A new report on Covid-19’s impact on TB infection and mortality rates, released by the Stop TB Partnership (STP) finds that the global response to the Covid-19 pandemic has unintended, yet drastic consequences on tuberculosis services, with lockdowns and limitations on diagnosis, treatment and prevention services expected to increase the annual number of TB cases and deaths over the next five years. At least five years of progress on TB response will be lost, the report states. 

The modelling analysis shows that under a three–month lockdown and a protracted 10 month restoration of services, the world could see a global incidence of an additional 6.3–million cases of TB between 2020 and 2025 and global mortality of an additional 1.4–million TB deaths during that same period.

“We never learn from mistakes. For the past five years, TB, a respiratory disease, has remained the biggest infectious disease killer because the ‘TB agenda’ consistently became less visible in front of other priorities,” said Dr Lucica Ditiu, executive director of the Stop TB Partnership.  

“Today, governments face a torturous path, navigating between the imminent disaster of Covid-19 and the long-running plague of TB. But choosing to ignore TB again would erase at least half a decade of hard-earned progress against the world’s most deadly infection and make millions more people sick,” said Ditiu

According to STP, TB is a forgotten respiratory disease that still kills 1.5 million people each year, more than any other infectious disease. Incidence and deaths due to TB have been declining steadily over the last several years as a result of intensified activities by high burden countries to find people with TB early and provide appropriate treatment. 

 What does this mean for SA? 

South Africa already has a high burden of TB and drug resistant-TB (DR-TB), and a high number of missing cases, who drive community transmission. Experts warn that with Covid-19 putting TB services under pressure, there is a risk that TB transmission could rise, along with TB illness and TB-related deaths in the country. 

 Speaking to Health-e News Dr Anja Reuter, a DR-TB doctor working for Doctors Without Borders (MSF) in Khayelitsha, explains how Covid-19 impacts TB response in South Africa.  

“We see a decrease in TB testing as well as a decrease in patients started on TB and drug resistant TB treatment,” she says. 

Reuter adds that TB services are being negatively impacted because of   lockdown structures hampering patient mobility and access to services, as well as socio-economic challenges of lockdown making patients less likely to go to their local clinic, but rather prioritising basic needs such as food security.  

 “Another major issue is the significant overlap of Covid-19 and TB symptoms – both may present with fever, and feeling unwell with a cough or tight chest.” 

 Reuter tells Health-e News that health services have been adapted in order to reduce non-essential services and have also incorporated Covid-19 screening to mitigate the risk of facility spread.  

 “However, there is a risk in that the facility-based COVID-19 screening and management strategy is leading to TB screening and testing being deprioritised by clinical staff and facilities,” she adds. 

 ‘Piggyback TB testing onto Covid-19 testing’ 

Additionally, says Reuters, stakeholders such as the National Department of Health and non-governmental organisations must come together to ensure that TB is reprioritised, meaning that TB screening and testing ought to be integrated with the Covid-19 screening, triage and management systems.  

“Put another way, facilities should not only be screening and testing for Covid-19 – they should also ensure that TB screening, testing and treatment initiation is still happening.” 

She continues: “Another likely explanation for the pressure on TB services is the fact that many TB room staff, as well as TB coordinators and community care worker in some facilities have been repurposed to tackle Covid-19.” 

Dr Francesca Conradie of Wits Health agrees that TB testing needs to intentionally be reprioritised by health workers, and the healthcare agenda.  

 “This needs careful but quick thinking.  We have a really good system for community screening and testing for SARS-CoV-2 (Covid-19). It has been assembled very quickly. My suggestion would be to piggyback TB screening onto this and test many more people for TB.” 

Conradie says there is a dramatic reduction in the number of TB tests being done since the Covid-19 pandemic.  

“There is no reason to suspect that the real number of TB cases has dropped, but we are not finding them. There are long–term consequences of not finding active TB,” she says. 

Conradie says that for the individual, there is a risk of getting sicker and even dying. But for the community, there is a risk that the person with TB will continue transmitting TB. This means more cases of TB down the line. 

“We need to make sure that people of aware that the health system has not closed. I think that we need more public announcements that visiting clinics is ‘allowed’ if you are not well and ensure that people can get there safely. This means making public transport as safe as possible,” she adds.
STP and their partners call upon the leadership of all countries – particularly those with high TB burdens – to ensure the continuity of the TB response in the time of Covid – Health-e News