Covid-19’s devastating effect on SA’s TB sufferers

A health worker conducts a COVID-19 coronavirus molecular test in Parkview, Johannesburg, on 22 October 2020. Picture: Luca Sola/AFP

The fight towards a world without TB has been made more difficult due to the pandemic. Funds, vaccine trials, treatment and contact tracing efforts have largely been devoted to fighting Covid-19 instead.

Close to 4000 people die of tuberculosis (TB) every day. Roughly one quarter of the world’s population is infected.

But despite it being around for centuries, a slow uptake in new recommendations on TB treatment guidelines has been observed around the world, and worryingly, in high-risk regions. 

This was revealed in a new report by the World Health Organisation (WHO) addressing the progress made in TB interventions since last year. 

A multi drug-resistant TB (MDR TB) survivor and vice-chairperson for POP TB Indonesia, Ani Herna Sari, said in a virtual launch of the Step Up for TB 2020 report on Monday that there was disproportionate reporting about TB when compared with Covid-19. 

Vaccines

Stop TB Partnership executive director Dr Lucica Ditiu explained that there was currently one vaccine for TB in the human trial phase. But for Covid-19, there were at least 47 vaccines in this phase, all of which were developed in less than a year. 

Ditiu said the world would be lucky if a TB vaccine was developed before 2027. 

“TB affects a large number of people from vulnerable groups and countries. The leaders of these countries and voices of relevant authorities in global health often forget about them, I think, and their needs.”

But Covid-19 did more than disrupt funding and attention for TB – it impacted the enrolments of the only vaccine for TB, which were first stopped due to the pandemic, and then decreased. 

The difference in speed between attention and understanding being given to Covid-19 and TB was stark. She said the media was also keeping readers informed on a daily basis “but for TB or any other infectious disease, there is no information screen on a TV to say how many people per country died of TB”. 

“People would freak out, and the investment would be very different.” 

TB still ‘killer number one’

Experts also noted that both TB and Covid-19 were airborne ailments, and TB remained “killer number one” around the world. 

“All lives matter. Unfortunately, TB is an undermined disease, an ‘old’ disease,” said WHO’s global TB programme director, Dr Tereza Kasaeva. 

Experts predicted that global TB deaths could increase by up to 0.4 million in 2020 alone if health services continued to be disrupted by Covid-19. This is because the number of people who are diagnosed and treated for TB will be affected by the pandemic.

In South Africa, the report revealed that between January and June, there were large drops in reported TB diagnoses, coinciding with the hard lockdown and a state of disaster was declared for the country in March. 

More TB challenges were also likely to surface due to the economic damage caused by Covid-19, as well as accompanying factors such as increased poverty and unemployment. Resources were severely constrained due to the pandemic, meaning some human and financial resources may have been reassigned to deal with Covid-19. 

In addition, patients found it difficult and risky to frequent medical facilities, and data collection and reporting had likely also been adversely affected.  

End TB Strategy

Around 85% of people with TB were successfully treated with a six-month drug regimen, and since 2000, TB treatment had prevented more than 60 million deaths. 

However, access to treatment and preventive treatment was falling short, the report revealed. 

An estimated 10 million people contracted TB in 2019, with around 1.2 million deaths. And 8.2% of those that died were people living with HIV. 

Infections (25%) originated in Africa, with South Africa among the eight countries that accounted for two-thirds of the global total. 

But some high-burden countries were still not on track to reach the WHO’s 2020 milestones of their End TB Strategy. Deaths were also not falling fast enough. 

The WHO hoped that by 2020, the global TB incidence rate would have reduced by 20%, TB deaths by 35%, and that medical costs be averted. 

The TB incidence rate was currently at 9%, the death reduction at 14%, and 49% of people with TB still faced “catastrophic” additional medical costs. 80% of households with MDR TB sufferers faced cost burdens. 

Sari pointed out that the battle against TB did not finish after treatment. Some patients experienced life-altering side effects, such as blindness and deafness, which meant they could return to work. 

“We must ensure that people don’t fall through the cracks.” 

Sari, who herself survived MDR TB, said her experience was one of shame, isolation and stigma. She emphasised that stigma was a barrier that needed to be overcome to end TB, and that survivors and patients should be heard in order to better understand and treat TB. 

Ditiu emphasised that an urgent policy shift should be adopted, to ensure that TB patients received the most modern treatment and medicine, and that awareness campaigns be stepped up as they had with Covid-19 to curb infection rates. 

“We need to have the tight policies in place, with intentional-level policies, but TB needs an uptake at country level, to make treatment accessible for everyone in need, and to work with the same speed as what has been made possible by Covid-19.”

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