Tuberculosis (TB) is widespread in India, and the Covid19 pandemic (and subsequent lockdown) may have only worsened the country’s TB burden. According to a recent report by The Print, Bihar — one of the worst afflicted states in India — recorded steep falls in TB diagnosis, likely because over 70% of Bihar’s tuberculosis control staff have been diverted to Covid19 care duty.
According to India’s official TB database, Bihar recorded around 64,000 cases from January 2020 till September 2020. From January to September 2019, Bihar had recorded around 92,000 TB cases. Overall, India’s TB diagnosis and notification rates have dropped by 60%, according to Dr.K.S. Sachdeva, the project director of the Revised National TB Control Programme (RNTCP).
In a letter to India’s state governments, Sachdeva states, “One pulmonary TB patient, if untreated, can infect 10-15 individuals in a year. In such circumstances, when TB patients are not able to access health services and are confined within their homes, there is all likelihood of an active intense transmission in the household contacts.” The letter also cited modeling efforts from Stop TB Partnership, which concluded that over and above current cases, India is likely to have five lakh more TB cases and one lakh more TB-related deaths over the next five years.
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The situation in Bihar paints a small portrait of the struggles TB patients are enduring since lockdown. All testing centers in the state were closed after the lockdown announcement, and only 50% are open as of now. Plus, 80-90% of private clinics shuttered, as doctors increasingly got infected with Covid19.
Around the country, TB patients faced further struggles as their access to medication suffered due to both the shuttering of clinics and due to the logistical issues with safely leaving the house during the Covid19 pandemic. The closing of community health centers and clinics also means the people most affected are marginalized and low-income individuals, for whom these centers are often the first and only point of medical contact.
To combat the impediments in health service delivery, the Indian Health Ministry stated in August that all Covid19 patients should be screened for TB, and vice versa. Some Indian states are also testing Covid-negative patients for TB. The Health Ministry note also calls for screening for patients with influenza symptoms and severe respiratory infections. However, the situation as it stands in Bihar now, shows that progress is slow and that India and its states will have to re-double its efforts to fight the tuberculosis epidemic while the Covid19 pandemic lingers.
