Written by Steven Burns
To Your Health
I had expected the email from the vital statistics department. Death certificates are never convenient or pleasant to fill out, but they are a necessary part of medical practice. I signed in to the website, and looked at the screen: Name, birthdate and demographic information. Military service. Date and place of death. Natural death or not. Was there an autopsy? I filled in all the blanks.
Next was the hard part: Cause of Death. I knew most of the entries without looking at his chart. He had multiple illnesses—dementia, heart disease, pacemaker, diabetes. We all seem to collect diseases, and by age 94, like a kid collecting coins or baseball cards, my patient had many. I noted the illnesses that may have contributed to his death, but were not a part of the final illness. Then came the cause of death: Pneumonia, due to COVID-19. He was my third patient to die of the pandemic. As with the others, I felt impotent anger rising, first against the disease and second against the people who discount it, who say things like, “Oh, he was going to die anyway. He just died with the virus, not because of it.”
Pneumonia is the primary cause of death in nearly 50,000 people annually in the U.S., making it the eighth leading cause of death in our country. Worldwide, an estimated 450 million cases of pneumonia occur yearly, affecting nearly 7% of the population. Over 4 million die yearly from pneumonia. For the year 2020, deaths will be hard to categorize, as most COVID-19 deaths resulted from pneumonia caused by the SARS-CoV-2 virus.
You see, pneumonia is a condition, not a disease, and it can be caused by infections, accidents, and chemicals. Pneumonia is defined as an inflammatory condition of the lungs, in which the alveoli, or air sacs, fill with pus (semiliquid material with white blood cells, tissue debris, and serum). Causes include bacteria, viruses, fungal organisms, and even parasites. It can also be caused by aspiration of stomach contents or chemicals. In the desert Southwest where I live, some pneumonias are caused by Valley Fever, a fungus found in the soil. As far as chemicals go, one of the worst cases I ever saw was when I was a medical student, and a 3-year-old came in after aspirating baby oil. The ensuing pneumonia nearly killed her.
Streptococcus pneumoniae is a bacterium that causes some of the most severe cases of pneumonia. We are more likely to get this form of pneumonia as we grow older, which is why the vaccine for it is recommended for all people at age 65, no matter their health status. Misnamed a “pneumonia shot,” it is effective in preventing this particular infection. Infants also get a different type of S. pneumoniae vaccine that helps prevent meningitis, pneumonia, and ear and sinus infections.
As we grow older, aspiration pneumonia becomes more common. This type of pneumonia occurs when we inhale food or liquids or stomach contents. The swallowing function becomes less efficient as we age, making the possibility of aspiration more likely. You may have “choked” on food or drink, and recovered quickly, while at the table for a meal. That becomes more frequent with the development of presbyesophagus (literally, “elder esophagus”).
So, what should you do to avoid getting pneumonia? First, get your vaccinations: flu, Strep pneumoniae (Pneumovax is one brand), and, as soon as it is available, one for COVID-19. Second, know the signs and symptoms of pneumonia: fever, chills, shortness of breath and cough, weakness (there are more), and see your physician right away if you develop any of them. Quick treatment can keep many out of the hospital. Third, if you tend to choke easily, work with a speech therapist (your doctor can arrange this) to help with techniques to avoid choking. Doing so may prevent an aspiration pneumonia.
Pneumonia is frequently avoidable and usually survivable if recognized in time. Having a relationship with a primary care provider is one of the best ways of staying healthy, regardless of your medical problems or concerns.
As a final note, at the time of this writing, we have seen the FDA authorization of two COVID-19 vaccines. Both are exciting, as there has never before been an m-RNA vaccine. Additionally, both have been shown to have very little risk of side effects, and there is no risk at all of getting the infection, as neither contains any infectious components. Explaining this further would take another article, but if you value your health and the health of those around you, please get the vaccine as quickly as it is available to you. And in the meantime, mask, wash, and socially distance. Those actions show your love for others and could help you to live a longer, healthier life.
Dr. Steven Burns is board-certified in family medicine and has been in practice for more than 30 years.
Opinions expressed are those of the author.