognition and importance of personal vaccinations.
The fragmented nature of pneumonia policies across Canada has created both inconsistent coverage, and inconsistent access to information. Integration of broad-based pneumonia prevention campaigns, more robust community vaccination programs, enhanced data collection and improved reporting will, according to experts lead to a more significant reduction in the burden of this dangerous condition.
The information found in this article sourced from National Institute on Ageing’s White Paper “As One of Canada’s Top Killers, Why Isn’t Pneumonia Taken More Seriously?”
Anjolina Rankin-West is a member of the editorial team at the Canadian Abilities Foundation
Image: Mac Loong
