Sharp increase in TB cases and deaths expected due to Covid-19

  • The Covid-19 crisis is causing an increase in other diseases, such as TB
  • Recent modelling estimates a 13 000 increase in TB-related deaths in SA
  • Researchers, therefore, advise that TB health services be maintained during the pandemic

People living with tuberculosis (TB) are more vulnerable to severe Covid-19, and national lockdowns have taken a heavy toll on TB programmes. According to new estimates published in the European Respiratory Journal, the pandemic could cause a significant spike in the global burden of TB, as a result of the disruption of health services and delays in diagnosis and treatment.

The research was carried out by academics from the London School of Hygiene & Tropical Medicine (LSHTM) and Lancaster University who indicated that before the pandemic over 4 000 people were dying from TB daily. Countries, where health services are already strained, may, however, face an increase in TB cases.

They further mentioned three countries that can expect this kind of increase over the next five years: South Africa, China, and India.

Physical distancing also crucial in fight against TB

Since, like the new coronavirus, mycobacterium tuberculosis – the bacteria which causes the disease – is transmitted via droplets in the air, physical distancing may help to reduce these numbers of cases and deaths, said the researchers. But even after considering this protective measure that has been largely implemented globally, their estimates still paint a worrying picture of more than 110 000 additional TB-related deaths.

The worst-case scenario, they said, could potentially reach more than 200 000 deaths, and is likely to happen if Covid-19 carries on placing immense strain on health services.

One of the study’s researchers, Dr Finn McQuaid, assistant professor in infectious disease epidemiology at LSHTM, said in a news release: "There is concern that the Covid-19 pandemic is resulting in decreased TB clinic attendance, delayed diagnosis and treatment.

“This is especially so in low- and middle-income countries where health services, or access to them, might be substantially disrupted. Early anecdotal information from China, India, and South Africa suggests that the number of people being diagnosed and treated for TB has fallen significantly."

Why SA, China, and India?

These three countries make up approximately 40% of global TB cases. To estimate the impact of Covid-19 on the global TB burden, the research team measured the effect of these factors on TB incidence in these three countries and modelled various scenarios, which included different implementations of physical distancing measures, as well as health service disruption lasting up to six months.

Their results showed that if, for example, there is a 50% reduction in TB cases detected and successfully treated, it would consequently result in an increase in both incidence and deaths from TB over the following five years, irrespective of physical contact.

However, the most probable scenario which was based on present information and physical distancing measures suggests an additional 6 000 deaths in China, 13 000 in South Africa, and 95 000 in India.

According to the latest statistics by the World Health Organization (WHO), TB caused around 63 000 deaths in South Africa in 2018 (figures for 2019 are not yet available).

TB health services during pandemic must be strengthened

"We need to act now to ensure innovative approaches to people-centric TB care are the focus, so that the fight to end this pandemic doesn't overwrite the hard-won gains made against this disease,” said McQuaid, adding:

"Given that health service disruption far outweighs the benefit of physical distancing, it is crucial to maintain and strengthen TB-related health services during, and after, Covid-19… Additionally, we examined physical distancing measures over a six month period, but with the potential of subsequent waves of the virus, the impact could last longer."

While the authors acknowledged limitations of their work, such as an absence of setting-specific differences within the three countries, other health experts have expressed the same sentiment in recent weeks.

Governments must work together

The International Union Against Tuberculosis and Lung Disease (Union) held a panel discussion in May to stress the urgency of continuing the fight against TB, and stressed that the disease must not be neglected while Covid-19 is in the spotlight, Health24 reported.

Leaders in the Union panel also discussed what the results of the modelling study by the Stop TB Partnership (in collaboration with the Imperial College, Avenir Health and Johns Hopkins University) mean, and how governments can all work together to prevent the potential 1.4 million TB deaths worldwide, caused by the Covid-19 pandemic.

“This crisis is ongoing and we can see a clear disruption of TB services in many low- and middle-income countries, but we have a chance to avoid dramatic disruption and additional deaths relating to this disruption,” said Dr Tereza Kasaeva, Director of the global TB programme.

“We are trying to advocate country officials to consider TB services as essential services as it’s a number one killer in the world,” she said, and added that governments should consider the socio-economic background of TB and should look at protecting the most vulnerable: the poorest, the malnourished, and those losing their jobs, as they are the key drivers of TB.

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