‘’Pneumonia strikes like a man-eating shark led by its pilot fish, the common cold’’- Consult your physician.

Many homes across Ghana often blame pneumonia on cold weather, rain, sleeping on bare floors, bathing at night, or sleeping under a fan or air-conditioner. These beliefs transcend generations and are widely accepted as fact. Similar misconceptions exist in many parts of Africa, Asia, and even some Western societies.

However, these ideas are wrong and dangerously so. The continuous spread of myths about its causes encourages harmful self-care practices, delays treatment, and importantly contributes to preventable illness and death among the vulnerable group: The children, elderly, and people with weakened immune system.

Common Myths and Facts

Myth 1: Cold weather causes pneumonia

Cold weather does not cause pneumonia. Germs do.
Cold seasons may increase pneumonia because people stay indoors more, live in crowded places, and transmission of such microbes via respiratory droplets is higher during drier and colder months when mucosal secretions are more substantial. Pneumonia cannot develop without bacteria because cold air itself does not infect the lungs.

Myth 2: Sleeping on bare cold floors, a fan or an air-conditioner

There is no medical evidence to the best of our knowledge to support this belief. Infections are not introduced into the lungs by sleeping on cold surfaces or under fans and air-conditioners. At worst, they may worsen discomfort in someone already with respiratory disease. Pneumonia only develops when disease-causing organisms enter the respiratory tract.

Myth 3: Pneumonia affects only children

Pneumonia affects people of all ages. While children under five years are highly vulnerable, older adults and immunocompromised individuals with conditions such as HIV, asthma, diabetes and heart diseases face a high risk of severe illness.

The Real Causes of Pneumonia

The leading cause of pneumonia is Streptococcus pneumoniae, also called pneumococcus. Given the enviable title of the ‘’Captain of the men of death’’ by Sir William Osler in 1918, this iconic gram-positive opportunistic pathogen was recognised as a significant respiratory pathogen soon after its discovery in 1881 and has since remained of interest to the biomedical community for its exceptional ability to colonise and cause diseases in humans.

Pneumococcus is transmitted through the respiratory secretions of infected individuals. In healthy individuals, this bacterium often stays quietly at the back of the nose and throat (nasopharynx/ nasopharyngeal area). Most of the time, it does no harm and causes no symptoms. Problems begin when the bacterium stays there for a long time or when the body's defences become weak.

When this happens, it causes non-invasive local infections like sinus infections. In children, pneumococcus can ascend the middle ear through a small passage called the Eustachian tube, a tube that helps drain fluid from the ear.

Younger children have shorter, narrower and more horizontal eustachian tube which makes it harder to drain fluid properly. When fluid builds up, germs grow easily, leading to ear infections (otitis media)
When the body’s natural defences in the nasopharynx are weakened, often after viral infections like the flu, pneumococcus can spread deeper into the body.

It may move from the nasopharynx into the lungs, where it causes pneumonia, a serious and sometimes deadly infection. If treatment is delayed, the bacteria can enter the bloodstream and even reach the brain, leading to blood infection and meningitis.

In the United States, this bacterium is responsible for more than half of all bacterial meningitis cases. These severe illnesses are known as invasive pneumococcal diseases. Even when people survive them, they may be left with long-term problems such as reduced lung capacity, memory difficulties, and a higher risk of getting serious infections again.

This is like a glass cup that has cracked: even if it is put back together and can still hold water, it is no longer as strong as it once was. Repeated pneumococcal infections greatly increase the risk of death.

Knowledge, perceptions, and attitudes toward pneumonia and its treatment.

Several cross-sectional studies have been done in Ghana about the knowledge, perceptions, and attitudes towards pneumonia treatment. In Ghana, community knowledge of pneumonia remains low despite its high burden.

Although many caregivers of under-five children recognize symptoms such as fast breathing, chest indrawing, and cough, pneumonia is often misidentified as “malaria” or “a routine childhood illness”, leading to delayed or inappropriate home care. Consequently, care-seeking is suboptimal, with families frequently relying on herbal remedies, over-the-counter medicines, or traditional healers before seeking formal health services[1, 2].

