The covid-19 pandemic has collided with the ongoing tuberculosis epidemic, leaving many without adequate medical care and stuck at home, where they could pass an infection on to others. Global cases of TB are set to increase by around 200,000 to 400,000 in 2020 alone, and most of the brunt will be borne by India, along with Indonesia, the Philippines and South Africa, according to the World Health Organization (WHO).
In 2019, 445,000 people died from TB in India, according to a . This figure could increase in the coming years. A study led by Finn McQuaid at the London School of Hygiene & Tropical Medicine found that there could be an additional 149,448 TB deaths above that baseline level in India between 2020 and 2024.
鈥淲e are definitely still expecting large numbers of additional cases and deaths from TB in India in particular,鈥� says McQuaid. 鈥淚t鈥檚 a major concern.鈥�
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Another study, by Anurag Bhargava at Yenepoya Medical College and Hemant Deepak听Shewade from global health organisation The Union, both based in India, estimated there would be nearly 186,000 additional TB cases and almost 88,000 extra TB deaths in India this year alone, owing to worsening poverty, undernutrition and under-detection of TB related to the covid-19 pandemic.
Undernutrition is a factor in 32 to 44 per cent of TB cases, and a one unit decrease in average body mass index across the population 鈥� 2 to 3 kilograms of weight loss on average 鈥� could lead to about a 14 per cent increase in TB incidence, the pair found. 鈥淚ndia has inadequate levels of baseline nutrition and the pandemic has worsened the situation,鈥� says Bhargava.
India launched a national TB control programme in 2017 with the aim of eradicating the disease in the country by 2025. Key to this project is accurate accounting, but under-detection of TB is a problem. Even before the covid-19 pandemic hit, there were more than 1 million TB cases missing from India鈥檚 official statistics, according to a of drug sales data.
This worsened this year when the government diverted public health resources from TB to the covid-19 response, including community health workers key to door-to-door screening.
The result was a 60 per cent drop in notifications of new TB cases in the first six months of 2020, according to India鈥檚 national TB report. Other reports have pointed to a fall of around 80 per cent in daily notifications during the lockdown period of 25 March to 31 May this year.
Treatment has also been lacking. A global survey launched in March by the Global Coalition of TB Activists (GCTA) and other TB researchers found that 36 per cent of TB patients in India reported their health facilities to be closed.
In India, there are currently 354 million people with latent TB, which means they are infected with TB bacteria but don鈥檛 have symptoms or feel ill. Disruption in door-to-door screening and monitoring by community health workers could let their infection become active. For those with active TB, disruption in care could allow their infection to become drug resistant. India has an estimated 124,000 cases of drug-resistant TB.
鈥淧rogression from infection to active disease is a serious concern now,鈥� says Bhargava. 鈥淲e will have to find a balance between covid response and caring for other serious diseases.鈥�
Concerned by the drop in notifications, the Indian government initiated a rapid response plan to restore TB services and instructed health centres to test people with tuberculosis for covid-19 and vice versa.
K. S. Sachdeva, the deputy director general at the Central TB Division in India, said in a statement that the coronavirus pandemic may not only lead to significant increases in TB cases and deaths, but also to an increased likelihood of active transmission in the household contacts.
鈥淲e would have been nowhere near ending TB by 2025 even without covid,鈥� says Blessina Kumar at the GCTA. India鈥檚 TB death toll is like two jumbo jets crashing every day, she says, but the response is 鈥渘owhere near enough鈥�.
鈥淎nd now we have jumped on the covid bandwagon, and rightly so, but we cannot afford for it to come at the cost of TB care. So someone will have to keep shouting, 鈥榃hat about TB?鈥欌��
Journal reference: European Respiratory Journal,
Indian Journal of Tuberculosis,
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