Deaths from tuberculosis around the world are on the rise, and COVID is blamed

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Tuberculosis patients have become collateral damage in the wreckage of the COVID-19 train.

Until the emergence of COVID, tuberculosis was the deadliest infectious disease in the world. But healthcare workers were making slow and steady progress to contain it. Today, for the first time in more than a decade, the number of deaths from tuberculosis is increasing.

Tuberculosis killed an estimated 1.5 million people in the first year of the COVID-19 pandemic, up from 1.4 million in 2019. And researchers say COVID is to blame.

“The COVID-19 pandemic has set aside years of progress and efforts in the fight against tuberculosis,” said Dr Tereza Kasaeva, head of the WHO’s global tuberculosis program. Speaking at a press conference as the WHO released its global annual report on tuberculosis, Kasaeva said COVID lockdowns, limited access to health care and patient concerns about visiting doctors medical clinics have made tuberculosis much more deadly during the pandemic.

COVID-19 has “severely impacted access to essential TB services,” Kasaeva said. “With significantly fewer people diagnosed and treated or receiving preventive treatment for tuberculosis in 2020 compared to 2019.”

How COVID-19 is causing more TB deaths

We reached out to Dr Francesca Conradie, a tuberculosis researcher and doctor in South Africa, to better understand how COVID-19 is causing more tuberculosis deaths. Conradie is Senior Lecturer at the University of the Witwatersrand in Johannesburg. She oversees three clinical research sites for tuberculosis patients in the country.

“South Africa launched its first containment around March of last year and the number of tuberculosis cases has declined,” notes Conradie. She then quickly points out that the “diagnosed” cases have decreased. She doesn’t think fewer people have been infected during this time. The drop in detected TB cases was in part due to South Africans not seeking medical care.

“The vast majority of South Africans depend on public transport, and public transport has become very limited (during blockades). This has mixed with the fear that ‘if I go to a clinic I will have COVID. That’s where the sick people are, ‘”says Conradie.” So it was a combination of things that kept people from accessing health services. ”

Fear has kept people from seeking health care

Even though the lockdowns have been lifted, she says the number of TB cases diagnosed in the country remains below pre-COVID levels. “I don’t think for a second it’s because we fixed the problem. I think it’s because people are no longer showing up at the clinics,” she said.

Many South Africans have started to view clinics as hotbeds of COVID-19 infection, she says.

“The reason people didn’t come for treatment (for tuberculosis) is mainly because they were afraid of having COVID in a healthcare facility. And let’s face it, it’s not impossible.” , said Conradie.

A simple case of tuberculosis takes at least six months to treat. Complicated, drug-resistant cases can take years for a patient to be cured. In South Africa, two thirds of tuberculosis patients are also HIV positive. This created two huge challenges for healthcare workers: Amid multiple waves of COVID-19 lockdowns, when people weren’t supposed to leave their homes and public transport was drastically cut, they had to find new ways to get patients infected with HIV and tuberculosis. their medications.

“What COVID has forced us to do is distribute over several months,” says Conradie. “Suddenly, instead of giving a week or two (supply of pills), we would give two months of anti-retrovirals. This strategy has also been applied to anti-tuberculosis drugs. In the past, anti-tuberculosis drugs were dispensed under what Conradie calls a “very fatherly system” known as directly observed therapy, or DOTS. As part of the DOTS strategy, a health worker had to stand up and watch the patient swallow their pills.

Even before the COVID-19 pandemic, clinicians were moving away from the DOTS strategy and embracing a philosophy of patients owning their own therapy and taking personal responsibility for their daily medications. Lockdowns in South Africa have accelerated this trend. “So I think that’s a good thing,” she said.

Tuberculosis patients who were already on treatment when the pandemic hit have done well, Conradie says. The problem was TB patients who had yet to show symptoms and had yet to seek care when the first COVID lockdown hit in March 2020.

Conradie says she doesn’t have hard evidence to prove it, but she believes the increase in tuberculosis deaths during the pandemic was among “patients who suffered from tuberculosis during the epidemic and who died before. the start of treatment “.

Many South Africans delayed seeking medical attention until they were seriously ill, she said. In South Africa, 90% of TB patients are diagnosed and treated at primary health care clinics, but that has changed during the pandemic. And the change, she says, has made patients sicker and sicker before they seek help.

Patients present with advanced tuberculosis

“Now we are seeing more and more TB diagnoses in hospitals, which means you went from coughing for two weeks to sweating profusely. You lost weight and finally went to the hospital. “, explains Conradie. Doctors are now seeing much more advanced and complicated cases of tuberculosis. Patients present with significant damage to the lungs.

“Of course, these are the ones who are in the hospital, which means they’re still alive,” she says. “I think what has happened is that the diagnosis is made later and that is demonstrated by the hospital burden of tuberculosis.”

One of the most concerning aspects of the impact of the COVID-19 pandemic on tuberculosis, says Conradie, is that even if the coronavirus goes away tomorrow, the damage is already done.

She believes it may take South Africa five years to bring tuberculosis back to pre-pandemic levels.

“If you have untreated TB, you’re going to infect eight other people in your community every year,” she says. “So it’s going to take us a long time to get over it. ”

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