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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 19  |  Issue : 2  |  Page : 96-98

Effect of COVID-19 on the management of tuberculosis at a rural hospital setting of India


1 Department of Microbiology, Government Erode Medical College, Erode, Tamil Nadu, India
2 MBBS Student, Coimbatore Medical College, Coimbatore, Tamil Nadu, India
3 Deputy Director, Medical Services (TB), Erode, Tamil Nadu, India

Date of Submission09-Dec-2021
Date of Decision20-Feb-2022
Date of Acceptance24-Mar-2022
Date of Web Publication06-May-2022

Correspondence Address:
A R Susethira
Department of Microbiology, Government Erode Medical College, Perundurai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_142_21

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  Abstract 


Background: Preserving and maintaining the continuity of tuberculosis (TB) essential services, expediting the surveillance of populations who are vulnerable to the disease, and carrying out high-quality epidemiologic research are required and very essential for reducing the TB burden in this era of COVID-19 pandemic. Hence, this study aimed toward assessing the effect of COVID-19 on the management of TB at a rural hospital setting of India. Methods: A retrospective observational cohort study is undertaken at a tertiary care hospital setting of India. The data from the TB center of a tertiary care hospital were gathered, where two cohorts are made based on a time frame, and the patients were evaluated over that selected time frame. Results: A total of 472 patients presented to the TB care clinic during the 2019 study period (Cohort A), whereas only 78 patients presented to the clinic in the 2020 study period. The diagnosis of TB was made based on the sputum examination and chest X-ray, where 104/472 (22%) were positive to TB in Cohort A and 42/78 (54%) were TB positive in Cohort B. Discussion: The fraction of TB patients who were obscured from the follow-up was prominently higher during the 2020 period when related to that of 2019 (17% vs. 9.6%; P = 0.01). There were 7 deaths that occurred during 2020 (17%), compared to only 3 deaths (2.8%) in the 2019 period (P = 0.04). Conclusion: Strengthening the governmental policies toward rapid adoption of TB control measures in times of newer challenges like COVID-19 must be an immediate priority in mitigating the disease burden.

Keywords: COVID-19, diagnosis, treatment, tuberculosis


How to cite this article:
Suthandhira M, Dheepa N, Susethira A R, Kousikha P, Kanagaraj K D. Effect of COVID-19 on the management of tuberculosis at a rural hospital setting of India. Apollo Med 2022;19:96-8

How to cite this URL:
Suthandhira M, Dheepa N, Susethira A R, Kousikha P, Kanagaraj K D. Effect of COVID-19 on the management of tuberculosis at a rural hospital setting of India. Apollo Med [serial online] 2022 [cited 2022 Jul 1];19:96-8. Available from: https://www.apollomedicine.org/text.asp?2022/19/2/96/344870


  Introduction Top


“Coronavirus disease 2019 (COVID 19),” which is a resultant of infection by “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2),” shares a common clinical basis with tuberculosis (TB), which is caused by Mycobacterium tuberculosis. This common clinical basis of COVID-19 and TB includes as both are respiratory types of illnesses, mode of spread is by droplets and both have similar kind of initial signs and symptoms.[1] India is still carrying the highest burden of TB across the globe, accounting for over one-fourth of the cases that are being reported globally. The COVID-19 pandemic has resulted in a bizarre stage of the global health crisis, restricting the mobility of the people and hampering the health-care delivery toward health conditions other than COVID-19.[2],[3] Since TB remains a prominent and important communicable disease in India, clinical testing, surveillance, and adequate treatment of it remains to be the priority of public health even during the times of COVID-19 pandemic. From the initial point of this COVID-19 pandemic in the way back December 2019, the governments have enforced and observed strict measures like the closure of public places and imposed mobility restrictions all over depending on the contamination rates.[4] The health services also have been reduced and compromised to a minimum at some point of time, where the daily outpatient visit numbers at the hospitals declined drastically due to a fear of infection among the public. Hence, the national programs that are aimed to fight against the TB burden need to be more engaging to secure a rapid and effective response toward the COVID-19 amid maintaining the TB mitigation measures.[5] Preserving the continuity and longevity of the TB essential services, expediting the surveillance of populations vulnerable to the disease, and carrying out high-quality epidemiologic research are required to reduce the burden of TB in this era of the COVID-19 pandemic.[6],[7]

Objective

The objective of this study was to evaluate the effect of “COVID-19 on the management of TB” at a rural hospital setting of India.


  Methods Top


This is a retrospective and observational cohort study which is undertaken at a tertiary care hospital setting of India. After obtaining the Ethical Committee approval from the institution with the reference number – GEMC/2019/028, the data from a TB center of the tertiary care hospital were gathered, where two cohorts were made based on a time frame, and the patients were evaluated over that selected time frame. The patients presented to the TB clinic from March 2019 to August 2019 were designated as Cohort A and those who presented to the TB clinic from March 2020 to August 2020 were designated as Cohort B. Both the cohorts were compared and further analyzed to foresee the impact of “COVID 19 over the management of TB” in two different time periods: with COVID-19 and without COVID-19. The information pertaining to the “demographic, clinical, diagnostic, and treatment outcomes” was recovered from the electronic and paper sources. The indicators of TB outcome were the number of “new TB diagnoses, adherence to the medical visits scheduled, and the outcome of TB treatment.” Frequencies and percentages were used to describe the categorical variables. An unpaired t-test with significant P < 0.05 was used for statistical analysis.


