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Mumbai, March 25, 2022: The global tuberculosis burden remains substantial, with more than 10 million people newly ill per year. Dr Zarir F Udwadia, the consultant chest physician at P.D. Hinduja Hospital & MRC, who co-authored the Lancet report that aims to review the interactions between COVID-19 and tuberculosis, including the population-level impact of COVID-19 on tuberculosis outcomes.
This paper talks about the clinical presentation and diagnosis of tuberculosis–COVID-19 co-infection, the patient-level impact of COVID-19 on the management and prognosis of tuberculosis, and interventional strategies that could be used to mitigate the devastating effects of COVID-19 on the global burden of tuberculosis, including lessons learned from responses to the COVID-19 pandemic.
At least 30 million people have developed COVID-19 in India. A devastating second wave has left many individuals with severe acute respiratory distress syndrome, a proportion of whom might develop post-COVID fibrotic sequelae. India also has the most significant number of people living with chronic fibrotic lung scarring caused by tuberculosis. Post-COVID sequelae superimposed on post-tuberculosis fibrosis is likely to result in considerable disability in many of these individuals.
The March 2020 lockdown had some catastrophic effects on healthcare provision and severely restricted access to tuberculosis diagnosis and treatment. Tuberculosis notification rates decreased by 50% in the private and public sectors. Treatment completion rates also reduced, as patients delayed diagnosis and often could not reach clinics. A modelling study in 2020 estimated that each month of lockdown would result in 40685 additional people developing tuberculosis that year and an additional 151120 tuberculosis deaths over the next 5 years. In 2020, the number of tuberculosis cases from India notified to WHO was 1629301, a reduction of 25·1% from the 2019 number.
Zarir Udwadia, consultant chest physician at P.D Hinduja Hospital & MRC said, “One of the major setbacks from the Covid-19 pandemic was its impact on tuberculosis control and care, resulting in an increase of tuberculosis-related deaths. The pandemic has, in a single stroke, wiped out decades of slow but steady progress we were making with global TB control. The pandemic resulted in a significant drop in tuberculosis testing and thereby case notifications. We have lots of ground to cover and it is now imperative to focus on strengthening community-based tuberculosis treatment and community-based active diagnosis. Finally, let us hope TB control can benefit from this pandemic. If we could discover 33 different vaccines for COVID within 2 years surely we can improve on the single, century old, BCG vaccine we use for TB?”
Some of the key findings of the research paper:
1.Tuberculosis incidence has slowly declined over the past decade, and mortality has decreased by almost a third in tandem.
2.Covid has reversed the positive trend with a substantial reduction in tuberculosis testing and case notifications, with an associated increase in mortality, taking global tuberculosis control back by roughly ten years.
3.Action plan to reverse the devastating effects of COVID-19 on tuberculosis suggested by the paper
4.The patient-level impact of COVID-19 on the management and prognosis of tuberculosis and interventional strategies that could be used to mitigate the devastating effects of COVID-19 on the global burden of tuberculosis, including lessons learned from responses to the COVID-19 pandemic
5.Emphasises how tuberculosis care and management have been neglected compared with COVID-19 and how low SARS-CoV-2 vaccine coverage in tuberculosis-endemic countries, despite the high rates of infection and emergence of new variants, will continue to fuel the global tuberculosis pandemic
6.A thorough review of the impact of COVID-19 at the population level on tuberculosis case detection, morbidity and mortality, and the patient-level result, including susceptibility to disease, clinical presentation, diagnosis, management, and prognosis
7.The paper proposes strategies to reverse or mitigate the harmful effects of COVID-19 and restore tuberculosis services.
8.Patients with lung disease after tuberculosis might be at greater risk of developing COVID-19 pneumonia, and hence lung disease after COVID-19, and are at increased risk of death when hospitalised with COVID-19 pneumonia, as discussed in the previous subsection.
Prevention:
9.Strengthen community-based tuberculosis treatment services
10.Scale up virtual care, digital health, and community-monitoring solutions to provide remote support such as video-supported therapy
11.Scale up SMS-based communication to improve treatment adherence and patient-centred care and support
12.Use bulk dispensing, open-air dispensing, or both to reduce barriers to care and minimise risk to patients and health-care workers
Dr Udwadia has over 50 PubMed indexed publications, the majority of them international, in every critical medical journal, including Lancet, Lancet-ID, New England Journal of Medicine, British Medical Journal, Clinical Infectious Disease, Thorax, American Journal of Respiratory & Critical Care Medicine. His work on drug-resistant tuberculosis has improved India’s National Tuberculosis Control Programme. Dr Udwadia was the only Indian invited by the WHO to be part of the T.B.’ Guidelines Group’, which formulated the 4th edition of the T.B. Guidelines, published in 2010.
