Disruptions in services caused by the Covid-19 pandemic have led to further setbacks and according to a new report, there has been a 25 to 30 per cent drop in tuberculosis (TB) case notifications across three high-burden countries – India, Indonesia and the Philippines – between January and June 2020 compared to the same period a year before.
The Global TB report, released on Wednesday by the World Health Organisation, has collated data from over 200 countries that has shown significant reductions in TB case notifications. These reductions in case notifications could lead to a dramatic increase in additional TB deaths, according to WHO modelling. Their analysis of the pandemic’s impact on TB mortality indicates that a 50 per cent drop in the detection of TB cases over three months will lead to almost 4,00,000 more people dying from TB.
“The Covid-19 pandemic threatens to reverse recent progress in reducing the global burden of TB disease, if health services are disrupted to the extent that the number of people with TB who are detected and treated falls by 25–50 per cent over a period of three months,” Dr Tereza Kasaeva, director, WHO Global TB Programme, said at a virtual media conference.
In 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, following the imposition of a national lockdown. Subsequently, there has been some recovery, but as of the end of June, not to pre-March levels. Compared with the first six months of 2019, monthly notifications in the first six months of 2020 were approximately 25–30 per cent lower in India, Indonesia and the Philippines.
Notifications of new people diagnosed with TB and relapse cases in the country increased from 1.2 million in 2013 to 2.2 million in 2019. This followed the introduction of a national policy of mandatory notification in 2012, and the roll out (also since 2012) of a nationwide web- and case-based reporting system (called ‘Nikshay’), which facilitates reporting of detected cases by care providers in the public and private sectors.
According to the data from the Central TB division, Union Ministry of Health and Family Welfare, as against 12.50 lakh TB cases that were notified to the National TB Elimination Programme from January till June 2019, a total of 9.15 lakh TB cases were notified with officials in the same period this year.
Prof Madhukar Pai, Canada Research chair in epidemiology and global health and Director of McGill International TB Centre, said the Global TB report 2020 confirms what we know that TB services have been seriously disrupted in India. “It is worrisome that the disruptions extend over several months rather than just weeks. The first pressing priority is to catch up on all the missed patients. India alone needs to actively find over half a million persons with TB who were missed during the past six months and offer them TB treatment,” Prof Pai told The Indian Express.
Globally, approximately 1.4 million people died from TB-related illnesses in 2019. Of the estimated 10 million people who developed TB last year, some 3 million were not diagnosed with the disease, or were not officially reported to national authorities. The number of people who fell ill with TB has been declining very slowly in recent years.
Prior to the Covid-19 pandemic, many countries were making steady progress in tackling TB with a 9 per cent reduction in the incidence seen between 2015 and 2019 and a 14 per cent drop in deaths in the same period. High-level political commitments at global and national levels were delivering results. “The Global TB 2020 report is a sobering one and the Covid-19 pandemic has now made it harder to getting back on track,” Peter Sands, Executive Director, Global Fund, said during the media conference.
“Now we will need to tap into some of the innovations that are being used for Covid-19 -like public education via WhatsApp, greater use of masks among people with respiratory symptoms, use of screening apps and contact tracing apps, tele-health consults, novel sample collection closer to homes of patients, rapid molecular testing to check for both Covid-19 and TB e-pharmacies to home deliver medicines and digital adherence technologies to ensure treatment completion,” Prof Pai said.
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