India reports sharp decline in tuberculosis registration after COVID-19 lockdown

Extra;0.2-0.4;million global TB;deaths;could;push;world;eight;years;back, says;WHO;report;
A Tuberculosis patient in Delhi. Photo: Samrat Mukherjee / CSE
A Tuberculosis patient in Delhi. Photo: Samrat Mukherjee / CSE

India registered a decline in the notification of tuberculosis (TB) cases by about 85 per cent in April this year, after the imposition of the novel coronavirus disease (COVID-19) lockdown.

In other words, for every 100 cases being registered in India till January 2020, only 40 cases were registered by April due to a decline in access to TB services in the country, according to the Global Tuberculosis Report, 2020 released October 14, 2020 by the World Health Organization (WHO).

India, incidentally, has the highest TB burden across the globe, which accounts for 26 per cent of the total global cases. That a huge per cent of potential cases remained out of the TB registration net, could amplify the problems many times for India.

The weekly and monthly number of TB case notifications fell by more than 50 per cent between the end of March and late April in India, following the imposition of a national lockdown, according to the report.

Subsequently, there was some recovery. But as of the end of June, it had failed to reach pre-lockdown levels. Decreases occurred in the public and private sector, the report noted.

Source: WHO World TB Report 2020

Global Impact

The effect was felt not just in India. There could be between 200,000 and 400,000 excess TB deaths globally in 2020, according to the prediction of the modeling analysis presented in the report. Compare that with a little over 1,000,000 COVID-19 deaths till now.

Years of progress made in the fight against the TB could be undone. “An increase of 200,000 would take the world back to 2015 levels and an increase of 400,000 to 2012 levels,” the report said.

India, Indonesia, the Philippines and South Africa account of 44 per cent of global TB cases. These countries would bear the maxium brunt of COVID-19- induced TB problems.

In Indonesia, monthly notifications fell sharply between March and May, with some signs of a modest recovery in May.

“Compared with the rest six months of 2019, monthly notifications in the rest six months of 2020 were approximately 25–30 per cent lower in India, Indonesia and the Philippines,” the report said.

Source: WHO World TB Report 2020

Why decline?

The report cited many plausible reasons for this decline. Reallocation of TB resources — the staff and digonsitic kits — was one.

“Many countries reported the use of GeneXpert machines for COVID-19 testing instead of diagnostic testing for TB (43 countries including 13 high TB burden countries, including India), reassignment of staff in national TB programmes to COVID-19 related duties and reallocation of budgets (52 countries including 14 high TB burden countries, including India),” the report said.

The other probable reason cited was that people were generally discouraged from seeking healthcare and were encouraged to delay it during the months of the lockdown if it was not urgent. There were general advisories to do so to avoid crowding in health facilities.

Delay in procurement and transportation of TB medicines and other laboratory consumables; restrictions on the movement of people and loss of wages making it difficult to access health centres and a fear of stigma given the similarities in some clinical features of TB (for instance fever and cough) with those of COVID-19, excerbated the problem.

Economy contraction and TB 

Due to the pandemic, the global gross domestic product will contract by 5.2 per cent in 2020, with many countries reporting a much steeper decline, according to World Bank estimates.

“Negative impacts on employment opportunities threaten the livelihoods of many millions of people and those most at risk of developing TB are among the most vulnerable,” the global report said. Not just indivudals, even the governments are suffering. And, this in turn, may force governments to divert resources meant for TB mitigation to COVID-19 response.

The WHO has also suggested several measures to mitigate this impending TB disaster including maximising remote care for these patients through the use of technology and providing TB patients with at least one-month supply of drugs to reduce the visits to healthcare centres, among others.

The world as a whole, is nowhere close to meeting the targets of the 2020 milestones of the ‘End TB Strategy’. As against an aim of reducing TB cases by 20 per cent from 2015-2019, the actual reduction has been just nine per cent.

As for TB deaths, the aim was to reduce them by 35 per cent from 2015-2019. But they could be reduced only by 14 per cent, the WHO analysis said.

Eight countries continue to be home to two-thirds of the global total. India is followed by Indonesia (8.5 per cent), China (8.4 per cent), the Philippines (6 per cent), Pakistan (5.7 per cent), Nigeria (4.4 per cent), Bangladesh (3.6 per cent) and South Africa (3.6 per cent).

Drug-resistant TB continues to be a public health threat. Three countries that had the largest burden of these cases include India (27 per cent), China (14 per cent) and Russia (14 per cent).

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