Health-care providers in Ghana widely recognize pneumonia as a major contributor to under-five deaths and hospitalizations, yet compliance with national guidelines for treating community-acquired pneumonia (CAP) remains inconsistent.

Departures from recommended antibiotic selection and treatment duration are common, driven by factors such as high patient loads, inadequate training, and patient-related challenges including cost, distance to facilities, and past care experiences.

Meanwhile, digital innovations such as mobile-health diagnostic tools for pneumonia (e.g., mPneumonia) are generally perceived as acceptable and up to date by both clinicians and caregivers, particularly when their use is paired with appropriate education and counseling[3, 4]

Globally, we see a similar pattern in many low-to-middle income countries with systematic reviews indicating that about a quarter to one-third of caregivers have good knowledge of pneumonia and its treatment.

Perceptions vary by settings: Pneumonia is feared as a leading killer of children in some communities while it is downplayed as a transient respiratory complaint in others. Attitude towards treatment is generally positive with trusted and accessible healthcare[5, 6]

Current preventive and treatment methods

The knowledge gaps, perception, and attitude gaps accentuate why prevention and early, appropriate treatment are crucial components of pneumonia control. In the United States, there are now three vaccines that help prevent serious infections caused by pneumococcal bacteria.

Two of them are called pneumococcal conjugate vaccines (PCV15 and PCV20), and the third is a pneumococcal polysaccharide vaccine (PPSV23). These vaccines work by using parts of the sugary coating that surrounds the bacteria called the capsule to train the immune system to recognize and fight the germs.

Together, the three vaccines protect against 24 of the more than 100 different types of pneumococcal bacteria (serotypes). PCV15 (Vaxneuvance) and PCV20 (Prevnar20) are made by linking these sugar parts to a harmless form of a diphtheria toxin protein, which helps the body build a stronger and longerlasting immune response (CDC 2021).

On the preventive front in Ghana, PCV’s have become a foundation of national immunization programs, targeting key serotypes, and reducing invasive pneumococcal diseases and pneumonia- related hospitalizations. Despite this win, serotype replacement and emerging non- vaccine types continue to challenge long-term effectiveness.

In Ghana, community awareness off these vaccines remains low among caregivers despite its integration into national immunization programs. Many parents and even some health workers are unfamiliar with what these vaccines do in pneumonia prevention[2, 7] often confusing them with other routine childhood vaccines or perceiving them as optional rather than essential [8].

This limited awareness contributes to missed opportunities for vaccination, hesitancy, and underutilization of a key preventive tool, even in settings where PCVs are freely available.

For treating pneumonia that spreads in the community especially cases caused by Streptococcus pneumoniae, doctors often rely on a group of antibiotics called β‑lactams, which include penicillin and cephalosporins. Milder infections are usually treated with pills such as amoxicillin, while more serious cases may require stronger, injected medicines like cefotaxime.

Newer versions of cephalosporins still work well against many strains of S. pneumoniae that have started to resist older penicillin, making them an important option as antibiotic resistance continues to rise.

However, growing resistance is a major concern, since some bacteria can change their cell wall targets or produce enzymes that block β‑lactam activity, making these reliable antibiotics less effective over time[9]. Recent studies also show that shorter treatment courses sometimes just three days can work as well as longer ones in certain patients, helping to limit unnecessary antibiotic use and slow the spread of resistance[10].

Pneumonia strikes like a maneating shark led by its pilot fish, the common cold” is a clear way of saying that a seemingly harmless illness like a cold can silently pave the way for something far more dangerous. The “pilot fish” (the cold) swims ahead, weakening the body’s defenses and irritating the airways, while the “shark” (pneumonia) follows close behind, ready to take hold when the lungs are most vulnerable.

This image reminds us that what begins as a mild cough or sniffle can, in some people, escalate into a serious lung infection that needs prompt attention. Because pneumonia can hide behind the mask of a simple cold, it is always wise to listen to your body and seek medical advice early especially if symptoms worsen, breathing becomes difficult, or fever persists. Consulting your physician is not an overreaction; it is the best way to ensure that the “shark” never gets a chance to strike.