Tuberculosis: the next big threat of the post-pandemic world

Dr. Anuja Joshi, protein scientist and research consultant on Kolabtree, outlines how COVID-19 is affecting countries with a high TB burden. 

The coronavirus pandemic of 2020 started unusually slowly but has now infected 5 million people worldwide and accounted for more than 300 thousand deaths. The outbreak of the coronavirus disease (COVID-19) originally started in Wuhan, China in late 2019 and increasingly spread to Europe and across the globe by February this year. What was more surprising was the alarming rate at which this viral infection was contagious and the increased number of asymptomatic carriers. This not only made it difficult for the health care personnel to identify positively infected people but also for the government trying to curb down these ever-increasing numbers. Today the healthcare systems are under enormous pressure delaying regular healthcare for people with different illnesses such as tuberculosis (TB) making the situations in nursing homes worrisome. The entire world has stood together to come up with strategies to fight against this disease and is collaborating across borders. While we will come up with new vaccines and medicines for the novel coronavirus and win this war it is important to address the impacts of this crisis on the health care systems in the post-pandemic world, especially in countries with high TB burden. 

The COVID-19 (SARS-CoV-2) virus is highly like the former SARS coronavirus making it imperative to take a closer look at the outcomes of the previous SARS pandemic. Studies from SARS survivors demonstrate that progressive fibrosis of the lungs was a prime reason for the decline in their quality of life. About one-third of the SARS patients showed persistent pulmonary function impairment, a year after recovery. Pulmonary fibrosis is a lasting lung disorder that permanently scars the lung tissues reducing their efficiency. Extensive studies on the SARS-CoV-2 suggest pulmonary fibrosis to be one of the major complications of the COVID-19 disease. Although there is no consensus yet on the exact mechanism of the COVID-19 disease progression, existing data, points towards the possibility of sustained lung damage. Thus COVID-19 survivors are expected to be susceptible to various lung infectious diseases like TB; a possibility that has not been shed light upon so far. 

Around 10 million people in the world are affected by tuberculosis with 1.5 million deaths every year. Almost 90% of these cases are from India, China and other South-east Asian and South African countries that have high-TB burden according to WHO. Recent modelling studies based on these countries indicate that COVID-19 induced lockdown of 3 months and an extended 10-month restoration period (recovery time required to get back to normalcy) could potentially lead to additional 6.3 million cases of TB between 2020 and 2025. A detailed analysis also shows that there would be a further 1.4 million TB deaths during this time, implying a setback of 5 years in the end TB strategy program. 

For the effective elimination of the possible rise in TB cases, it would thus be crucial for these countries to be aware of the upcoming threat and be well prepared for early diagnosis, treatment, and prevention of TB deaths. The governments, citizens and social media communities should play an important role in eliminating the stigma associated around TB. Setting up TB surveillance and monitoring systems, availability of specialized TB personnel, and prioritization of the treatment of TB patients would be the need of the hour. Early diagnosis would play a key role in preventing the healthcare systems from collapsing and mass deaths due to TB. As they say,’ Stitch in time saves nine!”, being well prepared would go a long way in avoiding yet another battle with this deadly disease. 

References: 

• Heng Li, Shang-Ming Liu, Xiao-Hua Yu, Shi-Lin Tang, Chao-Ke Tang. 2019. Coronavirus disease 2019 (COVID-19): current status and future perspectives. Int J Antimicrob Agents. 2020 Mar 29: 105951. 
• Wang J, Wang BJ, Yang JC, Wang MY, Chen C, Luo GX, He WF. 2019. Advances in the research of mechanism of pulmonary fibrosis induced by Corona Virus Disease 2019 and the corresponding therapeutic measures. Zhonghua Shao Shang Za Zhi. 2020 Mar 16;36(0): E006. 
• Global tuberculosis report 2019. Geneva: World Health Organization; 2019. Licence: CC BY- NC-SA 3.0 IGO. 
• Ong, K. C. et al. 1-year pulmonary function and health status in survivors of severe acute respiratory syndrome. Chest 128, 1393–1400 (2005). 
• The potential impact of the covid-19 response on tuberculosis in high-burden countries: a modelling analysis. Stop TB Partnership, Geneva; 2020. Available from: http://www.stoptb.org/assets/documents/news/Modeling%20Report_1%20May%202020_ FINAL.pdf