Tuberculosis is a deadly infectious disease. In 2018, there were more than 10 million cases of active TB which resulted in 1.5 million deaths ("Global Tuberculosis Report" (PDF). WHO. WHO. 2019. Retrieved 24 March 2020). Tuberculosis control programs are mandatory to save lives. I assume due to the COVID-19 pandemic, tuberculosis control programs are getting less attention. Qiao Liu et al. in the attached article opined that the Covid-19 pandemic may impede global tuberculosis elimination goals. In Jiangsu Province, China, tuberculosis notifications dropped 52% in 2020 compared to 2015-2019. Treatment completion and screening for drug resistance decreased continuously in 2020. Urgent attention must be paid to tuberculosis control efforts during and after the Covid-19 pandemic. In this context, in your opinion what could be the possible impacts of COVID-19 on tuberculosis?
Harasit Kumar Paul Thanks for your precious and salient comment. In addition to distraction of people and health services from TB eradication programme, i want to mention here the devastating and perilous outcome of co-infection with these pathogens can cause in the lungs. As you know, we are discussing about two lethal maladies which affect lungs. So the co-infection can lower the possibility of relieves and thereby low survival rates in respiratory wards and ICUs.
Existing lung conditions increase susceptibility and risks of coronavirus disease progression (Gralinski et al., 2015; Baric et al., 2016). Coronavirus replication is higher in infected lungs (Gralinski & Baric, 2015). Decline in muscle endurance and strength increases the susceptibility of elderly to coronavirus infections (Rojas et al., 2015). I think this might be applicable to the case of tuberculosis.
Banik, G. R., Alqahtani, A. S., Booy, R., & Rashid, H. (2016). Risk factors for severity and mortality in patients with MERS-CoV: Analysis of publicly available data from Saudi Arabia. Virologica Sinica, 31(1), 81-84.
Gralinski, L. E., Ferris, M. T., Aylor, D. L., Whitmore, A. C., Green, R., Frieman, M. B., ... & Bell, T. A. (2015). Genome wide identification of SARS-CoV susceptibility loci using the collaborative cross. PLoS Genet, 11(10), e1005504.
Rojas, M., Mora, A. L., Kapetanaki, M., Weathington, N., Gladwin, M., & Eickelberg, O. (2015). Aging and lung disease. Clinical impact and cellular and molecular pathways. Annals of the American Thoracic Society, 12(12), S222-S227.
Interesting facts from Stop TB partnership
http://www.stoptb.org/assets/documents/covid/Covid%20impact%20on%20TB%20Modeling_Key%20Messages_FINAL.pdf
Article The burden of COVID-19 in Brazil is greater in areas with hi...
Initial analyzes show that in the case of TB vaccination, the course of COVID-19 disease is milder
Dear Mohammad Hossein Razizadeh thanks for your valued contribution. Yes, it is evident that the co-infection (COVID-19 and Tuberculosis) can lower the possibility of recovery and thereby low survival rates in respiratory wards and ICUs. I appreciate your response.
Dear Michael Halim thanks for your comments. You have rightly mentioned that existing lung conditions increase susceptibility, risks of coronavirus replication, and disease progression. Thanks for this important information and the useful references you shared.
Dear Saad Alghamdi , Carlos Dornels Freire de Souza thanks for the important links you shared. I appreciate your efforts.
Dear Łukasz Szarpak thanks for your answer. You have raised an important issue of BCG vaccination and the course of the COVID-19. It is appreciable.
https://www.theunion.org/news-centre/news/impact-of-covid-19-on-tb-diagnosis-in-northeastern-brazil
C'est une bonne question, sur quatre patients reçu co infection tuberculose-Covid, deux sont décédés, un avec des séquelles et un autre en bonne évolution mais nous craignons toujours les séquelles à la longue
Dear Carlos Dornels Freire de Souza thanks for the link you shared. It might help me for a better understanding.
