The number of Covid cases has increased. A thin and gaunt 56-year-old daily wage labourer arrives at the emergency department of a government hospital. He has had a low-grade fever and a dry cough for the last three months, which are typical Tuberculosis (TB) symptoms. He wished he could come earlier, but due to his meagre financial state, he couldn’t.
Once the doctor hears his symptoms, he sends him to the Flu Clinic to be tested for Covid-19. The doctor does not want a Covid-positive patient in a crowded OPD. When he arrives at the sample collection place, he is informed that it is closed for the day and that he must return tomorrow. Today, by the time he is released from the hospital, it is too late for him to return to work and earn his daily bread. He can’t afford to take the day off tomorrow and hence doesn’t return. This is a typical story that is happening with TB patients in our country.
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The important thing to understand is that both TB and Covid affect the lungs and have certain similar symptoms. In both, the patient coughs, has fever and malaise. Although the duration of symptoms is quite different. To an overworked doctor with Covid on their mind, the distinction between both diagnoses becomes hazy. With hospitals and dispensaries closing for non-Covid patients, it becomes difficult to get long treatments required by a TB patient. All of this is leading to an increase in deaths caused by TB in India.
Covid-19 has Reversed gains made in the past decade
The struggle against the Covid pandemic has hampered our decades-long progress against various health challenges, including hunger, Tuberculosis, and AIDS. For the first time in a decade, the cases of Tuberculosis have been on a rise globally. TB and Covid-19 both largely affect the lungs, however, the former is caused by bacteria and the latter by a virus. TB is still one of the most lethal infectious diseases, and while the globe is already dealing with a devastating pandemic, the risks connected with TB have increased.
Globally, every year, around 1.4 crore people fall ill with TB. Due to the disruption of diagnostic services and the stigma attached to Covid-19, there has been a significant drop in TB patients getting diagnosed. To win the worldwide battle, it is critical that the world does not turn its back on tuberculosis during the pandemic.
Globally, every year, around 1.4 crore people fall ill with TB. Due to the disruption of diagnostic services and the stigma attached to Covid-19, there has been a significant drop in TB patients getting diagnosed. To win the worldwide battle, it is critical that the world does not turn its back on tuberculosis during the pandemic.
TB Continues to be a Huge Killer in India
The World Health Organization (WHO) says that millions of people suffering from TB haven’t been reported to national authorities during the ongoing pandemic. India alone accounts for a 41% drop in official notification for Tuberculosis. TB alone kills more than 15 lakh people every year across the globe. As of 2020, India accounted for 34% of the total number of TB deaths worldwide. The country had over 5.2 lakh TB deaths in 2020. Although over the past two decades due to global cooperation and availability of better and inexpensive treatments, we have firmed our grip against the infectious disease, it continues to be one of the biggest killers in India.
TB: The disease of Poverty
Many socioeconomic factors determine who gets infected with Tuberculosis. TB as a disease is particularly prevalent in impoverished areas. People living with chronic poverty with poor nutrition, in crowded spaces with co-morbidities, are at higher risk of getting infected by Tuberculosis. The problem with the current situation is that due to lockdowns, economic slowdowns and supply chain disruptions, access to essential healthcare services has been affected. Many Indians have paid a high price for it.
Bringing TB elimination back on track
The first and most important thing we must do is cease ignoring the care of TB patients during the pandemic. It is critical that persons who are currently suffering from Tuberculosis remain a safe distance from those who are suffering from Covid-19. This can be accomplished by administering TB medications for longer periods of time to reduce physical visits to healthcare facilities. Organisations such as WHO have proposed transitioning to video visits but given the demographic of individuals impacted by Tuberculosis and the resources available to our healthcare personnel, this is simply not feasible. However, a system of regular phone calls, like the one developed for Covid-positive patients, can be implemented for TB patients. It is preferable not to close our TB dispensaries when COVID cases grow, and to keep them fully supplied and running.
In our third year of the pandemic, it is a disgrace that we are relying on existing infrastructure and manpower, such as TB dispensaries and hospitals, to provide Covid-19 care. It is imperative we increase our healthcare capacity. There is a need to understand the similarities between the two diseases and develop synergies and optimise the already available tools and resources.
Mahek Nankani is Assistant Programme Manager, The Takshashila Institution. Harshit Kukreja is Research Analyst, The Takshashila Institution. The views expressed in this article are those of the authors and do not represent the stand of this publication.
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