Researchers call for real-time tuberculosis data like Covid-19 dashboards

“It is not widely appreciated by the lay public that although the direct death toll from Covid-19 is estimated to be about 4·5 million people over an approximately 18-month period, the sustained death toll from tuberculosis over the past decade has been close to about 20 million people. A public-facing dashboard for tuberculosis has now been instituted in the Western Cape province of South Africa,” said Dr Zarir Udwadia, pulmonologist at P D Hinduja Hospital and Medical Research Centre, Mumbai, who is also among the key authors of the series.

App-based HIV self-testing programmes have already shown great promise, and their potential could be expanded to include tuberculosis testing, Dr Madhukar Pai, professor at McGill International TB Centre, McGill University, Canada, said.

“Almost one in three (around 3 million) people with active tuberculosis, even in the pre-Covid-19 era, remained undiagnosed or unreported globally. These individuals act as a potential reservoir for transmission. The majority of these so-called missing individuals often reside in peri-urban informal settlements of large cities in Africa and Asia. We need to take tuberculosis testing closer to where people live and work. Active case-finding strategies have always had important implications for tuberculosis prevention and reduced amplification of the epidemic even before the advent of Covid-19,” said Prof Keertan Dheda, head of the University of Cape Town’s Division of Pulmonology in South Africa.

According to the report, Covid-19 has set tuberculosis control efforts back by about a decade. “Compared with 2019, tuberculosis case detection in 2020 was reduced by 18 per cent globally (a decrease from 7.1 million to 5.8 million cases) and by around 24 per cent in the ten worst-affected countries with high tuberculosis burden. India, Indonesia, the Philippines, and China account for 1·3 million cases (93 per cent) in the global decline in tuberculosis case detection. Major reductions in notified cases have been seen in the Philippines (37 per cent), Indonesia (31 per cent), South Africa (26 per cent), and India (25 per cent),” it said.

“In 2020, the number of tuberculosis cases from India notified to the World Health Organisation (WHO) was 16,29,301, a reduction of 25.1 per cent from the 2019 number (2 1,76,677). At least 30 million people have developed Covid-19 in India, and a devastating second wave has left many individuals with severe acute respiratory distress syndrome, a proportion of whom might develop post-Covid fibrotic sequelae. India also has the largest number of people living with chronic fibrotic lung scarring caused by tuberculosis. Post-Covid sequelae superimposed on post-tuberculosis fibrosis are likely to result in considerable disability in many of these individuals. New strategies involving triage tools and innovative active case-finding interventions require an urgent implementation to reverse these alarming trends,” researchers said in the report.

The report also alluded to the Swiss cheese respiratory pandemic defence model created by virologist Ian Mackay.

“The model has several layers of Swiss cheese to illustrate the fact that a single layer of protection will not be enough to stop Covid-19. Because of the holes in each slice, the coronavirus will always get through; therefore, multiple layers of protection are needed to halt the pandemic. We need a similar, comprehensive approach for tuberculosis, captured in the tuberculosis Swiss cheese model, with three broad levels: societal, personal, and person-centric health-care,” researchers said.