Cher Muderhwa Busingo Justin merci pour votre réponse. Vous avez soulevé la question de la co-infection tuberculose-COVID. Parmi quatre patients que vous avez rencontrés, deux sont décédés, un a développé des séquelles. Cela signifie que 75% avaient un mauvais pronostic. C'est une information importante.
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Dear Muderhwa Busingo Justin thanks for your response. You have raised the issue of tuberculosis-COVID coinfection. Among four patients you encountered, two died, one developed sequelae. That means 75% had a bad prognosis. It is a piece of important information.
Disruptions in movements due to COVID-19 caused dramatic decline in case finding efforts. The IPC measures and commodities demand for COVID resulted in scarcity of masks.
Dear Stavia Turyahabwe thanks for your valued response. You have rightly said the COVID-19 pandemic caused a dramatic decline in TB case finding efforts.
Tuberculosis (TB) and COVID-19 are both infectious diseases that attack primarily the lungs. Both diseases have similar symptoms such as cough, fever, and difficulty breathing. TB, however, has a longer incubation period with slower onset of disease. TB patients should take precautions as advised by health authorities to be protected from COVID-19 and continue their TB treatment as prescribed. Health services, including national programs to combat TB, need to be actively engaged in ensuring an effective and rapid response to COVID-19 while ensuring that TB services are maintained. WHO Global TB Programme, along with WHO regional and country offices, has developed an information note to assist health authorities in doing so. Measures must be put in place to limit transmission of TB and COVID-19 in congregate settings and health care facilities, as per WHO guidelines.
https://www.who.int/teams/global-tuberculosis-programme/covid-19
Please see the following link:
https://erj.ersjournals.com/content/early/2020/07/23/13993003.02710-2020
Harasit Kumar Paul
TB, however, has a longer incubation period with slower onset of disease. While experience on COVID-19 infection in TB patients remains limited, it is anticipated that people ill with both TB and COVID-19 may have poorer treatment outcomes, especially if TB treatment is interrupted.
www.who.int › teams › covid-19
Dear Raya Al-Naimi , Serdar Kalemci
thanks for your valued responses.
Dear Manal Hadi Kanaan thanks for your response and the links you shared. You have mentioned that the health services need to be actively engaged in ensuring an effective and rapid response to COVID-19 while ensuring that TB services are well maintained. I support your viewpoints.
Dear Nirmala S.V.S.G thanks for your valued response and the link you shared. You have rightly said that experience on COVID-19 infection in TB patients remains limited and the people infected with both TB and COVID-19 may have poorer outcomes, especially if TB treatment is interrupted. I agree with your views.
1. If known TB patients are infected with SARS-COV-2 its impact will be devastating for the patients but they might gate appropriate treatment for the TB which will help them to get better.
2. If unknown TB patients are infected with SARS-COV-2 its impact will be more devastating for the patients even the patient might die because now days if you have symptoms of COVID-19 and tested positive it will be considered that your illness is due to COVID-19 not other diseases and the TB might kill this patient because he didn't get the treatment he need.
So COVID-19's impact of TB case is high.
Dear Shimelis Teshome Ayalneh thanks for your nice response. I appreciate your point of view.
Dear Prof Harasit Kumar Paul, your topic of discussion is a time-demanding one to accentuate the efforts for TB control & prevention during this pandemic era, particularly in the TB-prone countries.
Dear Md Rabiul Alam thanks for your valued comments. I support your viewpoints that every tuberculosis prevalent country should strengthen its TB control programs during this pandemic, otherwise TB itself could threaten our existence.
Dear Harasit It is true that Tuberculosis control program is getting less attention due to Covid 19 pandemic but precautionary measures like social distancing, use of mask and sanitizer will surely reduce the spread of tuberculosis
Dear Gopal Chauhan thanks for your excellent response. You have well said that social distancing and the use of face masks might reduce the spread of tuberculosis. I acknowledge your point of view.
