AMID the ongoing Covid outbreak and what it called its “unprecedented demands”, the Union Health Ministry underlined the need to maintain essential health services. With the health infrastructure in states strained fighting Covid, tuberculosis seems to be one of the first casualties.
Public records on the Nikshay dashboard, the official database for TB across the country, between February 14 and 29 — the corona outbreak came on the national radar in early March — as many as 1,14,460 TB cases were notified. Of these, 83,697 were from the government sector, the rest from private hospitals.
Between April 1 and 14 that number has dramatically shrunk to just 19,145 with 15,813 being notified by the government sector.
For the entire three-week lockdown period, the total number of notifications is 34,566.
This when the disease, according to government estimates, kills an average of 1,400 people per day in India.
This sharp drop in notifications, experts warn, could not just lead to a rise in transmission of the disease as patients miss out on medical care and continue to spread the disease, but also worsen outcomes at a later stage and even accelerate dropouts from TB’s long treatment cycle.
Uttar Pradesh, the state with the highest TB burden in the country, deferred an active case finding campaign for TB that was to occur between April 20 and 30 in 31 districts of the state.
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“Our field workers are deployed for COVID work. The OPDs in government hospitals are not functioning, private clinics have closed down. Even patients who are symptomatic cannot access facilities. The notifications have dropped because of that. It is not just the case in UP but this is a countrywide phenomenon,” said state TB officer Santosh Gupta.
“We have about 4,75,000 active cases. It is a huge challenge to get medicines to them. We are trying our best to ensure that their treatment is not disrupted,” he added.
Notification is key to TB’s treatment plan. It helps ensure that patients get and complete their medicine course and the monthly Rs 500 nutrition support.
India, as per a pledge by Prime Minister Narendra Modi, is working to end TB by 2025, five years ahead of the global goal. While field staff for TB are mostly deployed on Covid duty, TB testing machines, too, are being requisitioned for Covid testing.
Dr Madhukar Pai, Canada Research Chair in Epidemiology & Global Health and Director, McGill International TB Centre at McGill University, has been watching this carefully. When contacted, he told The Indian Express: “India should act soon to resume routine TB services. Otherwise, too many people will be in grave danger. At a minimum, existing TB patients should be called to check on their health, and TB medicines should be supplied to them via courier, or via local pharmacies. Tele-consultations could be offered, and e-pharmacies could be leveraged. But that still might not address new TB patients who are yet to be diagnosed.”
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The red flags, incidentally, came early. The Union Health Ministry’s guidance document on essential services released Tuesday cited the Ebola outbreak to highlight how routine health services could be derailed. “Analyses from the 2014-2015 Ebola outbreak suggests that the increased number of deaths caused by measles, malaria, HIV/AIDS and tuberculosis attributable to health system failures exceeded deaths from Ebola,” the guidance said.
On the ground, though, it is easier said than done. Lockdown logistics is the key hurdle and negotiating car passes, coordinating with police and directions to field staff to reach out to TB patients — all are being tested by the Covid firefighting.
Said K N Sahay, state TB officer for Bihar: “80 per cent of my staff has been deployed for Covid and I have 125,000 TB patients currently on treatment. We are trying our best to ensure drugs are supplied but it is a difficult task. Cars are not being allowed without passes; on the other hand patients cannot come because of the lockdown. We are trying our best.”
TB is a notifiable disease since 2012. Globally, India has the highest TB burden. According to the national strategic plan for Tuberculosis Elimination 2017-2025, TB continues to be India’s “severest” health crisis. Each year, it kills an estimated 480,000 Indians. And “more than a million ‘missing’ cases every year. are not notified and most remain either undiagnosed or unaccountably and inadequately diagnosed and treated in the private sector.”
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