Tuberculosis During COVID

Tuberculosis (TB) is an infectious disease caused by bacteria that can spread via droplet transmission mainly affecting the lungs, as defined by the Mayo clinic. Typically our immune systems fight off the tuberculosis bacteria, M. tuberculosis, before you get sick which is how we can determine latent from active TB. Active TB can present with extended coughing, coughing up blood or mucus, chest pain, or pain with breathing or coughing, unintentional weight loss, fatigue, fever, night sweats, chills, or loss of appetite. “People with active tuberculosis must take many types of medications for months to get rid of the infection and prevent antibiotic resistance.” Historically, starting in 1985 tuberculosis infections were on the rise in the United States due to the immuno-compromising HIV/AIDS, but decreased again in the last 90’s. Now with the introduction of COVID-19, another significant pandemic affective large chunks of the world’s population, we are seeing impacts on this pulmonary-targeting disease yet again.

In countries such as Africa and India which due to environmental and social structures tuberculosis has been an issue for decades. However, the impact of COVID has presented to be both beneficial and negative. While the diagnosis rate seems to be decreasing significantly due to increased mask wearing and physical separation, we also see increased difficulties in treating the current cases of TB due to stress on social and medical systems that allowed for easier access to the treatments. As explained by Jain et al.’s 2020 paper, India’s out-patient challenges skyrocketed as patients and providers had to navigate the world of telehealth balanced with in-person checkups and direct treatments. This included extents such as home visits to ensure medicine administration as well as enrollment in the DOTS program for virtual video consultations to monitor progress and any emerging symptoms. As the modes of transmission of COVID-19 and TB overlap, the worldwide efforts into advancing aspects of COVID prevention, care, and monitoring have directly aided those of TB especially in regards to the advancements in contact tracing and subsequent testing.

Despite the technological advancements shared by COVID and TB researchers, other healthcare-related observations demonstrate the negative impacts that our pandemic is having on TB epidemics. This mainly includes the attention drawn away from TB care resulting in decreasing availability for TB medicine due to limited treatment support and medication stock-outs occurring in the early months of COVID. With this treatment delay, concerns increased for the impact on TB cases improvements as the antibiotics, usually isoniazid INH with rifampin, pyrazinamide and ethambutol, used to alleviate risk, were of low access to developing areas, such as parts of India where TB is most common and COVID has the least preventative measures, as explained by McQuaid et al.’s 2021 paper. Between the quarantines, curfews, and delivery strains, TB patients are suffering in the time of COVID with the need for healthcare workers to re-evaluate how treatment occurs. The silver-lining remains however that these precautions causing stress on the current TB patients are also what is slashing rates of new diagnoses with COVID precautions working double-duty against the just as fatal TB.