New Delhi: Though Covid-19 has strained the health infrastructure across India, Bihar appears to be one of the worst affected. Over 70 per cent of the staff meant for tuberculosis control and testing were reassigned to Covid duty and continue to be in that role, even as other states have started returning them to their original roles.
This has led to a massive decrease in TB notifications in Bihar this year. According to public records on the Nikshay dashboard, the official database for TB in India, as many as 63,617 cases have been notified in Bihar this year — 35,740 in government hospitals and 27,877 in private institutions.
In the same period last year (January-September), 91,836 TB cases were notified in Bihar, of which 58,413 were in the government sector and 33,423 in the private.
Overall, India has reported a 60 per cent decline in TB notifications due to the Covid-induced lockdown. The national TB programme has also estimated additional 5 lakh cases and 1 lakh deaths in the next five years.
Only 50% testing centres open
Speaking to ThePrint, K.N. Sahay, state TB officer for Bihar, said 54,000 patients are currently being treated under his watch, attributing the decline in notifications to the lockdown.
“All the testing centres were closed during the lockdown. Even now, only 50 per cent of those have opened,” Sahay said.
“One of the key challenges right now is that even if the treatment is initiated, we are not able to follow up… 70 per cent of my staff has still been deployed for treatment of Covid-19,” he added.
Doctors in Bihar say some TB patients have started seeking treatment after the lockdown was eased.
Dr Vinay Kumar, president of the Resident Doctors’ Association at AIIMS Patna, said: “About 6-7 per cent patients are coming back for TB-related OPDs. TB patients have largely been neglected in the state due to lockdown; there isn’t enough staff to test and control the disease. The upcoming Bihar elections have also diverted the attention of the authorities only to the fight against Covid-19.”
However, some doctors say the lockdown helped control the spread of tuberculosis.
Dr Prakash Sinha, consultant, pulmonary medicine & TB at Patna’s Paras Hospital, said: “Regular TB patients weren’t visiting us during the lockdown. They didn’t step out of their houses and were isolating, so the disease didn’t spread much.”
Human resource issue
Dr Nita Jha, a public-health professional working with World Health Partners in Bihar, explained that the notifications declined since private clinics were shut during the lockdown.
“Many doctors in Bihar got infected with the coronavirus, resulting in the shutting down of 80-90 per cent of clinics,” Jha said.
“All CBNAAT lab technicians were only involved in Covid-19 testing. Even though machines were available, lab technicians weren’t available,” she pointed out. CBNAAT — cartridge-based nucleic acid amplification test — is a TB diagnostic tool that has also been adapted for Covid detection.
“While it is true that other states have deployed TB staff back to their original commitments, it hasn’t happened in Bihar. I think scarcity of human resources is the biggest problem. There aren’t enough lab technicians in each district,” Jha added.
In order to combat this human resource issue, Sahay said, the state has started conducting dual screening for Covid-19 and TB, as mandated by a letter written to state governments by the Revised National TB Control Programme.
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