Dear Harasit Kumar Paul According to Husain and coworkers, literature concerning effect of Covid-19 infection on the patients are very limited, in case of coinfection they anticipated poorer treatment outcomes. Please go through the link given below:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7434422/
Like tuberculosis, the new coronavirus infection affects the lungs, and its symptoms - cough and fever - can mimic tuberculosis. It is likely that people with lung damage, in particular those with tuberculosis, or people with weakened immunity, as with a high viral load against the background of HIV, in the event of infection with COVID-19, will carry coronavirus infection in a more severe form. In addition, tuberculosis is common in densely populated areas, which increases the risk of contracting coronavirus infection for tuberculosis patients, especially in overcrowded settlements with poor access to clean water and medical care.
Health systems, especially in resource-limited countries, will be under significant strain from the pandemic. We know from past examples that with limited access to medicines, diagnosis and treatment of life-threatening diseases, including tuberculosis, mortality from such diseases increases.
Together with the global response to the coronavirus epidemic, health authorities, partner organizations and international donor organizations must make every possible effort to maintain essential services and reduce risks to vulnerable groups.
Given the high risk of severe coronavirus infection in TB patients, efforts to mitigate the effects of the pandemic should include the provision of personal protective equipment for caregivers and caregivers, diagnosis of coronavirus infection, and isolation if suspected and confirmed to prevent further infection.
There is very little data on COVID-19 / TB co-infection or COVID-19 in people with a history of tuberculosis. It is possible that people with damaged lungs may have worse outcomes with COVID-19.
Regards, Sergey Viktorovich Pushkin
Dear Arbind K. Choudhary thanks for your contribution and the valued link you shared. I do agree with you that COVID-19 and TB coinfections might lead to poorer treatment outcome.
Dear Sergey Viktorovich Pushkin for your excellent response. You have well said that health systems especially in resource-poor countries are under significant strain from the pandemic. There is limited access to medicines, limited diagnostic and treatment facilities of life-threatening diseases like tuberculosis might have an increase in mortality from such diseases.
Dear M.K. Tripathi
thanks for your nice response. I realize your comment.
Dear Suhad Mohammed thanks for your response. I realize your viewpoints.
Please this link
https://theunion.org/news/impact-of-the-covid-19-pandemic-on-the-detection-of-tb-in-shanghai-china
Dear Marwah Firas Abdullah Al-Rawe
thanks for your interest in the topic. You are welcome.
Dear Lamia Mustafa Al-Naama thanks for sharing an important link. I appreciate your efforts.
We are currently facing a reality, and that is that patients with covid can suffer from coinfections and that these clearly influence the clinical outcome.
Article Are we now observing an increasing number of coinfections be...
In my clinical experience we have seen a patient with coinfection with TB and, another one with HIV, both undergoing management for their pathology, the patients, despite being symptomatic and having clinical manifestations of about a month, did not present complications or ventilatory requirements, both manuscripts are in the process of publication.
Dear Jorge Andrés Sánchez-Duque, thanks for your valued contribution and the shared link. You have raised a pertinent issue of COVID patients who presents with coinfections that might influence the outcome. I appreciate your response.
While experience on COVID-19 infection in TB patients remains limited, it is anticipated that people ill with both TB and COVID-19 may have poorer treatment outcomes, especially if TB treatment is interrupted. TB patients should take precautions as advised by health authorities to be protected from COVID-19 and continue their TB treatment as prescribed. https://www.who.int/teams/global-tuberculosis-programme/covid-19#:~:text=While%20experience%20on%20COVID%2D,TB%20treatment%20as%20prescribed.
People ill with COVID-19 and TB show similar symptoms such as cough, fever and difficulty breathing. Both diseases attack primarily the lungs and although both biological agents transmit mainly via close contact, the incubation period from exposure to disease in TB is longer, often with a slow onset.
.http://www.who.int/tb/COVID_19considerations_tuberculosis_services.pdf#:~:text=People%20ill%20with%20COVID%2D,with%20a%20slow%20onset.
