Tuberculosis – world’s second leading infectious killer


With most healthcare professionals focusing on Covid-19 cases, patients suffering from tuberculosis (TB), considered one of the biggest killers are facing neglect, which doctors fear could lead to a rise in the number of cases. In the interim, hospitals ran on skeletal staff, with outpatient departments shut and only emergency services operational. Patients could not reach DOTS (Directly observed treatment, short-course) centres to get their regular stock of TB drugs, nor did they have access to their regular doctors or healthcare staff when suffering from side-effects.

Single parent and cancer survivor Sarada Devi’s 22-year-old daughter was diagnosed with TB two days before the lockdown began on 25 March, and the government hospital allegedly refused treatment because of the Covid-19 emergency, as she was not a previously registered patient. Now getting her daughter treated at a private hospital, Sarada Devi is running out of money and doesn’t know how long she will be able to manage. Even previously diagnosed drug-resistant TB patient like Kondal Rao, getting a Amikacin injection is a nightmare, because doctors refused in the fear that they may catch an infection. “Missing even a single dose meant risk of developing resistance to the drug,” Rao said, adding that the anxiety added to her ill health.

On 24 April, the Ministry of Health and Family Welfare wrote to the states to ensure uninterrupted diagnosis and treatment for TB patients, including steps like supplying drugs for a month. But this was exactly a month after the lockdown began. Speaking to Hello Vizag, Dr.R.Vijay Kumar, Pulmonologist said there are grave consequences if TB patients aren’t diagnosed or don’t get drugs amid the Covid-19 pandemic. In our focus on the Covid-19 pandemic, let’s not lose sight of the fact that tuberculosis kills 1,400 Indians every day, a far high number than the coronavirus ever will. “This is because one, TB is infectious, and two, because tuberculosis patients suffer from compromised lungs, which makes them more vulnerable to Covid-19,” Kumar said.

According to the report, the World Health Organisation (WHO) estimated India’s TB cases in 2019 at 26.9 lakh. However, India’s TB notification — which gives the number of patients registered with the Central TB Division — saw 24.04 lakh TB patients. This means that 2.86 lakh cases were missed in the year. Nevertheless, India’s TB notification jumped to its highest figure — an 11.6 per cent rise over 2018. The report comes at a time India recorded over 4.73 lakh Covid-19 cases and nearly 15,000 deaths since the pandemic hit the country.

Experts worry that the number of TB cases might suddenly increase once the lockdown ends, because of the backlog. “The symptoms of tuberculosis and coronavirus are also very similar, so patients are scared to seek care in case they are mistaken for Covid-19,” said Dr. S A Bhavani, Retired Civil Surgeon Residential Medical Officer, Government TB and Chest Hospital. She added that undiagnosed TB patients may be transmitting the disease, especially to their family members who are now forced to spend more time together due to the lockdown.

According to India TB report 2020 released by the Union Health Ministry, India missed detecting nearly 3 lakh tuberculosis (TB) cases in 2019 compared to 10 lakh cases that were missed in 2017. Missing TB cases are an important metric for disease control as undiagnosed, untreated cases may spread the infection in the community. TB kills around 4.8 lakh Indians every year, or about 1,400 people daily, according to estimates from the National Strategic Plan for TB Elimination (2017-25). Like Covid-19, TB is an infectious disease which usually affects the lungs. Despite being completely curable and largely preventable, India has struggled to control the spread of this disease. It has the highest TB burden as well — responsible for over one-fourth of the world’s cases and one-third of the deaths.


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