Editorial

Caring for TB patients in the time of Coronavirus disease

India continues to have the highest burden of both TB and drug-resistant TB in the world. India launched a TB Free India Campaign on March 13, 2018 at the Delhi End TB Summit and has set 2025 as the deadline of eliminating TB from the country.

Today, with much of the global focus, including resources, being shifted towards COVID-19, other diseases such as TB run the danger of being relegated to the background.

But, can we afford to do so? Not, if we are to meet the deadline, which is five years before the global target of 2030.

There are lessons to be learnt from COVID-19. COVID-19 has in a way shown us the path to control the TB burden in the country. Prevention is the key and this is what will bring us closer to our goal of making India TB-free.

Both COVID-19 and TB can have similar symptoms such as cough, fever and difficulty breathing. Do not ignore any patient with cough. The WHO recommends that tests for both conditions should be made available for individuals with respiratory symptoms.

TB is an airborne infection which spreads via droplet nuclei (< 5 µ in size) released into the air when the infected person coughs, sneezes, sings or even talks. COVID-19, though not yet known to be air-borne, spreads by large droplets (> 5 µ in size).

Open TB cases are infectious and just being within close proximity of an infected person may expose a person to the risk of acquiring the infection. The risk of disease transmission is particularly high in overcrowded conditions. Anybody could be harboring the infection and therefore could be the source of infection, which could also be COVID-19.

Measures must be put in place to limit disease transmission; protective measures such as basic infection prevention and control, hand hygiene, cough etiquette are common to both.

All household and close contacts of patients with infectious TB should be traced and tested and treated with a full course of ATT if found positive for TB. This also includes people living with HIV and other people at risk with lowered immunity or living in crowded settings. These groups are also at high risk of COVID-19. And if infected, they are at risk of developing severe disease.

Contact tracing interrupts the chain of transmission of the disease by early diagnosis of cases as well as timely and complete treatment.

All TB patients, especially active and drug-resistant cases, should be isolated or self-quarantined for 14 days.

The CDC has defined the “minimum period of isolation of the patient: pulmonary tuberculosis also includes mediastinal, laryngeal, pleural, or military TB. Until bacteriologically negative on the basis of three appropriately collected and processed sputum smears collected in eight – 24 hour intervals (one of which should be an early morning specimen), and/or until 14 days after the initiation of appropriate effective chemotherapy, given that therapy is continued as prescribed, and there are signs of clinical improvement (i.e., decreasing cough, reduced fever, resolving lung infiltrates, or AFB smears showing decreasing numbers of organisms.” (Available at: https://www.cdc.gov/tb/programs/laws/menu/isolation.htm)

Every case of TB should be notified and diligently followed up during the course of its treatment. Public awareness at grass root level must be created to the scale similar to COVID-19.

Social distancing, adopted as a preventive measure for COVID-19, may interrupt the treatment of TB. The government must act to ensure availability of anti-tuberculosis treatment.

TB is a treatable condition. But any disruption in treatment can result in drug-resistant TB.

The WHO has published an information note to assist national TB programs and health personnel to ensure continuity of essential services (prevention, diagnosis, treatment and care) for people affected with TB during the COVID-19 pandemic. It has cautioned that during the COVID-19 pandemic, adequate stocks of TB medicines should be provided to all patients to take home in order to ensure that the treatment is completed without the need to visit treatment centers unnecessarily to collect medicines. (https://www.who.int/tb/COVID_19considerations_tuberculosis_services.pdf)

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Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA