Background: There is a growing literature on the association of SARS-CoV-2 and other chronic conditions, such as noncommunicable diseases. However, little is known about the impact of coinfection with tuberculosis. We aimed to compare the risk of death and recovery, as well as time-to-death and time-to-recovery, in COVID-19 patients with and without tuberculosis. Methods: We created a 4:1 propensity score matched sample of COVID-19 patients without and with tuberculosis, using COVID-19 surveillance data in the Philippines. We conducted a longitudinal cohort analysis of matched COVID-19 patients as of May 17, 2020, following them until June 15, 2020. The primary analysis estimated the risk ratios of death and recovery in patients with and without tuberculosis. Kaplan-Meier curves described time-to-death and time-to-recovery stratified by tuberculosis status, and differences in survival were assessed using the Wilcoxon test. Results: The risk of death in COVID-19 patients with tuberculosis was 2.17 times higher than in those without (95% CI: 1.40-3.37). The risk of recovery in COVID-19 patients with tuberculosis was 25% lower than in those without (RR ¼ 0.75,05% CI 0.63-0.91). Similarly, time-to-death was significantly shorter (p ¼ .0031) and time-to-recovery significantly longer in patients with tuberculosis (p ¼ .0046). Conclusions: Our findings show that coinfection with tuberculosis increased morbidity and mortality in COVID-19 patients. Our findings highlight the need to prioritize routine and testing services for tuberculosis, although health systems are disrupted by the heavy burden of the SARS-CoV-2 pandemic.

Background: There is a growing literature on the association of SARS-CoV-2 and other chronic conditions, such as noncommunicable diseases. However, little is known about the impact of coinfection with tuberculosis. We aimed to compare the risk of death and recovery, as well as time-to-death and time-to-recovery, in COVID-19 patients with and without TB. Methods: We created a 4:1 propensity score matched sample of COVID-19 patients without and with tuberculosis, using COVID-19 surveillance data in the Philippines. We conducted a longitudinal cohort analysis of matched COVID-19 patients as of May 17, 2020, following them until June 15, 2020. The primary analysis estimated the risk ratios of death and recovery in patients with and without tuberculosis. Kaplan-Meier curves described time-to-death and time-to-recovery stratified by tuberculosis status, and differences in survival were assessed using the Wilcoxon test. Results: The risk of death in COVID-19 patients with tuberculosis was 2.17 times higher than in those without (95% CI: 1.40-3.37). The risk of recovery in COVID-19 patients with tuberculosis was 25% lower than in those without (RR=0.75, 95% CI 0.63-0.91). Similarly, time-to-death was significantly shorter (p=0.0031) and time-to-recovery significantly longer in patients with tuberculosis (p=0.0046). Conclusions: Our findings show that coinfection with tuberculosis increased morbidity and mortality in COVID-19 patients. Our findings highlight the need to prioritize routine and testing services for tuberculosis, although health systems are disrupted by the heavy burden of the SARS-CoV-2 pandemic.

Abstract-Achievement of universal health coverage requires better allocative efficiency in health systems. Countries like the Philippines, however, do not have quality local data for these decisions. We present a method that applies existing global data, e.g., Global Burden of Disease and Disease Control Priorities project, into creating a local priority list of diseases and interventions that may be useful in providing a rational plan for expanding coverage of health services paid by public financing. In the context of the Philippines, this refers to the Department of Health for vertical programs like immunization and disease control, and the Philippine Health Insurance Corporation for inpatient and outpatient health services. We found that the top 48 (or 22%) of diseases account for 80% of total disability-adjusted life years (DALYs), reflecting a well-known concept in management, the Pareto principle. Due to its simplicity and widespread applicability, the Pareto principle facilitated interest in rational priority setting among high-level officials in the Philippine health sector. Priority setting must not be limited to disease burden and cost-effectiveness criteria. Our lists can be used after further deliberation and stakeholder consultation. Priority setting is a complex, value-laden process, and a purely utilitarian approach to prioritization may lead to further deterioration in the health status of vulnerable populations. We recommend that DOH and PHIC set up a joint, independent agency primarily responsible for implementing a sustainable, transparent, and participatory priority-setting process that will advise them on future service coverage expansions.

The Philippines confirmed local transmission of COVID-19 on 7 March 2020. We described the characteristics and epidemiological time-to-event distributions for laboratory-confirmed cases in the Philippines. The median age of 8,212 cases was 46 years (IQR: 32-61), with 46.2% being female and 68.8% living in the National Capital Region. Health care workers represented 24.7% of all detected infections. Mean length of hospitalization for those who were discharged or died were 16.00 days (95% CI: 15.48, 16.54) and 7.27 days (95% CI: 6.59, 8.24). Mean duration of illness was 26.66 days (95% CI: 26.06, 27.28) and 12.61 days (95% CI: 11.88, 13.37) for those who recovered or died. Mean serial interval was 6.90 days (95% CI: 5.81, 8.41). Epidemic doubling time pre-quarantine (11 February and 19 March) was 4.86 days (95% CI: 4.67, 5.07) and the reproductive number was 2.41 (95% CI: 2.33, 2.48). During quarantine (March 20 to April 9), doubling time was 12.97 days (95% CI: 12.57, 13.39) and the reproductive number was 0.89 (95% CI: 0.78, 1.02).

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