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Tuberculosis and the impact of COVID-19

While India continues to pour resources into fighting the ongoing COVID-19 pandemic, other health issues are too often sidelined. Many, such as tuberculosis (TB) have plagued India since long before the pandemic. TB, due to rapidly developing drug resistance, threatens to become all but untreatable in the coming decades. This situation can only worsen as the continuum of treatment is diminished during the pandemic.

TB Photo credit: Prof Madhukar Pai, MD, PhD Canada Research Chair in Epidemiology & Global Health Director, McGill Global Health Programs Associate Director, McGill International TB Centre
X-rays of a tuberculosis patient in India

Health Issues India reported back in March, at the onset of the pandemic, that “officials of the World Health Organization (WHO) noted that, due to the pandemic and its disruption to airlines, there is the potential that medications for diseases such as TB could be limited in supply. Such an eventuality in the context of TB, particularly owing to the ever-present threat of drug resistance, could lead to a resurgence of the disease. This would, in turn, make other diseases far more difficult to address should the issue of COVID-19 subside in the near future.”

Such an eventuality appears to be manifesting according to recent studies. 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, according to a study entitled “COVID-19 -Tuberculosis interactions: When dark forces collide” by Zarir Udwadia, a pulmonologist at Mumbai’s P.D. Hinduja Hospital and Medical Research Centre.

“Miss a few days of any other treatment and you may not be harmed, but gaps in TB treatment will amplify resistance,” Udwadia said. “Our lack of health infrastructure is the reason we have been floundering amidst the sea of COVID cases. It’s the reason why we have not been able to make progress against traditional and old enemies like malaria, typhoid, dengue.”

Globally, of the 500,000+ people who develop drug-resistant tuberculosis (DR-TB) each year, India currently contributes to over 25 percent of cases. While in February Union Health Minister Dr Harsh Vardhan affirmed that the Centre is working towards its goal of TB elimination ahead of global targets, this effort has been severely hampered by the COVID-19 crisis.

According to the study, in April, one million fewer children received the Bacillus Calmette–Guérin vaccine that prevents severe tuberculosis. Extrapolating this data across the COVID-19 pandemic, several million may have missed a vaccine that is vital in bringing TB under control. Should diseases be neglected for any further amount of time, India could soon be facing many more issues once COVID-19 has been brought under control.

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