World Tuberculosis Day: How did the Lockdown Affect Patients? 

From disrupted drug supply to not being able to visit a doctor during lockdown, TB patients’ heartbreaking stories.

6 min read
World Tuberculosis Day: How did the Lockdown Affect Patients? 

(World Tuberculosis Day is observed annually on 24 March to raise public awareness about the global epidemic of tuberculosis and aim to eliminate the disease. FIT is republishing this article to shed light on this.)

"I have not been able to find Kanamycin - an injection used for TB treatment - in absence of which I can feel my symptoms surfacing again. Every time I take oral medicines, I puke immediately."

Kavita Kumari, from a small town in Jharkhand, made a visit to the medical store when she wanted to buy medicines for herself and her father, both TB patients, only to hear a rejection.

She says that she worries about her father because of his age. She hasn't been able to take her father to the hospital and fears his symptoms also match those of COVID-19 patients.

"Two people can't travel together in my town during the lockdown. Since this is a rural place, the restrictions imposed are strict.", She tells FIT.

Can we really afford to let a new virus affect the management of more than a century-old deadly bacteria?


Patients With TB, an Old Infection Face New Threat from COVID-19

Tuberculosis (TB), an old and deadly respiratory infection continues to take the lives of nearly 4.5 lakh people in India every year and 1.5 million people globally despite being curable and preventable. WHO statistics show India houses the world's largest population of TB patients, around 27% followed by China (9%).

This situation can worsen further if the immunization process gets affected and health care gets disrupted, as it has currently. Another major concern is patients developing drug resistance - a dangerous condition that can occur if they discontinue taking the drugs on time. Once the mycobacterial tuberculosis (MTB) - a bacteria that spreads TB, turns resistant - the drug used to treat TB cannot fight it in most cases.

A TB patient, amid coronavirus outbreak, is not only facing the brunt of the overburdened healthcare system in the country but also the threats posed by COVID-19.

While there is no conclusive research done on the correlation between COVID-19 and TB, few initial studies show that TB patients might be more susceptible to COVID-19 since TB affects a patient's lungs and does other harm to the body such as weakening the immunity and causing respiratory issues. Both the diseases show similar symptoms such as fever difficulty breathing, cough and attack the lungs.

WHO in its advisory has said,

“While experience on COVID-19 infection in TB patients remains limited, it is anticipated that people ill with both TB and COVID-19 may have poorer treatment outcomes, especially if TB treatment is interrupted.”

To dig deeper and to understand how the severity of TB is overshadowed by a new pandemic ie COVID-19 in India, let's look at a few things.

'Drug Stock Not Available, Unable to Visit Doc': TB Patients Share Their Grief

Kavita has finally found a pharmacy that stocks TB injections. There's one problem:

“After making some calls, I have managed to find a shop where the injection is available but it is 60 kms from where I live. If the police allow me to go with someone, I will be able to get the needed medicines for my father and me.”
Kavita Kumari

Khageswor Kumar, a TB survivor and activist from Jharkhand tells FIT that it has been difficult to provide medicines to patients during coronavirus lockdown.

"Patients are also unable to visit the bank to get the relief fund of 500 INR offered to them under Nikshay Poshan Yojana", he adds.

"I know an MDR TB (multidrug-resistant TB) patient here whose condition is worsening but he has not been able to visit a doctor. I spoke to one doctor for him but he was unavailable. Discontinuity in TB drug consumption will be even more dangerous for him at this time", he says.

Kumar also tells us that TB patients are aware of the risk looming over them due to COVID-19, and as a result, some are scared to visit crowded areas or hospitals.

TB patients are facing an unprecedented situation and are uncertain when will things become normal again. As they speak of poor management and disrupted TB essential services, activists echo the same sentiment, worried about the potential consequences.

Huge Drop in Number of TB Notifications

According to Nikshay, a web-based tool from the National TB Elimination Programme initiated by the Union Ministry of Health & Family Welfare, that helps authorities to track real-time notified TB patients both from the private and public hospitals, there has been a huge drop in the TB notification since February first week.

