TB patients in limbo due to COVID-19

COVID-19 has made headlines every day over the past two months, but tuberculosis (TB) patients across South Asia have their treatment interrupted due to the lockdown.

South Asia is a vast hub for TB. India alone had 2.7 million new cases and 440,000 deaths due to TB in 2018 — the highest in the world. Every year, tuberculosis kills at least 6,000 people in Nepal and every other person is a carrier of the microbe.

The WHO has set global targets to reduce new cases of TB by 90% and deaths by 95% between 2015 and 2035. However, the fight against TB faces a setback of an estimated 5-8 years globally, due to COVID-19.

The COVID-19 crisis has uncovered gaps in the present healthcare system in the Subcontinent. There is now a shortage of functioning sputum testing centres as well as DOT (Directly Observed Treatment Short-course) centres. Healthcare workers are also wary of going on-ground and carrying out tests and diagnoses.

Migrant workers with TB, who are travelling away from their workplaces, are at risk of treatment interruption, which may lead to multi-drug-resistant (MDR) TB. Additionally, due to the stigma attached with the symptoms of COVID-19, people are now afraid to get tested for TB, which has symptoms similar to those of COVID-19.

This can exacerbate the problem, as undiagnosed patients can infect many more. Those with lung injuries due to TB may be prone to more severe outcomes if infected with COVID-19.

“In India, health-seeking behaviour has completely changed after COVID-19. People think twice before seeking a doctor,” says Khasim Sayyed of TB Alert India. “We are expecting a very high number of patients across all DOT centres and outpatient departments once the lockdown is lifted, because the patients are afraid to get diagnosed right now.”

A combination of strategies will be required to restore normal TB services, with the objective to reduce the accumulated pool of undetected TB patients. Here are some other steps that can be taken to strengthen both diagnosis and treatment:

Diagnosis

• Governments should collaborate with non-profits and use technology to ramp-up active case-finding and contact tracing.
• Community health workers should conduct door-to-door sample collection.
• Health system should ensure diagnostic services for TB. Currently, most labs are being used for COVID-19 testing only.
• GeneXpert test should be enabled for MDR TB cases as they are quicker and can identify if a person has resistance to the drug.

Treatment

• Healthcare workers and non-profits should facilitate tele-counselling to sensitise family members about the possible side effects and severe symptoms of TB.
• The government, in collaboration with non-profits, should run a helpline so that TB patients can better manage severe symptoms or side effects.
• Health practitioners should leverage digital tools to diagnose patients and prescribe first-line treatment.

Additionally, institutions must also work to safeguard healthcare workers from tuberculosis, as well as COVID-19, during any intervention. And as more private practitioners turn to digital facilities for diagnosis and consulting, there is a need to design solutions for marginalised communities.

The projected numbers for TB highlight the urgency for a better intervention strategy. While the COVID-19 pandemic deserves attention and intervention, the response to it should not come at the cost of another disease. (IPS)

Devika Agarwal has worked with TB Alert India, Ministry of Health and Family Welfare, Government of Delhi, and the non-profit Aaroogya. 

This story was originally published by India Development Review (IDR) and has been reprinted under an arrangement with Inter Press Service (IPS).