Tuberculosis in COVID Era: Challenges in Diagnosis, Treatment and Prevention - Dr A Jayachandra

I came across Ravi (Name Changed), a 35-year-old an entrepreneur, who had been persistently coughing for months. Initially dismissing it as a seasonal flu, his condition deteriorated significantly by the time he sought medical attention.

His case was far from unusual. Like numerous others, delays in care resulted from disruptions caused by the COVID-19 pandemic. By the time he reached us, his tuberculosis had advanced considerably, complicating treatment efforts.

Ravi's experience echoes those of innumerable patients worldwide as the pandemic profoundly impacted TB diagnosis, treatment, and prevention

Silent Epidemic Eclipsed by COVID-19

Tuberculosis, caused by Mycobacterium tuberculosis, continues to rank amongst the deadliest infectious diseases globally. In 2020 alone, the World Health Organization estimated 10 million individuals fell ill with TB, and 1.5 million succumbed.

However, as COVID-19 took centre stage, TB faded into the shadows. Healthcare assets, from hospital beds to diagnostic tools, were redirected toward managing the coronavirus crisis, leaving TB patients in a precarious position.

Lockdowns, overwhelmed healthcare systems, and fear of visiting hospitals led to a significant decline in TB case detection.

According to WHO, global TB case finding dropped 18% in 2020 compared to the previous year, equivalent to approximately 1.4 million "missing" TB cases. These undiagnosed individuals not only suffered prolonged illness but also continued spreading the infection within their communities.

Challenges in Diagnosis and Treatment

Before the pandemic, countries with substantial TB burdens had been making steady progress detecting and treating the disease. However, COVID-19 brought about several difficulties:

1. Disruptions in Diagnostic Services:

COVID-19 testing took precedence, with many GeneXpert machines (used for TB diagnosis) repurposed for COVID-19 testing. Fewer people visited hospitals as concerns grew around contracting the deadly virus. Volunteers with nonspecialized skills were diverted to assist with the influx of COVID patients.

2. Interrupted Treatment and Drug Shortages:

Rigid lockdowns made acquiring life-saving medications nearly impossible for some. Transportation disruptions hindered deliveries of TB drugs, endangering treatment continuity. The global supply chain upheaval resulted in shortfalls of crucial TB medicines, jeopardizing adherence for vulnerable groups.

3. Delayed Healthcare Seeking Behaviour:

Fearing overburdened clinics, the symptoms of respiratory illness went unreported, enabling further transmission. Health experts shifted focus from detecting latent TB to COVID response efforts. Stigma around coughing in public grew rapidly, worsening already inadequate care access.

4. Double Burden: TB and COVID-19 Co-Infection

For tuberculosis patients, a coronavirus infection posed grave risks. Damage to the lungs from either disease amplified suffering from the other. Research links TB with heightened COVID severity and vice versa. Identical symptoms muddied diagnosis, postponing lifesaving treatment.

One of my refugee patients, a malnourished elderly woman, came to us unable to breathe. Misdiagnosed initially with pneumonia, further testing uncovered active TB complicated by diabetes. By the time treatment began, irreversible scarring occupied much of her lungs. Prolonged recovery has been difficult.

Innovative Responses to Overcome Challenges

Despite immense obstacles, creative workarounds emerged. Telehealth and digital tools helped patients maintain adherence from afar. Drive-through testing, 3D printed PPE, and repurposed ventilators demonstrated resilience and adaptability in challenging times.

1. Decentralized TB Care: Community health workers played a pivotal role in accessing those suffering from TB in their homes, ensuring continuation of treatment and observation.

2. Integrated COVID-19 and TB Screening: Numerous medical centers launched concurrent screening initiatives, enabling simultaneous testing for both illnesses, leading to earlier identification.

3. Reviving BCG Vaccination Programs: With heightened cognizance about respiratory diseases, governments refocused on Bacillus Calmette-Guérin (BCG) vaccination, particularly in children, to reinforce TB prevention strategies.

Road Ahead Demands Renewed Commitment

As the world recuperates from COVID-19, it is imperative that we rebuild and bolster TB control programs with vigor. Governments and healthcare organizations must prioritize without delay:

1. Reinvesting in TB Diagnosis and Treatment: Nations must allocate sufficient resources to restore TB services and ensure prompt detection.

2. Expanding Community-Based Interventions: Strengthening primary healthcare and community outreach can help pinpoint and treat TB cases before severe complications arise.

3. Improving Public Awareness: Just as COVID-19 taught us about the importance of masks and hygiene, similar awareness campaigns should be launched with focus on TB prevention and treatment adherence.

4. Bolstering Research and Innovation: Investments in more rapid diagnostic tools, novel TB vaccines, and shortened treatment regimens can transform TB care.

Conclusion

Ravi’s case had an unlikely benefit—after months of treatment and assistance, he recovered and resumed his work. But millions like him continue waiting for timely access to care.

The COVID-19 pandemic may have disrupted TB control efforts, but it also presents an opportunity to rethink our strategies. By integrating learnings from TB and the pandemic, we can develop resilient healthcare systems that leave no one behind.

The fight against tuberculosis remains unfinished, but with restored commitment, innovation, and global cooperation, we can regain lost progress and move closer to a world free of TB.