Tuberculosis, globally, is known to be the biggest cause of death due to infectious disease and India contributes to over 30 per cent of the global TB burden. As the Covid-19 pandemic derailed global efforts to curb TB, the government is set to launch a special door-to-door TB screening initiative on war footing, as only three years remain of its 2025 target to eradicate the deadly disease.
The initiative will be launched officially on March 24, globally observed as World TB Day.
Under this initiative, over the next two to three weeks, health workers will be visiting the vulnerable population that is potentially exposed to the infection and check for typical symptoms of TB, such as persistent cough, chest pain, weight loss and fatigue. Those found to be symptomatic will be tested using TrueNAT, an indigenous portable, battery-operated, Internet of Thing-enabled RT-PCR platform developed and manufactured by Goa-based Molbio Diagnostics.
In March last year, an analysis by the Health Ministry had notified that Covid brought down TB detection by 25 per cent in India in 2020. Tuberculosis notifications reduced to 18.02 lakh in 2020 from 24.04 lakh in 2019 due to the lockdown and diversion of resources, the Health Ministry had said.
Similarly, the Global TB report 2021 released by the World Health Organization (WHO) showed that India accounted for 41 per cent of the global dip in reporting TB cases during the pandemic.
Mubasheer Ali, Senior Consultant, Apollo Telehealth, explained that Covid can have an impact on the immune system many months after the virus is contracted even among those who have mild symptoms. An increased number of immune cells and antibodies and a strong dysregulation of gene expression (the information stored in DNA) that governs the way cells react to changing environments leads to a weakened immune system in these patients.
"Among many sequelae one is immunosuppression which leaves patients prone to severe opportunistic infection.The COVID-19 pandemic is likely to impact TB burden in a number of ways and one is increased number of TB infections in patients recovered from covid due to the impaired immune system of the body which can facilitate easy transmission and spread of Mycobacterium,organism causing tuberculosis," Ali said.
"The COVID-19 pandemic may lead to a spike in the incidence of active TB. This is why there is a great need for a preemptive approach to the diagnosis of TB given the possibility of an atypical presentation taking the COVID situation into consideration. Early identification of patients with TB and subsequent contact tracing will be essential to help control the spread of TB," he added.
Sriram Natarajan, CEO, Founder & Director, Molbio Diagnostics, said that the impact of Covid has been very significant on TB, because from March 2020 for at least about eight to nine months, absolutely zero TB testing took place, whether at public or at private centres.
"The same patter followed during the second wave also. For the last one-and-a-half years, there's hardly been much TB testing. From about 12 per cent, the case positivity rate has gone up to 35-40 per cent. We have gone back by at least about five to seven years," he said.
Even after the gap brought in by Covid, Natrajan said, "We still have three years to quickly scale up the operations. It is definitely possible to reduce the burden dramatically. That's why the government is taking the initiative on a war footing to scale up testing in the country."
"Despite the pandemic and its disastrous implications on global health and economies, TB continues to be one of the most life-threatening diseases. The situation is especially worrisome for India as it's a major contributor to the TB caseload globally. It further puts pressure on the already stressed healthcare infrastructure of the country. Hence, our primary focus should be to create awareness about the disease to prevent its spread. We should also focus on early detection, containment, and cure which can only be achieved through a robust infrastructure," Dr Deepak Namjoshi, Pulmonologist & Medical Director, CritiCare Asia Multispecialty Hospitals and Research Centre, said.