Early COVID-19 pandemic’s toll on tuberculosis services, WHO European Region, January to June 2020

Abstract

Background Essential health services, including for tuberculosis (TB), are being affected by public health and social measures (PHSM) introduced to control COVID-19. In many settings, TB resources, facilities and equipment are being redirected towards COVID-19 response. Aim We sought to assess the COVID-19 pandemic’s impact on TB services in the World Health Organization (WHO) European Region. Methods The fifty-three European Region Member States were asked to report qualitative and quantitative data in quarter one and two (Q1 and Q2) 2020. TB notifications were triangulated with the severity score on domestic movement restrictions to assess how they may have influenced TB detection. Results Twenty-nine countries reported monthly TB notifications for the first half of 2019 and 2020. TB notifications decreased by 35.5% during Q2 2020 compared with Q2 2019, which is six-fold more than the average annual decrease of 5.1% documented during 2015–2019. The number of patients enrolled in rifampicin-resistant/multidrug-resistant TB treatment also decreased dramatically in Q2 2020, by 33.5%. The highest movement restriction severity score was observed between April and May 2020, which coincided with the highest observed decrease in TB notifications. Conclusion A decrease in TB detection and enrolment to treatment may cause increases in TB burden and threatens the Region’s ability to reach the TB targets of the 2030 Sustainable Development Goals, still this might be mitigated with rapid restoration of TB services and the implementation of targeted interventions during periods with severe PHSM in place, such as those introduced in response to the COVID-19 pandemic.

Impact of COVID-19 on tuberculosis detection and treatment in Baja California, México

“…Consequently, TB incidence and TB mortality are projected to increase by 5–15% over the next 5 years, resulting in hundreds of thousands of additional TB deaths worldwide ( 19 , 20 ). COVID-19 adaptations found in our study were similar to mitigation strategies used in other counties, such as reduced frequency of outpatient visits for treatment monitoring or drug dispensing, allowing TB patients to take a 1-month or more supply of anti-TB drugs home, expanded use of remote advice and support, and home delivery of anti-TB drugs ( 7 ).…”

“…Mexico is not unique in terms of the effects of COVID-19 on TB. According to a global survey, 25 of 44 countries had introduced changes to TB service delivery since the start of the COVID-19 pandemic, with 10 countries and nine countries reducing the number of in-patient and outpatient TB facilities, respectively ( 7 ). Like BC, challenges were also reported by TB professionals in both West African and European settings, especially regarding staff shortages and laboratory issues that predated COVID-19 ( 18 ).…”

“…Health systems in Mexico prioritized COVID-19 mitigation efforts and were overwhelmed by high COVID-19 case rates, consequently interrupting other health services ( 6 ). By December 27, 2020, Mexico reported 1,372,243 official cases and 121,837 confirmed deaths—the fourth most COVID-19 deaths at the time, behind the United States, Brazil, and India ( 7 ). Conversely, in 2020, Mexico reported its lowest TB case count (16,752) and incidence rate (13.1 cases per 100,000 persons) on record ( 8 ).…”

Practical management of suspected hypersensitivity reactions to anti‐tuberculosis drugs

“…19,20 In addition, there is an emerging evidence regarding the detrimental impact of the SARS-CoV-2 pandemic on established TB services worldwide and the negative impacts on the United Nations (UN) and the WHO TB treatment targets. [21][22][23] Hence, there is an urgent need to develop a standardised, equitable, safe and pragmatic approach in the global management of HSRs to anti-TB drugs, to ensure treatment adherence is not compromised at a patient level and reduce the risk of MDR-TB and RR-TB from a global public health viewpoint. This narrative review aims to combine the evidence from current literature and draw from the clinical experience of authors from high-income countries (HICs) and multiple LICs/LMICs regarding the management of suspected HSRs to anti-TB drugs.…”

Investigating the response to COVID-19 and understanding severe TB cases: The 2022 Pulmonology TB series

“…Pulmonology was in the frontline of the fight against TB with its TB series published in 2018 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 and in 2021 12 , 13 , 14 , the latter focused on the COVID-19 pandemic and its relationship with TB. TB is essentially one of the main ‘victims’ of the COVID-19 pandemic, for several reasons including the direct interaction between the two diseases in terms of morbidity and mortality 12 , 15 , 16 , 17 , 18 , 19 , the shifting of specialised staff from TB services to manage the COVID-19 emergency and the effects of fear on patients and staff, the impact of lockdown/social distancing measures and the re-organization of health services among others 20 , 21 , 22 , 23 , 24 .…”