MANILA — The coronavirus has disrupted tuberculosis programs in many countries, but a new modeling analysis reveals the seriousness of the situation.
TB cases could increase by up to 11% globally between 2020 and 2025 under a 3-month-lockdown, with delays in the resumption of TB services, according to a new report commissioned by the Stop TB Partnership in collaboration with the Imperial College London, Avenir Health, and Johns Hopkins University, and supported by USAID.
“The more severe the lockdown, the more severe the long-term impact is going to be in terms of TB burden.”— Nimalan Arinaminpathy, associate professor, Imperial College London
That’s equivalent to 6.3 million new cases of TB in five years, levels last seen in 2013, said Nimalan Arinaminpathy, associate professor in mathematical epidemiology at Imperial College London, in a virtual briefing on Tuesday.
TB deaths could also increase by 16%, or an additional 1.3 million people, in the same period.
The estimates are based on a modeling of TB impact in three high-burden countries — India, Kenya, and Ukraine — where lockdowns have been put in place to slow the spread of COVID-19. The experts then extrapolated findings from these three countries to provide a global estimate of the impact on TB.
But in the same briefing, Suvanand Sahu, deputy executive director of the Stop TB Partnership, cautioned the results may only reveal the impact on TB at the minimum. He said the modeling considered the impact of COVID-19-related measures, such as lockdowns and social distancing. But issues such as the TB and COVID-19 co-infection, and people’s economic situation were not included.
“We don’t have enough information as of now … to look at the co-infection between COVID and TB,” Sahu said.
Countries responding to COVID-19 are benefiting from established tuberculosis programs worldwide, from diagnostics to contact tracing. But the patients meant to benefit from these TB tools and services face access barriers.
“What was also not modeled there, we all know that [when] you have settings where there is undernutrition, loss of livelihood [and] poverty, TB thrives there and increases,” he said.
And this is only for a 3-month-lockdown scenario. The longer the lockdowns, the longer it will take to resume TB programs, and the more people developing TB and dying from the disease.
“The more severe the lockdown, the more severe the long-term impact is going to be in terms of TB burden,” Arinaminpathy said.
The experts said it is important for TB programs to resume as soon as lockdowns are lifted to mitigate impacts, combined with supplementary measures such as ramped up active TB case finding. It may take some time for TB services to fully resume, they said. Potential reasons include stigma and discrimination, and overwhelmed health systems.
“You have people who [have] the same symptoms of COVID, and they will be afraid to go to the health facilities [and be] infected with COVID, but also afraid of being considered that they have COVID just because they have fever and cough,” said Cheri Vincent, chief of USAID’s TB division.
There may also be limited health workers that can attend to TB patients, as many of them have been tasked to care for COVID-19 patients. There is also the issue of drug-resistant TB.
“People [who] were not able to continue their treatment are at risk of developing drug-resistant TB … And what we’re hearing is that some of the drug-resistant TB hospitals are being converted to COVID-only hospitals,” she added.
It could also take some time for tools such as TB diagnostics being used for COVID-19 now to be reconstituted back to TB services, Arinaminpathy said.
There are plans to expand the modeling study to include other countries, said Dr. Lucica Ditiu, executive director at the Stop TB Partnership. Such a study can help national TB program managers quantify to their governments the impact on TB of the measures taken to slow the spread of COVID-19 infection, she said.
“We don’t say, don’t do the lockdown. We say, we need to be mindful of the impact [on TB],” she said, adding such information can be an “extremely powerful tool to make people understand that this is not a joke.”
They also plan to look into the financial implications of the potential sliding back of TB gains to 2013 levels, she said.
“I am outraged that just by not being able to control what we implement in countries, and forgetting about the other programs that exist, we basically lose so much, starting with [the] lives of people,” she said.