Don't forget TB, SA's biggest killer, in focus on Covid-19, experts warn

A TB patient is examined by a doctor. A new report says there could be more TB infections and deaths brought about by neglect of the disease during the Covid-19 pandemic.
A TB patient is examined by a doctor. A new report says there could be more TB infections and deaths brought about by neglect of the disease during the Covid-19 pandemic.
Image: JAMES OATWAY

The global response to the Covid-19 pandemic and protracted lockdowns could spell disaster for those living with tuberculosis.

A report by the Stop TB Partnership says curbs on diagnosis, treatment and prevention services during the lockdown would have unintended yet drastic consequences on TB.

A three-month lockdown and another 10 months to restore services would lead to an additional 6.3-million TB infections worldwide and 1.4-million more deaths, said Tuesday's report.

“We never learn from mistakes. For the past five years, TB, a respiratory disease, has remained the biggest infectious disease killer because the ‘TB agenda’ consistently became less visible in front of other priorities,” said Dr Lucica Ditiu, executive director of the partnership.

“Today, governments face a torturous path, navigating between the imminent disaster of Covid-19 and the long-running plague of TB.

“But choosing to ignore TB again would erase at least half a decade of hard-earned progress against the world’s most deadly infection and make millions more people sick.”

Prof Linda-Gail Bekker, head of the Desmond Tutu HIV Centre at the University of Cape Town, says it is crucial that TB programmes are not neglected.

“While we grapple with acute infection of Covid-19, it’s important that we don’t lose ground in our TB fight. We need to ensure that TB programmes are strengthened, instead of being forgotten,” she said.

“The Covid-19 fight is important but we should not lose sight of South Africa’s two epidemics - HIV and TB - which we haven’t got under control yet.”

TB remains SA's leading cause of death. The World Health Organisation (WHO) estimated that 310,000 people contracted TB and 63,000 died of it in 2018.

The estimated number of people who have died of TB since the Covid-19 pandemic reached SA is 10,500 – about 70 times more than coronavirus deaths.

Prof Harry Hausler, head of TB/HIV Care, said the restriction on movement during the lockdown has resulted in “catastrophic costs, and increased desperation and hunger in TB-affected communities”. He said the responses to Covid-19 and TB should be integrated.

“Contact investigation of household contacts for TB should be done at the same time as contact investigation of Covid-19 contacts, and TB preventive therapy for household TB contacts should be implemented at scale," he said.

"To decrease contact with the health system during Covid-19 and improve patient-centred care for people with TB, there should be multi-month dispensing of anti-TB medications and community distribution of TB and HIV-related medications, including TB preventive therapy and antiretroviral treatment."

According to the new study, which was commissioned by the Stop TB Partnership along with Imperial College in the UK and Johns Hopkins University in the US, new TB cases and deaths in 2021 will increase to levels last seen between 2013 and 2016 - implying a setback of at least five to eight years in the fight against the infection.

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