In the first week of February, the number of notified patients was 51,292. In the first week of March, this number dropped to 48, 712 and to 9, 419 in the first week of April. The total number of notifications in the month of February was 206,514 and further saw a huge dip in March with only 145,924 cases reported.

The numbers might get updated further.

World Tuberculosis Day: How did the Lockdown Affect Patients? 
(Photo: FIT)

The drop in notification indicates that ever since coronavirus has gripped India, the number of people getting tested for TB has reduced.

FIT reached out to Vikas Sheel, Joint Secretary, Union Health Ministry who also heads the National TB Elimination Programme.

“The reporting of cases might have got affected due to the lockdown or detection operators for TB getting deployed for COVID-19 detection. However, I will not attribute this visible reduction to disruption in TB services.”
Vikas Sheel, Joint Secretary, Union Health Ministry

"It's very natural that when we have an emergency, sources do get diverted there", he adds.

Dr. Nerges Mistry, Director of FMR (Foundation for Medical Research) and an expert in TB research told FIT, "The drop in notifications could be because of the lockdown or people who might have registered at the health facility may have migrated out of the area. One can safely say that most of it is due to lack of physical accessibility."

FIT also reached out to Dr K S Sachdeva, Dy. Director General, Central TB Division, Ministry of Health and Family Welfare (GoI). On the question of inaccessibility of drugs for TB patients during the lockdown, he told us, "All State TB Officers (STOs) have been instructed to issue at least a month of dosage to the patient and for those not able to access the health services arrangements should be made by the facility to deliver drugs at the doorstep of the patient. Further, at the central level two dedicated officials have been designated to resolve queries."

He also added that TB Diagnostic Centres and services are kept fully operational, during the lockdown period. However, how the patients will reach to these centres from their remote villages, still remains a serious question.

TB Activists Raise Concerns, Write to Govt

Touched by TB - the Coalition of TB people in India, in a letter to Union Health Ministry's Central TB Division, which is addressed to Health Minister among other senior officials, raised concerns about the COVID-19 threat to TB community.

The letter accessed by FIT, dated 1 April, says, "We are concerned that we might get affected with novel coronavirus when we approach crowded DOTS centres for our medicines."

It further requests the ministry to strictly implement guidelines given to the states to ensure proper management of TB services during this pandemic. The letter further suggests the government to take measures such as ensuring medicine availability, allowing kin of patients to receive the medicines on behalf of them and releasing guidelines for TB patients diagnosed with COVID-19.

Blessina Kumar, a well-known health activist and co-founder of Touched by TB, tells us that as of 14 April, they have not received a response from the government. She further says,

“It’s been difficult for TB patients to receive the support they need and it is challenging time for them. The government’s response to COVID-19 has shown that the government can do something if they really want to or if there is a will.”

'TB Facilities Should be Fully Operational': Indian Govt's Advisory

On 25 March, Central TB Division released a guideline to states saying, in view of the COVID-19 situation and restrictions imposed due to it, all facilities under the National TB Elimination Programme should continue to be fully operational in the interest of TB patients.

Speaking to FIT, Vikas Sheel, also said, "Availability of drugs for TB is not an issue. We have written to the states to ensure that the treatment of notified patients is not affected. So far we have not received any complaint regarding service disruptions."

Despite the government's guidelines, patients on the ground seem to be facing difficulty and are unable to access TB services.

On 4 April, WHO in its new guidelines spoke on the same lines and said,

"It is important to ensure that essential services and operations for dealing with long-standing healthproblems continue to protect the lives of people with TB and other diseases or health conditions."

It further added,

“Health services, including national programmes to combat TB, need to be actively engaged in ensuring an effective and rapid response to COVID-19 while ensuring that TB services are maintained.”

It is quite evident that India can't afford negligence at this time. The effective work done in many years by the government and activists to mitigate TB can't be put in jeopardy while India tries to tackle a brand new problem.

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