COVID-19 outbreak had an impact on both short-term and long-term global tuberculosis control. In addition to model prediction, little is known about the specific impact of COVID epidemic on TB. https://erj.ersjournals.com/content/early/2020/07/23/13993003.02710-2020
While experience on COVID-19 infection in TB patients remains limited, it is anticipated that people ill with both TB and COVID-19 may have poorer treatment outcomes, especially if TB treatment is interrupted. TB patients should take precautions as advised by health authorities to be protected from COVID-19 and continue their TB treatment as prescribed.
Dear Chinaza Godswill Awuchi thanks for the response and the useful link you shared. You have well said that coinfection with both TB and COVID-19 may have poorer treatment outcomes. I appreciate your thoughts.
Dear Chinaza Godswill Awuchi, you have raised a valued issue that the COVID-19 outbreak will have an impact on both short-term and long-term global tuberculosis control. I appreciate your thoughts. Thanks for the links you shared.
COVID-19, sarcoidosis and tuberculosis are closely related with proinflammatory cytokines especially with IL-2, IL-2R that activate NF-kB.
These disorders may be cured with exploring medical mechanism.
Dear Isam Alkhalifawi, thanks for your nice contribution. You have well said that coinfection with both TB and COVID-19 may have poorer treatment outcomes. So, TB patients should follow every personal protective measure with due sincerity.
Dear Masato Hada thanks for your valued response. I realize your viewpoints.
Worryingly, the COVID-19 pandemic has the potential to slow down and eliminate previous gains in TB control. It is expected that the similarities in the symptoms between the two diseases is a double-edged sword that will either facilitate or hinder screening and detection of both diseases. https://theunion.org/news/impact-of-covid-19-on-tb-care-experiences-of-a-treatment-centre-in-nigeria
Initial assessment of COVID-19 on TB treatment has brought to the fore some of the major impacts of the pandemic. In 2020, there has been a marked reduction in the number of presumptive cases and TB case detection in comparison to 2019. There were no deaths reported, however, there were occasional reports of the failure to fulfil follow-up appointments. COVID-19 has restricted access to diagnostic assessment, as indicated by the declining number of presumptive cases, and to uninterrupted treatment. The greater the number of symptomatic individuals tested, the greater the number of TB cases that would likely be detected https://theunion.org/news/impact-of-covid-19-on-tb-care-experiences-of-a-treatment-centre-in-nigeria
Dear Chinaza Godswill Awuchi thanks for your valued contribution and the shared link. You have rightly said COVID-19 pandemic has the potential to slow down previous gains in TB control. It is essential to run all of the ongoing disease prevention and control programs with due importance.
Dear Chinaza Godswill Awuchi, yes, it is a fact that in 2020, there has been a marked reduction in the number of TB case detection in comparison to 2019. It is alarming. I do hope and believe that every concerned authority would look into the issue seriously. Thanks for your valued contribution.
Please go through the following RG links and a PDF attachment.
Article The potential impact of COVID-19-related disruption on tuber...
Article Anticipating the impact of the COVID-19 pandemic on TB patie...
Article Impact of COVID-19 on tuberculosis services in India
Article Insight into impact of COVID-19 epidemic on tuberculosis bur...
Arvind Singh, you have added an ample number of valued links. It is highly appreciable. Thanks for your efforts.
Ijaz Durrani
thanks for your excellent contribution. You have well said that TB patients should take preventive measures against COVID-19 as advised by the health authorities and continue their TB treatment as prescribed.I acknowledge your response.
The preventative measures against COVID-19 (i.e. facemasks and social distancing) will also reduce the risk of transmission of tuberculosis.
Also, take a look at the following RG link.
Article The impact of COVID-19 on TB: a review of the data
Article Impact of the COVID-19 pandemic on tuberculosis management in Spain
Also visit the following links for more insight.
https://www.nejm.org/doi/full/10.1056/NEJMp2118145
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00006-8/fulltext
Patients suffering from tuberculosis are at an increased risk of contracting COVID-19 due to co-morbidity and they should be vaccinated.