The COVID-19 pandemic, combined with impacts on care-seeking behaviour, threatens to reverse the recent progress in reducing the global burden of tuberculosis (TB) disease, the World Health Organization (WHO) warns in the latest Global TB Report.
“There is already evidence from several high TB burden countries of large reductions in the monthly number of people with TB being detected and officially reported in 2020, especially in India and other countries,” the report says.
While India accounts for 26% of TB cases in the world, the TB notifications during the period January-June 2020 in India fell by 25% compared to the same period in 2019.
The TB notifications in India in February this year increased compared with January but then reduced sharply in April to reach less than 40% of the January figure before increasing to reach about 75% of January figure in the month of June. However, compared with Indonesia, Philippines and South Africa, the dip in TB notifications has not been very sharp in India and the recovery after the dip has been more in India than the other three countries.
In terms of weekly TB notifications in India, the numbers reached over 50,000 a few weeks before the national lockdown before dipping to about 15,000 notifications a week in about three weeks after the lockdown went into effect. It then increased to reach about 35,000 cases notified a week by mid-May, before slightly reducing in the following weeks.
Overall, there has been a recovery from the lowest point in mid-April, but it has not been at the pre-March levels when the lockdown came into effect. Decreases occurred in both the public and private sector.
In India, notifications of people newly diagnosed with TB increased 74% from 1.2 million to 2.2 million between 2013 and 2019. Despite the increase in notifications, there is still a gap in the number of people newly diagnosed and reported in the world and the estimated number of people who would have developed TB in 2019. In the case of India, this gap accounts for 17%, the WHO report says. This gap is due to a combination of underreporting of people diagnosed with TB and underdiagnosis (if people with TB cannot access health care or are not diagnosed when they do).
The report says that the global number of TB deaths could increase by “around 0.2-0.4 million in 2020 alone, if health services are disrupted to the extent that the number of people with TB who are detected and treated falls by 25-50% over a period of three months”.
In March, when the pandemic began to spread to many countries across the world and as countries were declaring lockdowns to gain time to control the virus spread, the WHO had urged member states to maintain continuity of TB services even during the global outbreak of COVID-19. It said programmes already in place to combat TB and other major infectious diseases can be leveraged to make the response to COVID-19 more effective and rapid.
“The COVID-19 pandemic threatens to undermine our gains,” WHO Global TB Program Director Dr. Tereza Kasaeva said at a WHO virtual press briefing.
Among the problems cited is reassignment of people from national TB programs to COVID-1-related duties, reductions in the number health-care facilities treating people with TB, a reduction in collection of data. In addition, many countries, India included, are using rapid diagnostic tests used for detecting TB for COVID-19 testing instead.
“2020 is a critical year for all of us,” Dr. Kasaeva says. “While we struggle to overcome the COVID pandemic together, we should not neglect the millions of people suffering and dying from TB.”