Since Covid-19 hit South Africa in early 2020, Tuberculosis (TB) have been placed on the back burner. It may not be as contagious as Covid-19, however it was viewed as the leading cause of death in the country. It is not just an old disease compared to Covid-19; research shows this disease to have been a plague to mankind for the last 70 000 years.
TB hasn’t disappeared, the limelight has shifted away from it. In 2019, 360 000 individuals were infected with TB. 58% of the patients were HIV positive. Half of HIV-related deaths that year, were ruled with TB as the official cause of death.
The official plan
Photo: Dr Owen Kaluwa, Deputy Minister of International Relations and Cooperation, Ms Candith Mashego-Dlamini. February 2020. Photo by World Health Organisation (WHO).
On World TB day (WTBD), 24 March, WHO Representative in South Africa, Dr Owen Kaluwa, called on the government and other stakeholders to “bridge the financial gap for the TB response and to accelerate efforts towards achieving the targets and commitments to end TB, for the benefit of the South African population and her future generations.”
The WTBD event was held in Nelspruit under strict compliance with COVID-19 public gatherings measures.
South Africa’s Deputy President and Chairperson of the South African National Aids Council, David Mabuza told the crowd, “we are joining the world to galvanise our own society to realise that the clock is ticking. Let’s find, treat, and end TB now.”
The National Strategic Plan on HIV, TB and STIs launched in 2017 entails diagnosing at least 90% of all people infected with TB, treat 100% of those who have tested positive, and decrease TB deaths by at least 30%. The deadline for this goal however, is unclear.
Wrench in the works
The symptoms for TB and Covid-19 are similar in some instances. Symptoms for TB may include:
- Chest pains, painful breathing, coughing, coughing blood, phlegm, shortness of breath
- Chills, fatigue, fever, loss of appetite, malaise, night sweats, or sweating, swollen lymph nodes
The similarity in the symptoms may indeed cause a delay in diagnosis.
Statistics for 2020 is not available yet, but there was an increase of 20% in infections from 2018 to 2019. The fact that some patients may have died from Covid-19 whilst also infected with TB, may attribute to some margin of error in new statistics presented.
According to a recent paper in the South African Medical Journal (SAMJ), “Globally a projected setback of 5 - 8 years in TB incidence and deaths is projected for 2021, with TB mortality estimated to increase by 20%.”
The SAMJ recommends that, “In our TB-endemic setting, given the overlap of clinical signs and symptoms for TB and COVID-19, those who screen positive for either TB or COVID-19 should be tested for both pathogens, creating an efficient mechanism for patients to enter the TB diagnostic pathway.”
However, the strain on government resources and the capacity of laboratories to handle the large amount of test samples will definitely be a wrench in the works with this plan.
Treatment
As TB can be latent or active, the treatment may vary. In severe cases, treatment may last up to 9 months and include several medications. The risk increases when a patient feels better and stops their treatment early. This causes drug-resistant TB, that will no longer respond to treatment. Not only will the patient be affected, but anyone they infect will also then have a drug-resistant strain. It is of utmost importance that any patient with TB completes their treatment.
As with the case of HIV patients, many are avoiding clinics and check-ups, as they fear contracting Covid-19, or the clinics providing their medications are closed or out of stock due as a result of the pandemic.
Who is at risk?
The risk of developing active TB is higher in patients:
- With a weakened immune system
- Who first developed the infection in the past 2 – 5 years
- Older adults and young children
- Who use injected recreational drugs
- Who have not received appropriate treatment for TB in the past
The silver lining
Globally, we have come to adjust our “cough etiquette”. Wearing a mask is the norm, and everyone is aware of any respiratory disturbance. The hard work that is done to eradicate Covid-19 and improve the treatment thereof, will prove useful in supporting the efforts against TB. The SAMJ is also confident that, “Improved infection prevention and control (IPC) at health facilities will reduce the number of healthcare workers who become infected with TB annually”.
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