Covid-19 decelerates India’s fight against tuberculosis

Pandemic overwhelms Indian healthcare system

Society

March 24, 2021

/ By / New Delhi

Covid-19 decelerates India’s fight against tuberculosis

India accounts for nearly a quarter of global deaths due to TB, with 450,000 persons succumbing to it in 2019, as per WHO data

Focus on fighting coronavirus in India has led to a severe slippage in the long battle against tuberculosis in the country that is already home to the largest number of TB patients in the world.

Diagnosis and treatment of tuberculosis in the nine most impacted countries in the world fell by up to 41 pc on 2020, due to the coronavirus pandemic outbreak, says a report by Stop TB Partnership, a global body fighting the killer disease since 2000.

In its report published last week, Stop TB Partnership says the nine countries – Bangladesh, India, Indonesia, Myanmar, Pakistan, Philippines, South Africa, Tajikistan, and Ukraine – which account for 60 pc of global TB cases saw a decline of 1 million in diagnosis and subsequent enrolment for treatment, pushing the battle against TB back by 12 years. The drop in identification of the deadly disease fell anywhere from 16 to 41 pc in the nine nations.

For decades now, India has been known to have largest number of TB cases in the world. The country accounts for nearly a quarter of global deaths due to TB, with 450,000 persons succumbing to it in 2019, as per World Health Organisation data. With 2.64 million new infections, India was also home to 26 pc of the total new cases registered across the world in that year.

Yet, in 2020 with the government’s entire focus being on tackling the coronavirus, diagnosis and treatment of an equally fatal disease was pushed on the backburner. As a result, various studies estimate that India and other high burden countries missed detection of millions of new cases last year.

India saw a dramatic decline in TB notifications in the first half of the year as notifications (diagnosis) of new cases fell 70 pc between weeks 10 and 15 of 2020, says report by Stop TB Partnership.

In May 2020, Stop TB Partnership, in collaboration with Imperial College, Avenir Health, Johns Hopkins University conducted a modelling study on impact of  Covid-19 on TB services. The projections of the study showed that at the global level, 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. Global TB incidence and deaths in 2021 would increase to levels last seen in between 2013 and 2016, respectively – implying a setback of at least 5 to 8 years in the fight against TB due to the Covid19 pandemic.

Impact of Covid-19 on battle against TB

The onset of the pandemic and subsequent lockdowns, to curb the spread of the virus, aggravated the problem of inadequate testing and lack of awareness and access to treatment. While the Indian healthcare system nearly collapsed, as in many nations globally, trying to accommodate the ever increasing number of cases, other pre-existing severe health conditions got little attention.

The Covid19 pandemic turned into something far more hazardous for people already suffering from underlying health problems like diabetes, asthma, hypertension and tuberculosis. Evidence suggests patients with latent TB and other pulmonary disease have an increased risk of contacting Covid-19 and predisposition towards developing severe Covid19 pneumonia.

“Because of the precautions that the government is taking for corona, which is absolutely necessary, the rest of the services are suffering out. So the TB medicines that were given one at a time, as we monitored the developments and then prescribed the next medicine. But now we are giving one month medicine. Now many of the patients have to go out to get the medicine. With the transportation being affected many of the patients are not getting their regular supplies. Those patients are suffering,” Dr Vaishali Venu of Doctors For You, an NGO that provides medical care to vulnerable communities, told Media India Group,  in April 2020.

A latest report of July 2, 2020 by the Integrated Disease Surveillance Program, under the Ministry of Health and Family Welfare, India that analysed the death of 15,962 patients with Covid-19, found presence of any one or more comorbidities in 57 pc of patients, while 43 pc had no comorbidities.

Global concern over rising TB cases

The World Health Organisation has expressed concern over the disruption of TB services globally, especially in high burden settings  due to countrywide lockdowns imposed to reduce the effects of the ongoing pandemic.

Though India saw a sharp fall in detection of fresh cases in the initial few weeks of the pandemic last year, it did manage to increase the pace later in the year. In accordance with WHO guidelines, India has expanded the use of digital technology for remote advice and support and to reduce the need for visits to health facilities, virtual communication platforms such as e-Sanjeevani, a Government of India, integrated telemedicine solution have been set up.

The government also launched a Direct Benefit Transfer Scheme (DBT) in line with its ‘End TB’ strategy which aims at providing nutritional support to all TB patients. Under this scheme, INR 500 is to be transferred in the bank accounts of the beneficiaries.

Though many beneficiaries have complained of substantial delays in transfer of payments, some also reportedly felt that the amount was not sufficient. However, there have also been many success stories of people receiving financial aid and affordable treatment at government health centres. One such person is Vinod Kumar, a resident of Agwanpur village, Faridabad in Haryana. A former TB patient, Vinod still vividly remembers his battle with the notorious killer. “I had to stay at home for 5-7 months during the treatment, my brother and sister-in-law took me to the government aided clinic where we didn’t have to pay anything for the treatment and medicines,” Vinod tells Media India Group. He says that the pandemic did not disrupt his treatment at all, adding “I received all my medicines on time even during the pandemic.”

Fighting the stigma

The problems faced by TB patients in India are a perfect example of the physical as well as the social implications of  this disease. The stigmas around TB lead to limited social participation and in extreme cases complete exclusion from the society which may result in economic burden for the household and severe emotional and mental distress for the patients. This makes it difficult for patients to get access to adequate treatment for the disease.

Apart from all these concerns the fact that Covid-19 and TB have similar symptoms such as coughing, shortness of breath and fever, and the stigma around tuberculosis has made it even tougher for patients to get an early diagnosis and, with that a chance to survive.

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1 COMMENTS

  1. Avatar Harley Kalscheuer says:

    Sincerely thanks!

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