The potential impact of COVID-19-related disruption on tuberculosis burden

Abstract

The potential impact of COVID-19-related disruption on tuberculosis burden To the Editor: Before the coronavirus disease 2019 (COVID-19) pandemic, over 4000 people were dying from tuberculosis (TB) every day [1]. As with past emergencies [2], the impact of COVID-19 on TB outcomes is a serious cause for concern [3] but is currently unknown. Health system overload, due to high numbers of COVID-19 cases, as well as interventions necessary to limit the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), could result in severe reductions in health service availability and access for the detection and treatment of TB cases [4]. However, physical distancing interventions could also limit Mycobacterium tuberculosis transmission outside of households, where most transmission occurs [5]. This has not been adequately explored in concurrent work [6-8], and it is currently unclear whether social distancing could compensate for disruptions in TB services, and what the impact of these combined COVID-19 disruption effects on TB burden is likely to be.

The Potential Impact of the COVID-19 Pandemic on the Tuberculosis Epidemic: A Modelling Analysis

“…5) illustrates that transmission reductions would only lead to a net decrease in TB burden over the next five years if these reductions are relatively strong, coupled with disruptions to TB services that are relatively mild. These results are in agreement with recent modelling analysis, that similarly showed how transmission reductions are unlikely to outweigh the negative impacts of disruptions to TB services [22]. We caution that À as with any models not fully capturing household and other population structures -these simulations are likely to overestimate the rate-of-change in TB incidence over short timescales, such as the drop in TB incidence shown during the lockdown period.…”

“…The horizontal dashed line in each figure indicates zero overall change; the region above this line corresponds to a net increase in TB burden over the next 5 years, and vice versa. Overall, and in agreement with recent analysis [22], the figure illustrates that TB transmission reductions are likely to lead to overall reductions in TB burden only when strong transmission reductions are combined with mild disruptions (orange lines, at >50% transmission reductions for Kenya, and >75% transmission reductions for India and Ukraine). be needed, even at a time when TB programmes are operating under severe constraints in human and material resources.…”

TB and COVID – Public and private health sectors adapt to a new reality

“…As COVID-19 began to spread rapidly across countries, several models predicted its impact on healthcare services, especially in low- and middle-income countries, where underfunded health services were barely coping with pre-pandemic public health needs ( Bhargava and Shewade, 2020 , Hogan et al, 2020 , McQuaid et al, 2020 , STOPTB PARTNERSHIP, 2020a ). Some of these modeling studies also included the effect of COVID-19 on TB services.…”

“…Some of these modeling studies also included the effect of COVID-19 on TB services. They predicted an increase in TB deaths of between 350,000 and 1.5 million deaths in 5 years deaths; as well as disruptions in case finding and treatment services ( Bhargava and Shewade, 2020 , Hogan et al, 2020 , McQuaid et al, 2020 , STOPTB PARTNERSHIP, 2020a ).…”

Spatiotemporal Integration of Tuberculosis and COVID-19 during the COVID-19 Pandemic  in Libya. 

“…How COVID-19 will manifest itself in persons infected with TB is still uncertain and the impact of these pandemics on resource-limited nations remains unknown. However, it has been speculated that lesions associated with COVID-19 may increase the risk of TB and TB exposures increase the risk of morbidity and the mortality of COVID-19 (3,4). Therefore, a thorough understanding of the interactions between these infections is crucially important.…”