In recent weeks, Tanzanians have been posting on social media and public forums about a sudden spike in pneumonia cases in the country.
The rise has attracted the attention of local media and government officials. Tanzania’s national newspapers shared articles on how to protect against the disease. In mid-January, the Ministry of Health circulated a notice on treating pneumonia.
Tanzanian lawmaker Zacharia Issay spoke in parliament about the pneumonia cases and the high number of deaths from respiratory problems. He was “tired of going to funerals,” he remarked, and on visiting a friend in the hospital, noted that “all the ventilators were in use.”
An increase in pneumonia cases among adults would be remarkable even in normal times (pneumonia is typically more common in children under five in the country). But it comes at a time when Tanzania has done a complete U-turn on its approach to the coronavirus pandemic—declaring the country completely free of the virus after an initial strict shutdown in response to the pandemic.
Some suspect the country is actually in the grip of a second wave of Covid-19—and a much more severe one, due to the lack of measures in place. Activists claim the number of deaths in the country is higher than normal. “Every morning we wake up to news of avoidable deaths in Tanzania,” Fatma Karume, a well-known former lawyer in Tanzania, wrote recently.
Still, there are some influential groups that are reluctant to attribute deaths to the coronavirus. The Tanganyika Law Society (TLS), which represents the country’s attorneys, recently reported it had lost 10 lawyers within two months. TLS president Dr Nshala attributed the casualties to the “current pneumonia” and other non-communicable diseases.
It is almost impossible to quantify the numbers of diagnosed pneumonia cases in the country due to the lack of data available. But this is not just the case with pneumonia. The last time Tanzania published data on its Covid-19 numbers was 29 April, 2020, when it said it had just over 500 cases.
Weston Ndomba, a 45-year-old project manager from the capital Dar es Salaam, was diagnosed with pneumonia at the end of January. Shortly thereafter, he was admitted to hospital, where he spent the next two weeks in intensive care on a ventilator. He said it felt like it was 50/50 whether he would live or die.
Ndomba says he began to feel unwell about a week before his diagnosis, experiencing a high temperature, joint and muscle pain, loss of smell and taste, and shortness of breath.
These symptoms are associated with Covid-19, but the idea that he might be infected with the virus did not occur to Ndomba at first: “We believed there was no coronavirus in Tanzania. I was comfortable going to work and socialising without a mask,” he said. “I thought I had malaria, or an infection in my blood. So, I went to the hospital and had many tests done. I was told I had pneumonia, but no one gave me a test for coronavirus.”
Tanzania’s initial response to the coronavirus pandemic in March last year was swift. It shut down its borders and schools, limited social gatherings, and instituted other strict measures for nearly three months, slowing down economic growth dramatically. Still, some in the government expressed skepticism about the severity of the pandemic from the start.
Then, in June—a few months before national elections—president John Magufuli announced that the country was coronavirus free. He questioned testing numbers from the country’s own lab, and congratulated those not wearing masks at public events. He has also since said that the country won’t participate in the rollout of Western vaccines. It’s an approach that’s reverberated globally, with Covid-denialists latching on to the government’s stance as evidence that the pandemic is not as serious as it’s made out to be.
For those on the frontline in the hospitals, the situation is dire. One doctor from Muhimbili National Hospital, the country’s largest healthcare centre, says that people are “dying helplessly” because of the lack of medical supplies available.
The doctor, who does not wish to reveal his identity, says that healthcare workers are not allowed to mention Covid-19: “We are calling it viral pneumonia, or atypical pneumonia, as patients coming in have no features of bacterial pneumonia. However, we know it is coronavirus. Patients coming in have shortness of breath, fever, a persistent cough and a loss of taste or appetite.”
The doctor said that patient numbers have been rapidly increasing since January this year, which could be down to the new, more contagious virus strains that were first detected in South Africa and the UK. With the isolation wards full, some are waiting up to 12 hours in the emergency department before receiving oxygen.
He blames the government for its refusal to acknowledge the presence of the virus. “When a pandemic like this happens, you need to be organized in all areas,” he said. “We are doing our best at the hospitals, but we cannot manage the situation without being informed, and without the correct guidance. More people could survive this if we had a coordinated response.”
According to the World Health Organization (WHO), second waves of Covid-19 are appearing across the continent, with a higher fatality rate than last year. The WHO Regional Director for Africa recently urged Tanzania to “ramp up public health measures” against the virus.
Under Magufuli’s rule, the government has tightened its grip on information, cracking down on the press and opposition. The legitimacy of the recent 2020 presidential election, which saw Magufuli secure a landslide win despite criticism over his handling of the pandemic, was called into question. Still, some organizations have spoken out to warn of ongoing dangers, including the US embassy in Tanzania and the Catholic Church, which has reported an unusually sharp increase in the number of funeral services being held. “Covid is not finished, Covid is still here. Let’s not be reckless,” bishop Yuda Thadei Ruwaichi said.
In a rare interview with the BBC, Tanzania’s government spokesperson Hassan Abbas said: “We are not saying Tanzania is Covid-free, because we are part of the global world…what the president is insisting is that we have controlled it.”
A medical consultant based in Dar es Salaam, who also asked to remain anonymous given the political pressures, explained that pneumonia is the closest diagnosis doctors can give. With no Covid-19 tests available in the hospitals, healthcare workers are unable to confirm whether a patient has contracted coronavirus. “Only the National Laboratory is testing. They are the only ones with the mandate and the real numbers of Covid-19,” he said.
The current rise in pneumonia cases is unusual, he explains, because “among adults, it is not as common, only with those who are immunocompromised. It is very rare to see hospitals full of patients with this infection.”
The issue of misdiagnosis is having serious consequences. Without national guidance, healthcare workers are uncertain as to what medication should be provided and the best guidance for isolation. The medical consultant says this is making it difficult to slow down the current rates of infection.
“We are being told there is no Covid-19 in Tanzania,” says Ndomba. “So, when I got sick, I was living my life as normal. I was going to pick my kids up from school, going to work, and meeting friends. If I had known coronavirus was there, I would have protected myself, and others.”
While the government remains quiet, Tanzanians are talking. “People are sharing information on their social media on how to stay safe,” Ndomba said. “Pneumonia is our code word.”
This story has been updated to clarify Tanzania’s initial shutdown measures.