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Due to Disruptions Caused by COVID-19, India’s TB Notifications Fell by 25%

Due to Disruptions Caused by COVID-19, India’s TB Notifications Fell by 25%

An electron micrograph of Mycobacterium tuberculosis bacteria, which cause TB. Photo: NIAID/Flick, CC BY 2.0.

New Delhi: The COVID-19 pandemic is derailing global efforts to tackle tuberculosis (TB), the world’s deadliest infectious disease, with cases likely to rise without urgent action and investment, says an annual report released by the World Health Organisation (WHO) on Wednesday.

The WHO’s annual TB report found that tuberculosis killed some 1.4 million people in 2019, little changed from the 1.5 million deaths it caused in 2018. It warned that many countries are not on track to meet targets for successfully diagnosing and treating cases to try to stop the disease’s spread.

Disruptions in services caused by the COVID-19 pandemic have led to major setbacks to TB programmes, the report found. In many countries, human, financial and other resources have been reallocated from TB to the COVID-19 response.

“Accelerated action is urgently needed worldwide if we are to meet our targets,” the WHO’s director-general Tedros Adhanom Ghebreyesus said in a statement with the report.

India accounts for over a fourth of global TB cases and the imposition of the lockdown to contain the spread of the novel coronavirus saw a significant dip in notifications of the disease in the country. “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.

Also Read: Can We Co-Opt the Fight Against COVID-19 With That of Tuberculosis?

Between January-June 2020, TB notifications in India dipped by 25% when compared to the same period in 2019.

According to The Hindu, TB notifications increased in February when compared with January, but then reduced sharply in April (after the imposition of the lockdown in the last week of March) to reach less than 40% of the January figure. The number then rose to about 75% of the January figure in June.

“In India, the weekly and monthly number of TB case notifications fell by more than 50% between the end of March and late April, following the imposition of a national lockdown. Subsequently, there has been some recovery, but as of the end of June, not to pre-March levels,” WHO said in the report.

However, the report also says that compared with Indonesia, Philippines and South Africa, the dip in TB notifications in India is not very sharp and the recovery has been quicker.

The WHO said that the decrease in monthly case notifications could plausibly be explained by people with chronic conditions or mild symptoms being discouraged from seeking care to mitigate crowding in health facilities; reductions in the number of health facilities offering TB diagnostic and treatment services; TB staff and molecular diagnostic platforms have been reallocated to the COVID-19 response.

It said that other reasons include the disruption of procurement and transportation of medicines and laboratory consumables, restrictions in movement and loss of wages making it harder for people to travel to health facilities and concerns about stigma, given the similarities in some clinical features of TB (like fever and cough) with those of COVID-19.

A file photo of health workers participating in a tuberculosis awareness rally on World TB Day in Agartala, 2018. Photo: PTI

“Negative impacts on essential TB services include the reallocation of human, financial and other resources from TB to the COVID-19 response,” the report says. WHO’s modelling suggests that a 50% drop in TB case detection over 3 months could result in “400,000 additional TB deaths this year alone”.

In June, a study published in the European Respiratory Journal estimated that India could see 95,000 additional tuberculosis (TB) related deaths over the next five years due to disruptions to health services, and delays in diagnosis and treatment caused by COVID-19.

India has been the biggest contributor to the rise in TB’s global burden. Disease notifications of people newly diagnosed with TB in India rose from 1.2 million to 2.2 million between 2013 and 2019, an increase of 74%.

Though across the globe, there has been an increase in TB notifications, the WHO estimates that there are several million more cases which are not detected. In 2019, while 2.9 million people were newly diagnosed with TB, the WHO estimates that 10 million people developed TB in that year. “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.

India accounts for 17% of the global gap, followed by Nigeria (11%), Indonesia (10%), Pakistan (8%) and the Philippines (7%).

Also Read: What Toll Will COVID-19 Take on Tuberculosis and HIV Treatment?

‘Dismally slow’ progress

Sharonann Lynch, a TB policy expert at the global health charity Medecins Sans Frontieres (MSF), told Reuters that progress against the killer disease had been “dismally slow.” “It’s disheartening to see that governments are not on track,” she said in a statement.

Before the COVID-19 pandemic, the WHO’s report said, many countries had been making steady progress against TB, with a 9% reduction in incidence seen between 2015 and 2019 and a 14% drop in deaths in the same period.

The WHO’s ‘End TB Strategy’ aims to cut TB deaths by 90% and reduce the TB incidence rate by 80% by 2030 compared to a 2015 baseline. Interim targets for 2020 include a 20% reduction in incidence rates and a 35% reduction in deaths.

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