As with most advances in various areas of medicine underway at the time COVID-19 emerged, successes in the global fight against tuberculosis (TB) have been threatened as a result of the pandemic. In addition to delays in diagnosing and treating people with tuberculosis, the diversion of resources needed to fight COVID-19 has also disrupted ongoing tuberculosis research and control programs
Every year on March 24th, the World Health Organization (WHO) celebrates World Tuberculosis Day to raise awareness and accelerate global efforts to eradicate tuberculosis. For 2021, the theme for World TB Day is “The clock is ticking” to create a “feeling that the world is running out of time to meet commitments made by global leaders to end TB”. Since 2000, more than 60 million lives have been saved through these efforts
Nevertheless, almost 10 million people contracted tuberculosis in 2019, around 1.4 million people died from complications from tuberculosis, and 445,000 people contracted drug-resistant tuberculosis. Staying on track to significantly reduce these numbers is “especially important in the context of the COVID-19 pandemic, which has jeopardized the progress of the WHO’s End-TB Strategy, and equitable access to prevention and Care in line with WHO’s pursuit to ensure universal health insurance. “2
Although the full impact of the pandemic on TB progression remains undetermined, several model studies have highlighted the potentially significant impact on the incidence and mortality of TB without an adequate response. In a study published in the European Respiratory Journal in August 2020, the results showed that cumulative TB deaths in China, India, and South Africa alone could increase by up to 8% to 14% over the next 5 years
More recent analysis has resulted in similar or worse estimates.4,5 The results of an October 2020 study suggest that a three-month suspension of TB services could ultimately result in an additional 1.19 even if lockout requirements lead to a decrease in TB services. 50% transmission leads to millions of cases and 361,000 deaths in India alone, with significant increases in cases and deaths also forecast for several other countries. “The main reason for these adverse effects is the accumulation of unrecognized TB during an lockdown,” said Cilloni et al.5
In a broader sense, interruptions in TB services threaten to undermine the obligation to diagnose and treat 40 million TB patients by 2022 and to provide preventive treatment to 30 million people by 2022, including “24 million household contacts of TB patients – including 4 million children under [the age of] 5-6 million people living with HIV. “2 WHO has encouraged stakeholders to continue working towards these goals. Other goals include sustainable annual funding of $ 13 billion to support efforts to end tuberculosis and $ 2 billion for tuberculosis research
While “short-term disruptions can trigger an escalation of the TB burden that can take years to return to the level before the lockdown”, the long-term effect of these disruptions could “increase the TB burden in the short term through additional” catching ” be prevented. Detect and treat TB cases once restrictions are relaxed, ”wrote Cilloni et al.5
In fact, the WHO plans to publish guidelines for systematic screening later this month. Systematic screening for TB is “the systematic identification of people at risk for TB disease in a given target group by evaluating symptoms and using tests, examinations or other procedures that can be quickly applied,” according to WHO.2 Early Detection and Starting treatment can improve patient outcomes and reduce associated costs, and reduce the prevalence of and prevention of more people in a community from developing tuberculosis
For further discussion on the advancement of tuberculosis and the current challenges, we have C. Finn McQuaid, PhD, Assistant Professor in the Department of Epidemiology of Infectious Diseases at the London School of Hygiene and Tropical Medicine (LSHTM) in the UK and Co-Director of the TB Center at LSHTM. Dr. McQuaid was also a co-author of the August 2020.3 study mentioned above
What is the general progress in the fight against TB and how has the COVID-19 pandemic affected this progress?
In general, we have made steady progress in the fight against TB, although it has been much slower than we would like. As the work of myself and others has shown, the COVID-19 pandemic is likely to have pushed back this progress by at least years as the incidence of TB, and TB mortality in particular, is expected to increase.
What solutions are needed to counter the impact of the pandemic on TB advancement?
Some of the solutions are already implemented, e.g. For example, providing additional medication to patients and using digital treatment compliance technology to help patients take their medication, which means patients do not have to go to clinics as often.3,6
As lockdown becomes easier in different locations, another important solution will be to actively look for people with undiagnosed tuberculosis as there will likely be a large pool of people who for various reasons did not have access to the diagnosis. Given that, in many cases, people have spent significantly more time in their homes and less in common rooms, it is likely that high levels of Mycobacterium tuberculosis were transmitted in those homes, so keeping track of household contacts is likely to be particularly important
What areas of research should future efforts focus on?
Dr. McQuaid: For me, social determinants are one of the most important areas that I need to focus on. COVID has re-emphasized how unfair the effects of disease can be, and issues such as an increase in malnutrition and poverty due to COVID will have long-term effects on susceptibility to TB. Linked to this are aspects like stigma which is a real problem for TB and which may have worsened due to COVID. I think that we at TB are increasingly aiming to be patient-centric in our approaches and COVID made it clear to me that this needs to be our focus more than ever.
References
1. Migliori G., Thong P., Akkerman O. et al. Coronavirus Disease Pandemic Impact on Tuberculosis Services Worldwide, January to April 2020. Emerg Infect Dis. 2020; 26 (11): 2709-2. 2712.
2. World Health Organization. World TB Day 2021: The clock is ticking. Online access on March 8, 2021. https://www.who.int/campaigns/world-tb-day/world-tb-day-2021
3. McQuaid CF, McCreesh N, Read JM, et al. The Potential Impact of COVID-19 Related Disorders on Tuberculosis Load. Eur Respir J. 2020; 56 (2): 2001718. doi: 10.1183 / 13993003.01718-2020
4. Hogan AB, Jewell BL, Sherrard-Smith E. et al. Potential Impact of the COVID-19 Pandemic on HIV, Tuberculosis, and Malaria in Low- and Middle-Income Countries: a Model Study. Lancet Glob Health. 2020; 8 (9): e1132-e1141. doi: 10.1016 / S2214-109X (20) 30288-6
5. Cilloni L., Fu H., Vesga JF, et al. The possible effects of the COVID-19 pandemic on the tuberculosis epidemic will be analyzed using a model analysis. EClinicalMedicine. 2020; 28: 100603. doi: 10.1016 / j.eclinm.2020.100603
6. Dall C. WHO warns of COVID impact on TB services. University of Minnesota Center for Infectious Disease Research and Policy. October 14, 2020. Online access March 8, 2020. https://www.cidrap.umn.edu/news-perspective/2020/10/who-warns-covid-impact-tb-services
This article originally appeared on Pulmonology Advisor
