There is no evidence to indicate a rise in tuberculosis (TB) cases due to the COVID-19 pandemic according to the Union Ministry of Health and Family Welfare. However, they do suggest that COVID-19 patients may be more susceptible to contracting TB and, as such, surveillance efforts ought to be scaled up.
“Due to the impact of COVID-19-related restrictions, case notifications for TB had decreased by about 25 percent in 2020 but special efforts are being made to mitigate this impact through intensified case finding in OPD [outpatient department] settings as well as through active case finding campaigns in the community by all states,” the Government said.
As with other diseases such as mucormycosis, or black fungus, the Health Ministry described TB as “opportunistic” and recommended screening for TB among COVID-19 patients and vice versa. It said “convergence” has been requested from states and union territories in disease surveillance and tracking as early as August of 2020.
The Ministry highlighted the complications of a dual morbidity of COVID-19 and tuberculosis, noting similar symptoms. “The dual morbidity of TB and Covid-19 can be further highlighted through the facts that both the diseases are known to be infectious and primarily attack the lungs, presenting similar symptoms of cough, fever and difficulty in breathing, although TB has a longer incubation period and a slower onset of disease,” it said.
In addition, “TB bacilli can be present in humans in a dormant state and has the potential to start multiplying when the individual’s immunity is compromised for any reason,” the Union Health Ministry said. “The same is applicable in post-COVID scenarios, when an individual may develop decreased immunity due the virus itself or due to the treatment, especially immune-suppressants like steroids.”
As reported by Health Issues India last year, “the current gap in care resulting from the COVID-19 pandemic has the potential to lead to an additional 6.3 million cases and 1.4 million deaths from tuberculosis by 2025.” This is alarming in a country like India, which shoulders a considerable proportion of the global TB burden and is behind schedule on tackling the disease despite a commitment by the Government to eliminate it by 2025. As we noted on World TB Day last year, “India lags far behind on targets aimed at reducing disease incidence by ninety percent and mortality by 95 percent by 2035 as compared to 2015…these targets are expected to be met by 2124, should the current trajectory of progress continue to be followed.” This was according to a 2019 Lancet Commission on Tuberculosis report.