  Results Top


A total of 472 patients presented to the TB care clinic of a tertiary care hospital during the 2019 study period (Cohort A), whereas only 78 patients presented to the clinic during the 2020 study period. The diagnosis was based on the “sputum examination and chest X-ray,” where 104/472 (22%) were positive to TB in Cohort A and 42/78 (54%) were TB positive in Cohort B. In Cohort A, there were 12 patients of multidrug-resistant TB (MDR-TB), two cases of extensively drug-resistant TB (XDR-TB), and one case of pre-XDR TB (PXDR-TB). There are 10 cases of MDR-TB, 4 cases of XDR-TB, and 2 cases of PXDR TB in Cohort B. In Cohort A, 10 patients (9.6%) were lost to follow-up, 16 patients (15.3%) had finished treatment, and 75 patients (72%) were continuing receiving care. Of 42 patients in Cohort B, seven (17%) were lost to follow-up, three (7%) had finished treatment, and 25 (59%) were still receiving TB treatment. Three people (2.8%) died of TB during the non-COVID-19 period, whereas seven people (17%) died of TB during the COVID-19 period.


  Discussion Top


The newer diagnoses of TB (42) that were made during the 2020 period (study period) were significantly lower than that of the new diagnoses (104) during the 2019 period (control period) (P = 0.02). The fraction of patients who were lost to follow-up during the 2020 period was prominently higher when compared to that of the 2019 period (17% vs. 9.6%; P = 0.01). A sum of 7 deaths occurred during 2020 (17%) in comparison to the 3 deaths (2.8%) in the 2019 period (P = 0.04). The data from our study denote that there was a predominant reduction in the diagnoses of TB during the COVID-19 period (2020) as well as a significant rise in the fraction of patients who were succumbed or missed to follow-up during that period. These differences could be brought up due to the reduced or decreased attention toward TB and its management or shift and drift of attention toward COVID-19 by the health-care systems, fear of getting infected, and the difficulties in accessing health services due to the lockdown period or stringent infection control measures.[8],[9] Novel techniques and strategies toward ensuring an effective continuity of TB care during times like that of the “COVID-19 pandemic” have to be identified and thought of. Telemedicine could be one such useful tool for ensuring the better engagement of patients toward the treatment of TB during these bizarre times.[10],[11] Moreover, awareness campaigns regarding the probable overlap of the clinical picture pertaining to the TB and COVID-19 should be conducted in a holistic manner to avoid diagnostic delays.[12]


  Conclusion Top


This study has reflected on the substantial changes that were resulted from the COVID-19 pandemic toward the TB care rendered. It is very essential to evaluate “the effect of COVID-19 and its effect on the management” of TB so as to mitigate the consequences and burden of TB. Strengthening the governmental policies toward rapid adoption of TB control measures in times of newer challenges like COVID-19 must be an immediate priority in mitigating the disease burden.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Togun T, Kampmann B, Stoker NG, Lipman M. Anticipating the impact of the COVID-19 pandemic on TB patients and TB control programmes. Ann Clin Microbiol Antimicrob 2020;19:21.  Back to cited text no. 1
    
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Jain VK, Iyengar KP, Samy DA, Vaishya R. Tuberculosis in the era of COVID-19 in India. Diabetes Metab Syndr 2020;14:1439-43.  Back to cited text no. 2
    
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Prasad R, Singh A, Gupta N. Tuberculosis and COVID-19 in India: Challenges and opportunities. Lung India 2020;37:292-4.  Back to cited text no. 3
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4.
Iyengar KP, Jain VK. Tuberculosis and COVID-19 in India- Double trouble! Indian J Tuberc 2020;67:S175-6.  Back to cited text no. 4
    
5.
World Health Organization. Tuberculosis Deaths Rise for the First Time in More Than a Decade Due to the COVID-19 Pandemic. Available from: https://www.who.int/news/item/14-10-2021-tuberculosis-deaths-rise-for-the-first-time-in-more -than-a-decade-due-to-the-covid-19-pandemic. [Last accessed on 2021 Oct 21].  Back to cited text no. 5
    
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Tadolini M, Codecasa LR, García-García JM, Blanc FX, Borisov S, Alffenaar JW, et al. Active tuberculosis, sequelae and COVID-19 co-infection: First cohort of 49 cases. Eur Respir J 2020;56:2001398.  Back to cited text no. 6
    
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Stop TB Partnership. The Potential Impact of the COVID-19 Response on Tuberculosis in High-Burden Countries: A Modelling Analysis. Available from: http://www.stoptb.org/assets/documents/news/Modeling%20Report_1%20May%202020_FINAL.pdf. [Last accessed on 2021 Oct 21].  Back to cited text no. 7
    
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Shen X, Sha W, Yang C, Pan Q, Cohen T, Cheng S, et al. Continuity of TB services during the COVID-19 pandemic in China. Int J Tuberc Lung Dis 2021;25:81-3.  Back to cited text no. 8
    
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Boffa J, Mhlaba T, Sulis G, Moyo S, Sifumba Z, Pai M, et al. COVID-19 and tuberculosis in South Africa: A dangerous combination. S Afr Med J 2020;110:341-2.  Back to cited text no. 9
    
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Ghosh A, Gupta R, Misra A. Telemedicine for diabetes care in India during COVID19 pandemic and national lockdown period: Guidelines for physicians. Diabetes Metab Syndr 2020;14:273-6.  Back to cited text no. 10
    
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Monaghesh E, Hajizadeh A. The role of telehealth during COVID-19 outbreak: A systematic review based on current evidence. BMC Public Health 2020;20:1193.  Back to cited text no. 11
    
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Husain AA, Monaghan TM, Kashyap RS. Impact of COVID-19 pandemic on tuberculosis care in India. Clin Microbiol Infect 2021;27:293-4.  Back to cited text no. 12
    




 

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