Byline: Marc. Lipman, C. McQuaid, Ibrahim. Abubakar, Mishal. Khan, Katharina. Kranzer, Timothy. McHugh, Chandrasekaran. Padmapriyadarsini, Molebogeng. Rangaka, Neil. Stoker
March 24 is World Tuberculosis (TB) Day. In many countries, events marking World TB Day in 2020 were cancelled as national lockdowns began. This was not due to TB, but the 'other pandemic' and the year will be remembered as one where the virus SARS-CoV-2 and its disease COVID-19 dominated global health and disrupted national economies. Its direct effect has been felt in every country; its secondary impact has played out on other global diseases such as TB.
The United Nations Secretary General's 2020 progress report on TB recognized the potential for a loss of focus on the persisting crisis of TB and included as one of the 10 priority recommendations for actions needed to accelerate progress towards global TB targets, 'to ensure that TB prevention and care are safeguarded in the context of COVID-19 and other emerging threats'. This was reinforced in the WHO Global TB Report 2020.
These international political statements are important, but for genuine impact, these need to be enacted at regional, national and sub-national levels. This is vital given that the global TB targets set within the UN Sustainable Development Goals and the WHO End TB Strategy were not being met before the disruption brought about by COVID-19 and are now therefore, likely to be even further from their intended trajectory. Here, we discuss the short- and long-term impact of COVID-19 on TB patients and services, using examples and information from around the world, with a focus on India.
The immediate effect of COVID-19 was a significant disruption to global health care. This included the redeployment of staff and reallocation of resource from TB to other/COVID-support services and a loss of staff due to sickness/quarantining. Further, a reduction in public transportation and the introduction of movement restrictions made it harder for staff to travel to work. The staff shortages affected preventive therapy programmes including BCG vaccination, for example, a million fewer Indian children than usual receiving BCG in April 2020. It also became increasingly difficult for staff to reach TB patients on treatment. This was compounded by disruption to supply chains, meaning that medication and diagnostic reagents began to run out.
COVID-19 and TB symptoms are similar; poor levels of public knowledge about COVID-19 combined with stigma (for both diseases) encouraged symptomatic people to isolate from communities yet continue to mix with close friends and family. New cases of TB were often too frightened to attend healthcare services (which they perceived as places where they could catch COVID-19). This was not helped by the precautionary messages that healthcare facilities put out, discouraging people from attending without a good cause, and so avoid healthcare-related SARS-CoV-2 transmission.
The net result of symptomatic TB patients not using healthcare services, which themselves were severely stretched, was a global fall in the number of reported TB notifications. India, which accounts for over one-quarter of the world's TB cases at an estimated...