SARS-CoV-2 infection and pulmonary tuberculosis: an analysis of the situation in Peru.

Abstract

This review article discusses the concurrent infections of COVID-19 and pulmonary tuberculosis in Peru. In Peru, following confirmation of the first case in early March, the measures adopted by the government aimed to mitigate mass transmission and the impact on vulnerable populations through the imposition of an early quarantine, border closings, restriction of domestic and international travel, social distancing, a relief allowance for poor and extremely poor Peruvians, early withdrawal of deposits from private pensions, and closing of schools and universities in order to avoid the collapse of health systems, already weakened. Factors in the country's insufficient response to COVID-19 include lack of infrastructure and deficient logistics in the health systems at the national level, centralization of the response plan in hospitals in the capital Lima, low initial budgeting to deal with disease, which includes insufficient medical supplies, limited commitment by the population to comply with the containment measures imposed by the government, and precarious job security and high labor informality. The results are the consequences of decades of low investment in health, education, and labor. TB patients are at high risk of succumbing to the novel coronavirus due to their vulnerability from chronic lung damage, associated comorbidities, including HIV infection and diabetes mellitus, malnutrition, and poverty. A preliminary observational study in China had already identified pulmonary TB as a risk factor for severe COVID-19, corroborating previous findings with other viral pneumonias: influenza, MERS-CoV, and SARS-CoV-1. In addition, case series of coinfection have already been reported that involve a diagnosis of TB following infection with the novel coronavirus. Meanwhile, COVID-19 survivors may run a high risk of acquiring TB, and infection with the novel coronavirus itself can increase the risk of progression of latent TB infection to the active disease. The hypothetical mechanism lies in immunodepression. A challenge for Peru's national public health system is to mitigate the pandemic's effects without failing to care for preexisting diseases. It is thus essential to anticipate the potentially destructive synergy between COVID-19, TB, and poverty.