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Screen all TB patients for COVID and COVID patients for TB

With lockdown and consequent impediments in health service delivery severely affecting diagnosis and reporting of tuberculosis (TB), the health ministry Wednesday issued a guidance note to screen all diagnosed TB patients for Covid-19, and all coronavirus-positive patients for TB.

The two diseases often show very similar symptoms and many states have already started doing TB screening for Covid-negative patients. The latest guidance takes it a step forward to bidirectional screening.

“Tuberculosis and Covid-19 are infectious diseases, which primarily attack the lungs. They present with similar symptoms of cough, fever and difficulty breathing, although TB disease has a longer incubation period and a slower onset of disease,” the guidance note stated.

“The prevalence of TB among Covid-19 patients has been found to be 0.37 — 4.47 per cent in different studies. There has been an overall decline in TB notification by 26 per cent during January to June 2020 as compared to previous year, due to the Covid-19 pandemic,” it added.

The note further said that studies have shown that the history of active as well as latent TB is an important risk factor for SARS-CoV-2 infection.

“This not only results in increased susceptibility, but also rapid and severe symptom development and disease progression with poor outcomes. Tuberculosis is associated with a 2.1-fold increased risk of severe Covid-19 disease. In addition, TB patients also tend to have co-morbid or living conditions (malnutrition, diabetes, smoking, HIV etc.) that increase their vulnerability,” the document said, while laying down detailed criteria for the screening.

It also called for TB screening of patients with influenza-like illness and severe acute respiratory infection that meet the laid-down diagnostic criteria such as two weeks of cough, persistent fever, weight loss, etc.

Lockdown affected TB notification
TB is a notifiable disease in India since 2012. Any doctor in the private or government sector, who doesn’t notify the disease, can be fined or imprisoned or both.

However, the near complete closure of healthcare services other than those related to Covid after March and the deputation of most staff from the TB programme for Covid contact-tracing duties caused TB numbers to fall dramatically.

Between 1 January and 17 August in 2019, a total of 15,59,000 TB cases were reported, of which 4,42,326 were from the private sector (hospitals, clinics, etc). In the same period this year, as many as 10,79,513 cases have been reported, of which 3,00,871 are from the private sector, according to government data.

According to the National Strategic Plan for Tuberculosis Elimination, a government programme that aims to eliminate the disease in India by 2025, TB kills an estimated 4.8 lakh Indians every year or more than 1,400 every day. – The Print

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