Abstract
Tuberculosis (TB) is a severe global threat killing more than one million people annually (WHO). With a successful TB control programme in place, there has been a decrease in the number of TB cases and deaths globally over recent years. The World Health Organisation (WHO) End TB Strategy has been momentously shocked by the COVID-19 pandemic and it seems that any success made over recent years is likely to be reversed. We are now more than one year into the pandemic, and the effect COVID-19 has had on TB services is devastating. Hospitals typically dedicated to TB have been converted to COVID-19 hospitals and diagnostic laboratories focus on COVID-19 testing rather than TB. Delivery of TB care is being prioritised for people who have active TB disease whereas prevention and diagnosis of latent TB infection (LTBI) is being put on hold. This pause can lead to an increase in TB cases and transmission. Here, we discuss the connection between SARS-CoV-2 infection and latent TB and highlight the importance of TB prevention management in LTBI post-COVID-19 patients. Community engagement and contact tracing are of high importance in fighting TB in the post-COVID19 era. Getting back on track with TB progress is essential, thus further modelling on the COVID-19 impact on TB burden and its determinants is critical.
Highlights
As the COVID-19 pandemic continues to unfold, all eyes are on diagnostics, therapeutics, and vaccination programs to fight the virus and reduce cases, hospitalisations, and deaths
Heavy focus on a single pathogen has reshaped activities across the diagnostic landscape with basic health services and screening programmes being disrupted. What effect has this disruption had on a much older infectious and endemic disease – Tuberculosis (TB)? The focus on the COVID-19 pandemic has had a direct impact on the TB care cascade, with considerable delays in diagnosis and interruption to treatment, as well as a decrease in demand and access to treatment.[1]
Mathematical modelling conducted by multiple research groups estimates the impact of the COVID-19 pandemic on TB incidence and mortality, suggesting an increase of around 5-15% over the 5 years.[1,2,3,4,5]
Summary
As the COVID-19 pandemic continues to unfold, all eyes are on diagnostics, therapeutics, and vaccination programs to fight the virus and reduce cases, hospitalisations, and deaths. Clinical studies have shown that co-infection with SARSCoV-2 accelerates TB progression by weakening host immunity.[18,19] Inflammation is the major driving pathology for severe disease in COVID-19 patients, and anti-inflammatory drugs such as corticosteroids (CST) are used to treat severe COVID-19 cases.[20] CSTs work by suppressing the immune system, and as such treatment with CST poses a significant risk for acquiring opportunistic infections, reactivating LTBI or exacerbating existing TB among COVID-19 cases.[20] In addition, SARS-CoV-2 infection can cause severe immune dysregulation, with a reduction of lymphocyte subsets including CD4 and CD8 T cells, in COVID-19 patients.[21,22] Together, the signifcant depletion of CD4 T cells caused by COVID-19 coinfection and the concurrent administration of CSTs for COVID-19 treament might promote reactivation of LTBI.[17,23] At present, most COVID-19 cases are not screened or monitored for LTBI before and during immunosuppressive therapy This situation could delay the diagnosis of TB and increase the number of undiagnosed cases contributing to the overall global TB burden.
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