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

Abstract

Background: Routine services for tuberculosis (TB) are being disrupted by stringent lockdowns against the novel SARS-CoV-2 virus. We sought to estimate the potential long-term epidemiological impact of such disruptions on TB burden in high-burden countries, and how this negative impact could be mitigated. Methods: We adapted mathematical models of TB transmission in three high-burden countries (India, Kenya and Ukraine) to incorporate lockdown-associated disruptions in the TB care cascade. The anticipated level of disruption reflected consensus from a rapid expert consultation. We modelled the impact of these disruptions on TB incidence and mortality over the next five years, and also considered potential interventions to curtail this impact. Findings: Even temporary disruptions can cause long-term increases in TB incidence and mortality. If lockdown-related disruptions cause a temporary 50% reduction in TB transmission, we estimated that a 3-month suspension of TB services, followed by 10 months to restore to normal, would cause, over the next 5 years, an additional 1Á19 million TB cases (Crl 1Á06À1Á33) and 361,000 TB deaths (CrI 333À394 thousand) in India, 24,700 (16,100À44,700) TB cases and 12,500 deaths (8.8À17.8 thousand) in Kenya, and 4,350 (826À6,540) cases and 1,340 deaths (815À1,980) in Ukraine. The principal driver of these adverse impacts is the accumulation of undetected TB during a lockdown. We demonstrate how long term increases in TB burden could be averted in the short term through supplementary "catch-up" TB case detection and treatment, once restrictions are eased. Interpretation: Lockdown-related disruptions can cause long-lasting increases in TB burden, but these negative effects can be mitigated with rapid restoration of TB services, and targeted interventions that are implemented as soon as restrictions are lifted.

Gauging the impact of the COVID-19 pandemic on tuberculosis services: a global study

“…Epidemiological and clinical studies, including mortality rates of the first cohort of patients with COVID-19 and TB co-infection were described [3,4]. Several reports from individual countries suggested that the COVID-19 pandemic significantly affected TB services [5][6][7][8][9], including validation by modelling studies [10]. The Global Tuberculosis Network (GTN) reported that the COVID-19 pandemic affected TB services in 33 TB centres from 16 countries in the first four months of 2020 [11].…”

Impact of the COVID-19 Pandemic on Tuberculosis Control: An Overview

“…Prolonged contact at household level is one of the risk factors that increases the transmission of TB [37]. A recent modelling study showed that a 3-month lockdown due to COVID-19 would cause an additional 1.65 million TB cases and 438,000 TB deaths in India over the next 5 years [38]. Another study conducted in Brazil showed that intensity of household exposure increased the risk of TB infection and disease among household members [37].…”

Understanding the tuberculosis granuloma: the matrix revolutions

“…TB is a chronic and persistent human killer, causing more deaths in total over time than any other pathogen and, currently, is the most important infection after COVID-19. Furthermore, the TB pandemic is likely to worsen due to resources being diverted to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) control [ 1 ]. The causative organism, Mtb , has undergone long-term coevolution with humans and is an obligate human pathogen [ 2 ].…”