Collateral impact of COVID-19 pandemic on Tuberculosis burden and management

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Tuberculosis (TB) is a deadly infectious disease that has been around for almost 3 million years, according to the Centers for Disease Control and Prevention (CDC). Like SARS-CoV-2 causing COVID-19, TB also attacks the respiratory system of the infected person and spreads through close contact with the patient. Years after the discovery of Mycobacterium tuberculosis by Robert Koch, TB remains a significant cause of death worldwide. India has the highest burden of TB in the world with an estimated 40% of the population infected by the bacteria. With the onset of the novel coronavirus pandemic, the focus has rightly shifted from TB to COVID-19. The limelight that COVID-19 earned is not an issue, being a pandemic is entitled for such a place in media to educate the population. However, the problem emerges when the entire focus is targeted at one disease while other major health issues like TB are neglected.

The problem

As the government pushes to end TB by 2025, the COVID-19 pandemic has put the TB services on hold. The public records on Nikshay dashboard, the official database for TB across the country have shown a dramatic shrink in TB case notifications. As for the records, when the corona outbreak came on the national radar in early March, as many as 1,14,460 TB cases were notified, however, April 01 and 14, the case notifications dropped to just 19,145. Before the COVID pandemic, over 4000 people died of TB every day. The reduced TB notifications are an underlying threat and the impact of COVID-19 on TB is a serious health concern that needs to be recognized without any further delay. With untreated cases and disruption in the regular TB treatments, the spread in the disease fill further increase and with less medical care, people are more likely to drop out of their TB regime. This can worsen the outcomes at later stages for not only the individual but the population.

Impact of lockdown on TB

The corona pandemic has put a pause on our daily activities and resulted in a global lockdown. Countries across the globe have put a hold on social gatherings and urged the public to work from home. Social distancing interventions set up to fight the pandemic also limits the transfer of Mycobacterium tuberculosis outside the households where most of the transmissions occur. This is likely to reduce the TB infections which generally take place in schools, transport, and workplaces. On the other hand, due to the growing COVID-19 cases, the health system is overloaded. This has caused a severe reduction in the healthcare services for TB and has a detrimental effect on the diagnosis and treatment of TB. The regular regimes required to manage TB have gone downhill with most hospitals committed only towards the COVID patients. The TB patients are also reluctant and scared to step out of their homes and visit hospitals where they have higher chances of getting infected with the coronavirus. As a result of this, TB health care services have reduced both in quantity and quality.

TB deaths during the time of COVID-19

 With the corona pandemic around the world, we see the number of deaths due to this virus monitored and exemplified on our TV screens almost daily. What we don’t realize is the number of deaths due to other prominent diseases like TB, AIDS, etc. The seriousness of TB is somewhere disregarded and the deaths due to COVID-19 have perhaps out shadowed the mortality due to TB. Physical distancing has supported a reduction in the spread of both COVID-19 and TB, but the disruptions in TB treatment have withered the quality of TB health care. This decline in health services is likely to have a greater impact on patients with drug-resistant TB. Due to this, more TB patients remain untreated whereas others drop out of their course of medication. This increases the risk factor and the condition of the patients worsens leading to more deaths due to TB, which remain unseen due to the current pandemic. It is important that we don’t lose sight and jeopardize our progress, milestones, and gains in TB management due to the diverted resources. It is also crucial for us to come up with ways to manage multiple diseases at a time for a healthier future.

Impact on TB treatment

Upon reviewing various literature and research papers in order to analyze the impact of COVID-19 on the management of TB, it can be asserted that this pandemic has caused immense upheaval in the traditional TB services both in primary care and hospital settings. The current pandemic norms like social distancing, isolation, lockdown, etc. to prevent viral transmission has also helped in the mycobacterial transmission, however, COVID-19 has a significant impact on the delivery of various TB treatment, surveillance, and prevention strategies.

Role of media

Awareness is certainly one of the most important factors in any disease. To ensure that the health guidelines reaches the public at the right time, media plays a massive role. With the growing crisis, the news headlines are filled with coronavirus updates. However, in between the COVID statistics, the number of people dying of TB is somewhere lost. It is of absolute importance that we acknowledge the seriousness of TB not just because of the drug-resistant strains but also because it pushes millions into poverty and debt. With crowded countries like India, the danger intensifies 10 folds. It is therefore essential that the media is put to right use as COVID-19 has in terms exposed the cracks in the healthcare system. We need to work effectively in order to mend the healthcare system and to keep the horrors of TB at distance.

Conclusion

With the ever-rising number of corona infected people, we cannot ignore the TB patients who are vulnerable and at a higher stake in such times. This pandemic is indeed a wake-up call to boost the functioning of the health care system. As almost all the health care facilities are busy dealing with coronavirus, we now realize how important it is to make an independent governing body that deals with all the communicable diseases. This should ensure that all the related tests are done right on time and the drugs reaches both the private and public health sectors. Various NGOs can also support the treatment procedure and help spread much-needed awareness about diseases like tuberculosis. It is also crucial to keep a trail of the patients and develop virtual sessions that ensure they follow their medicine regimen in order to lower the drop-out rates. We also need cheap and effective test kits and financial commitment to ensure the availability and easy accessibility of these kits and TB drugs. The world has now clearly seen the traumas a microorganism which cannot be seen by naked eye can cause. It is extremely necessary that we comprehend the right lesson and use the latest techniques and human resources to contain the spread of a microorganisms. TB prevention and treatment is one such case scenario and we must work on it instantly and smartly in order to avoid a similar lockdown in the future.

References

[1] C. Finn McQuaid, Nicky McCreesh, Jonathan M. Read, Tom Sumner, Rein M. G. J. Houben, Richard G. White, Rebecca C. Harris. The potential impact of COVID-19 related disruption on tuberculosis burden, 2020.

[2] Toyin Togun, Beate Kampmann, Neil Graham Stoker and Marc Lipman. Anticipating the impact of the COVID-19 pandemic on TB patients and TB control programmes, 2020.

[3] Vijay Kumar Jain , Karthikeyan P Iyengar, David Ananth Samy , Raju Vaishya. Tuberculosis In the era of COVID-19 in India, 2020.

[4] Chapal Mehra. TB and coronavirus: A curable and incurable crisis, 2020.

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