Tuberculosis infections during the COVID-19 pandemic: Comparing USA and global tuberculosis in 2019 and 2020

Abstract

Background: Tuberculosis (TB) was the worldwide leading cause of mortality from a single infectious agent before the coronavirus disease 2019 (COVID-19) pandemic. The incidence of TB infections has continually declined since 2000, but the COVID-19 pandemic has reversed this trend. In 2020, global health officials reported a 21% drop in documented cases relative to TB cases in 2019. Although previous studies evaluated the impact of the COVID-19 pandemic on global TB cases, we are not aware of reports that compared U.S. and global TB cases during the COVID-19 pandemic. Objective: To analyze prepandemic and pandemic volumes of TB cases within the United States and compare findings with global TB volumes. Methods: This descriptive study used data from the Centers for Disease Control and Prevention to compare reported TB cases in the United States in 2019 and 2020. TB cases from the United States were compared with data about global TB cases. Results: The COVID-19 pandemic was associated with decreased TB testing and cases in the United States. The five states with the highest number of TB cases remained the same in 2019 and 2020, and included California, Texas, New York, Florida, and New Jersey. In these states, TB predominantly occurred in non‐U.S.-born residents and most patients solely presented with pulmonary manifestations. In the United States, the most substantial risk factor for TB was diabetes mellitus. Conclusion: The COVID-19 pandemic decreased access to TB services and discouraged patients from seeking TB care, which inadvertently disrupted international and U.S. TB surveillance systems. Given the decline in documented TB cases, leaders may need to anticipate an increase in TB cases and begin to aggressively reallocate resources to improve TB detection and care to mitigate the recent changes.