New Delhi: The Covid-19 pandemic and its consequences could derail India’s target of ending tuberculosis by 2025, notes an editorial in the Indian Journal of Medical Research (IJMR).
A monthly peer-reviewed journal, IJMR is a publication of the country’s apex medical research body Indian Council of Medical Research (ICMR).
An editorial titled ‘COVID-19 & the National Tuberculosis Elimination Programme of India’, published Friday, noted that India may not be able to achieve its ambitious plan of ending TB by 2025 because of the increasing focus and diversion of resources to Covid-19.
Other issues such as over-utilisation of laboratories meant for TB work, re-deployment of care workers, difficulty in movement of TB patients and supervisors to supervise treatment and lack of contact-tracing will adversely affect the outcomes, the article pointed out.
Authored by Digambar Behera, from the department of pulmonary medicine, and Ranjan Kumar Behera, from the department of ophthalmology, at the Postgraduate Institute of Medical Education & Research in Chandigarh, the editorial advises prioritising “various recommendations by different agencies” to regain some of the ground lost in the past year and a half.
According to the authors, other areas in need of augmentation include the alignment of the TB-Covid diagnostic and vaccination drives, active early case detection and porting, engaging participation of the private sector for providing care and mitigation of societal fear and stigma.
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 (2017-2025).
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.
Poor TB care due to Covid focus
According to the authors, treatment interruptions of new as well as drug resistant (DR)-TB cases, particularly those receiving short-course therapies, could have disastrous consequences.
“One does not know what will be the end result if treatment is stopped for a few days or weeks out of the currently used short course and standard longer duration of therapy, leading to poor quality of TB care and adverse outcomes,” the editorial said.
Moreover, since the symptoms of both diseases — Covid and TB — are similar, the diagnosis of tuberculosis can also be delayed, according to the article. “It can also lead to the worsening of stigmatization of TB patients,” it said.
The notifications of TB cases through Nikshay — an online case notification system — are an important component of the ‘End TB’ strategy but Covid-19 hindered this process.
According to the Nikshay dashboard notification, the TB cases between 1 January and 31 December 2020 numbered at just 60 per cent (18.02 lakh) of the year’s target of 25 lakh.
The case notifications from the public sector was 12.52 lakh (65 per cent of the target) and from the private sector, it was 5.5 lakh (52 per cent of the target).
“Till April 23, 2021, the case notification to the system was 6.36 lakh and with the current surge in COVID-19 again, the figure may likely be affected,” the article said.
Migrant workers and TB
The article also touched upon some India-specific issues regarding TB and Covid-19. It noted that the migrant workers’ exodus that took place following the nationwide lockdown in March 2020 also led to an interruption of treatment.
The authors added that the loss of earnings for workers, migrants and otherwise, will also lead to malnutrition, making them more susceptible to developing TB.
“Many co-infected cases with TB will be an issue both for the availability of ventilators, and more importantly, how to handle sputum-positive TB cases on ventilators,” they said.
(Edited by Rachel John)
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