25% dip in TB cases in 2020; experts cite low screening amid lockdown

There was nearly a 25% reduction in the number of tuberculosis (TB) cases reported in 2020 as compared to the previous year, which experts believe was mainly due to Covid-19-related lockdowns and other restrictions that kept people away from healthcare facilities.

According to data provided by the Union health ministry in Lok Sabha on Tuesday, India reported 1.8 million TB cases between January and December 2020 as compared to 2.4 million the year before.

While India’s first Covid-19 case was reported in January-end in 2020, the infection started spreading only in March that year. A nationwide lockdown was implemented on March 24 to curb the spread of the virus.

“During the lockdown, people weren’t able to go and get themselves tested. There was also a lot of fear of exposure to the virus, because of which no one wanted to go to the hospital. Even our staff had faced problems in reaching the centre and the daily testing was reduced,” Dr KK Chopra, director of New Delhi TB Centre, said.

Directly Observed Therapy (DOT) is the mainstay of the TB programme where medicines are given under the supervision of a healthcare worker at the health centre. However, during the pandemic, patients were given medicines for one month together to help them continue with their treatment and teleconsultations were held to ensure compliance.

All DOTS centres were allowed to give medicines to patients from other states or areas who were stranded in various places during the lockdown. Non-governmental organisations were also roped in to deliver medicines to those who were unable to visit the centres.

“We also collaborated with private medical practitioners to collect sputum samples from patients for testing. We were much better prepared during the second wave and are also well-equipped in case of any surge in Covid cases in the future,” Dr Chopra said, adding that more TB cases were gradually reported towards the latter half of 2020.

“Covid-19 is an acute infection and there is a lot of fear in people too, prompting them to visit hospitals each time they experience any of the symptoms. People usually do not do that with TB which is chronic. Cross referral of patients from TB and Covid-19 clinics actually helped in detecting more cases,” he said.

A drop in TB cases was reported also because out-patient clinics remained shut during and even after the lockdown. “The impact of Covid-19 was seen not only on TB but other diseases as well; the out patient departments or OPDs had stopped running for months together,” said Dr GC Khilnani, former head of the department of pulmonology at the All India Institute of Medical Sciences.

Experts fear that the undiagnosed cases of TB could facilitate the spread of the infection, but wearing of masks by a majority of the population might have an unintended but pleasant impact.

“TB is a droplet infection so people wearing masks will prevent the spread of the infection. The current dip in numbers is not because of that – the incubation period of TB is longer – but we will see an impact in the future,” Dr Khilnani said.