-Tara Singh Bam
COVID-19 has made us realize the importance of Health For All, where no one is left behind. Health security is essential for everyone. TB anywhere is TB everywhere is an old slogan but COVID-19 public health emergency reminds us again that what ails one, ails us all.
Moreover, if we are to mitigate the impact of COVID-19, we have to cut the chain of transmission of the infection. But we also have to look at emerging scientific evidence that is showing people with conditions such as non-communicable diseases (NCDs), are more at risk of developing severe COVID-19 and severe outcomes, including death. The COVID-19 pandemic reminds us why it will be essential going forward for countries to focus much more acutely on global health and security and the compelling public health case to advance progress on preventing NCDs. All disease prevention is pandemic prevention.
Tuberculosis (TB) is the world’s largest killer infectious disease. At the time of writing this article, most of the countries in Asia Pacific are on a lockdown because of the COVID-19 pandemic. According to the latest WHO Global TB Report 2018, Asia Pacific is home to over 6.2 million people with TB- 62% of the global estimate. Five countries of Asia Pacific (India, China, Indonesia, Philippines, and Pakistan) collectively account for 55% of the TB case burden globally.
As per the REPORT OF THE JOINT MONITORING MISSION FOR TUBERCULOSIS 2019 in Nepal shows Nepal is not on track to meet milestones and targets of the End TB Strategy. The burden of TB in Nepal is significantly increased, despite the huge investment (71 million USD only from Global Fund, not included government and other donors) in last 15 years. According to national TB prevalence survey 2018-2019, currently over 117 000 people are living with TB disease in Nepal.TB incidence is much higher (1.6 times) than previously estimated. About 7000 people die from TB each year in Nepal.
It is required that health services, including national programmes to combat TB, need to be actively engaged in ensuring an effective and rapid response to COVID-19 while ensuring that TB services are maintained and uninterrupted. It is important that the progress made in TB prevention and care is not reversed by the COVID-19 pandemic. Finding and treating people with TB remain the fundamental pillars of TB prevention and care and those would require maintained attention, even during lockdowns.
COVID-19 related lockdown measures are creating barriers in accessing comprehensive TB services. Early diagnosis, contact tracing, initiation of TB treatment, uninterrupted treatment, follow-up, side-effects management, monitoring of treatment and other comprehensive TB care is being affected. Governments have also promised to deliver on goals for addressing latent TB. We need to ensure that while we contain COVID-19, we do not lose the progress made in fighting the world’s biggest infectious disease, TB.
According to the WHO, “while experience on COVID-19 infection in TB patients remains limited, it is anticipated that people ill with both TB and COVID-19 may have poorer treatment outcomes, especially if TB treatment is interrupted.” People ill with COVID-19 and TB show similar symptoms such as cough, fever and difficulty in breathing. Emerging scientific evidence shows that active TB disease, as well as latent TB infection, both increase susceptibility to COVID-19 and disease severity.
Both national and sub national governments must ensure uninterrupted supply of medicines and healthcare services to people living with TB, including education and counselling on maintaining a healthy diet, avoiding alcohol, keeping physically active, safeguarding mental health, promoting cessation services to quit smoking, vaping and chewing tobacco. They must prioritize enactment of legislation to compliment the fight of the COVID-19 pandemic; ensure adequate budget for managing COVID-19 and secure health care budget for tuberculosis, NCDs, HIV, tobacco control and other essential services including immunizations and these programs must be run smoothly. A provision of surgical face masks throughout the treatment for people living with TB, NCDs and HIV should be budgeted and included in the package of essential services provided to them.
- Writer Bam is a Deputy Regional Director (Asia-Pacific) of The International Union Against Tuberculosis and Lung Disease (The Union).