The reallocation of staff, funding, and facilities from tuberculosis (TB) control to tackling the global Covid19 pandemic has made 200,000 to 400,000 excess deaths from TB likely in 2020, according to the World Health Organization’s Global Tuberculosis Report, 2020.
Particularly concerning, the report noted, is the diversion of GeneXpert machines, which are used to diagnose TB, but have been diverted to testing for Covid19.
Bihar, which reportedly has one of the largest TB caseloads in the country, has already begun recording irregular, steep falls in its TB diagnoses, after 70% of the state’s TB control and testing staff was reassigned to Covid19 duty, indicating TB cases are going unidentified and untreated.
“This is just one example of the very difficult choices that had to be taken to contain Covid19. It was obviously crucial that we tackle the pandemic but we cannot forget that we have other killers in our midst. We are going to have to be innovative in addressing them,” Thomas Kenyon, chief health officer of Project Hope, an international healthcare NGO, told The Guardian.
The economic impact of the pandemic is also expected to worsen TB risk factors, leading to a rise in cases even as diagnosis and treatment become farther out-of-reach. With poverty rates rising everywhere, more and more people are vulnerable to “overcrowded and substandard living or working conditions, poor nutrition, intercurrent disease (such as HIV/AIDS),” among other factors associated with poverty, according to the WHO. These influences alone could increase TB cases by more than 1 million per year in the period between 2020 and 2025, according to WHO’s report.
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At present, 26% of the total TB cases in the world are from India, according to the WHO. And India’s latest annual report on TB states that the disease claimed 79,144 lives in 2019. Prior to the pandemic, only 74% of TB patients in India were able to get treatment, according to a report by The Wire.
Due to the pandemic’s disruption in health services and higher household transmission due to the lockdown, the Indian government estimates the country alone could have 5 lakh more TB cases — and 1.5 lakh more deaths due to lack of diagnosis and treatment — in the next five years.
TB was declared as a “public health emergency” by the WHO in 1993. More than 25 years later, 1.4 million people died from TB in 2019. With the pandemic presenting an additional global health emergency, experts worry about the ramifications. “As the [Covid19] pandemic sweeps the world, I and others working to fight TB have growing anxiety about what this pandemic will do to a much older infectious killer — tuberculosis,” Dr. Madhukar Pai, director at McGill University’s Internal Tuberculosis Centre, wrote in Forbes in March.
