One year since the Covid-19 pandemic began, a new report released on Thursday showed that nine of the countries (including India) with the most tuberculosis (TB) cases —representing 60% of the global TB burden — saw a drastic decline in diagnosis and treatment of TB infections in 2020, ranging from 16% to 41% (with an average of 23%).
The drop brought the overall number of people diagnosed and treated for TB in those countries to 2008 levels, a setback of 12 years, but India has still made a good recovery, Dr Lucica Ditiu, executive director of the Stop TB Partnership, a United Nations-hosted entity based in Geneva, Switzerland, told media persons at a virtual conference after releasing the report on Thursday.
India was one of the first countries where the dramatic decline in TB notifications (70% decline between weeks 10 and 15 of 2020) was noticed as an impact of Covid-19 pandemic. But it has stepped up its recovery process.
In 2020, over 6.3 lakh TB patients were tested for Covid-19 and more than 5,000 had both Covid-19 and TB. “We have spent $ 137 million dollars as nutritional support to TB patients in India in the last three years,” Union Minister of Health and Family Welfare Dr Harsh Vardhan said while responding to a query from The Indian Express at an online conference.
Overall in India in 2020, TB notification was down by 25 per cent but month wise data shows that TB notifications gradually picked up later and by December 2020, TB notification was back to December 2019 level, said an official from the Central TB division, Union Ministry of Health and Family Welfare.
No country has a higher TB burden than India which accounts for a quarter of the 10 million global TB cases and 1.4 million TB deaths each year.
The findings released on Thursday were determined by looking at the diagnosis and treatment statistics for Bangladesh, India, Indonesia, Myanmar, Pakistan, Philippines, South Africa, Tajikistan, and Ukraine – nine countries that together represent 60% of the global TB burden – and comparing data from 2020 with 2019.
In these countries, TB diagnosis and enrolment on treatment in 2020 declined by a total of 1 million, ranging from 16% to 41% (an average of 23%) in individual countries,
In addition to the worldwide drop in TB diagnosis and treatment, data emerging from India and South Africa shows that people coinfected with TB and Covid-19 have three times higher mortality than people infected with TB alone. This makes contact tracing, case finding and bi-directional TB and Covid-19 testing essential, the report has said.
Dr Harsh Vardhan, while addressing the conference, said to mitigate the Covid-19 pandemic on TB services , bi-directional screening of TB and Covid-19 took place in people displaying influenza-like illness and severe acute respiratory infections. “At least 24 per cent of TB patients knew Covid-19 status in 2020,” said Dr Harsh Vardhan.
TB is top priority and a mass movement `TB Mukt Bharat’ has been launched to end the disease by 2025, Dr Harsh Vardhan said.
“One rapid molecular diagnostic facility has been set up in each district and plans are underway to decentralise to block level, including introducing newer drugs for effective treatment of drug resistant TB,” said Dr Harsh Vardhan.
A rapid response plan was developed by August 2020. Efforts to locate TB and Covid-19 cases in all healthcare facilities intensified, and rapid molecular testing for TB expanded. Contact tracing systems and testing for TB linked to Covid-19 contact tracing were quickly set up. Private-sector TB care facilities were reopened, and digital tools were rolled out to help people with TB stick to treatment regimens, among other measures, said Dr Harsh Vardhan.
Since March 2020, the Covid-19 pandemic has severely disrupted TB responses in low-and middle-income countries, stalling and reversing years of progress made against TB.
In May 2020, a modelling study conducted by the Stop TB Partnership in collaboration with Imperial College, Avenir Health, Johns Hopkins and the United States Agency for International Development (USAID) predicted the impact of Covid-19 related measures on TB. It showed that globally, a three-month lockdown followed by a protracted 10-month restoration could lead to an additional 6.3 million cases of TB between 2020 and 2025 and an additional 1.4 million TB deaths during this time.
This suggested that global TB incidence and deaths in 2021 could increase to levels last seen between 2013 and 2016, respectively – implying a setback of at least 5 to 8 years in the fight against TB. In March 2021, data from several countries showed that the impact on TB diagnosis and treatment happened as was assumed in the modelling.
However, the recovery has taken longer than expected, and as of March 2021, it is not complete in most high TB burden countries.