What disease kills more women than anything else in Malaysia?
Your first thought might be breast cancer, or perhaps a chronic disease like heart failure or diabetes.
However, the leading cause of death among women in Malaysia is pneumonia – a form of respiratory infection.
According to the latest data from the Statistics Department, this was the cause of 12.8% of deaths among women in 2018.
For men, pneumonia (11.1%) is second only to ischaemic heart disease (17.8%) as the highest cause of death.
Worldwide, pneumonia, which is a form of inflammation of the lungs primarily due to infection, is the leading cause of death in children and the elderly.
Eighty percent of these deaths occur in those under the age of two and those above the age of 65.
Pneumonia, and respiratory infections as a whole, have been hitting the headlines since the onset of the Covid-19 pandemic earlier this year (2020).
It therefore comes as no surprise that this year’s World Lung Day (commemorated on Sept 25) has “respiratory infections” as its theme.
But while the latest coronavirus may have made us more tuned in to the challenges of managing respiratory infections, these conditions have affected humankind for thousands of years.
Take a well-known respiratory infection, tuberculosis (TB), for example.
Egyptian mummies dating back to 2400 BC have skeletal deformities characteristic of TB.
Written records of TB can be found from ancient China and India, and is even described in the biblical books of Deuteronomy and Leviticus.
The father of modern medicine, Hippocrates, described TB as a fatal disease for young adults, and was able to accurately describe its symptoms and characteristic findings in the lungs.
Fast forward to today and TB still remains a killer.
There are approximately 10 million new cases of TB annually and 1.5 million deaths, mostly among children under the age of five and adults between 20 to 35 years old.
Deaths occur disproportionately (over 95%) in low- and middle-income countries, reflecting the role of socioeconomic circumstances in the management of the disease.
In Malaysia, many think that TB is a disease of the past.
Unfortunately, it still claims up to 2,000 lives annually with up to 25,000 new cases recorded every year.
The majority of fatalities occur due to a delay in seeking medical treatment.
This can be due to either complacency or lack of awareness.
It can be very difficult to ascertain the cause of an infection purely from symptoms alone.
Respiratory infections can be due to viruses, bacteria or fungi, but they may all present in a similar fashion.
Symptoms are usually a combination of lung-related symptoms such as coughing (with or without phlegm), chest discomfort and difficulty breathing, alongside more general symptoms like lethargy, fever and weight loss.
The latest virus on the block
In this day and age, many would automatically be worried about the SARS-CoV-2 virus, which causes Covid-19.
It is the most significant pandemic to have struck us in modern times, with the rapidity of contagion within and across communities leading to significant cessation of economic and social activities.
Coronaviruses are also a species that have affected our health for some time.
It is one of the causes of the common cold (rhinoviruses are the most common cause), as well as more severe respiratory ailments such as the Severe Acute Respiratory Syndrome (SARS) and the Middle East Respiratory Syndrome (MERS).
Covid-19 is just the latest manifestation of a coronavirus-related epidemic or pandemic.
It is worth repeating some of the facts regarding Covid-19 as the condition has affected more than 30 million people worldwide, with just under one million dead.
Although about two-thirds of those infected do not display any symptoms, the others not only have symptoms similar to those mentioned above, but also complain of general aches and pains, sore throat, nasal congestion, loss of taste and smell (see Loss of smell: Covid-19 or the cold? on p4), as well as a headache.
Approximately one out of every five of those who get Covid-19 becomes unwell to the point of requiring treatment at a hospital.
The virus not only causes breathing difficulties, but can also lead to multi-organ failure.
Those who have low oxygen levels require support, and in severe cases, this means a life support machine in the intensive care unit (ICU).
The risk of complications are higher among the elderly and those with underlying uncontrolled chronic medical diseases such as high blood pressure, heart and lung conditions, diabetes and cancer.
Unlike bacterial and fungal infections, which can be treated with antibiotics and antifungals respectively, we usually rely on our bodies’ own defence mechanisms to defeat viral infections.
In the absence of specific treatments, prevention remains a far superior option to cure.
Prevention in our hands
There are already a number of vaccines in existence for various respiratory infections.
Vaccines for the influenza virus, pneumococcal pneumonia, measles, tuberculosis (the BCG vaccine reduces death and illness in young children from this disease) and whooping cough (also known as pertussis) are widely used across the globe.
The race is on to develop a vaccine that can put an end to the current pandemic, with dozens of trials looking into the safety and efficacy of potential Covid-19 vaccines.
However, there are no guarantees that a safe and effective vaccine will be discovered soon.
Previous research tells us that less than 10% of vaccines in the pre-clinical trial stage succeed, and only approximately one in five of those that make it to clinical trials end up being successful enough for introduction to the general public.
This has led to the creation of Covax, a platform supporting the research, development and manufacturing of potential Covid-19 vaccines that is co-ordinated by Gavi, the Vaccine Alliance; the Coalition for Epidemic Preparedness Innovations (CEPI); and the World Health Organization (WHO).
Over 170 countries have signed up to this programme that not only negotiates the price of vaccines with manufacturers, but also guarantees equal access to successful vaccines irrespective of a country’s income levels.
The initial aim is to have two billion doses available by the end of 2021, which is deemed sufficient to protect high risk and vulnerable people, as well as frontline healthcare workers.
While waiting the widespread availability of a vaccine, we must continue to adopt practices that will help prevent the spread of Covid-19.
Happily enough, these measures will also halt the spread of other infections such as influenza and TB.
The importance of “simple” measures such as avoiding touching your eyes, nose and mouth; handwashing with soap or a sanitiser; wearing a face mask properly; and physical distancing, cannot be overstated.
In organising World Lung Day, the Forum of International Respi-ratory Societies (FIRS) calls for:
- Research to prevent, detect and treat respiratory infections, particularly Covid-19 and TB.
- Health security and prevention of future Covid-19 outbreaks.
- Predictive tests to show who is immune and who will develop disease from novel infections.
- Diagnostic tests to identify and treat those at risk of progressing once infected.
- High quality randomised controlled trials to find the best vaccines and treatments.
- Access to effective, affordable vaccines and treatments for all.
- Educating all on the benefits and safety of the influenza and pneumococcal vaccines, as well as the Covid-19 vaccine once developed.
The public health and socioeconomic havoc wrought by Covid-19 should serve as a stark warning on the importance of preparing and dealing with respiratory infections.
This is not the first pandemic to affect our lives, nor will it be the last.
Dr Helmy Haja Mydin is a respiratory physician and chief executive officer of the Social & Economic Research Initiative, a thinktank dedicated to evidence-based policies. He would like to acknowledge FIRS for providing data for this column. For further information, email firstname.lastname@example.org. The information provided is for educational and communication purposes only. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.