The Ministry of Health and Family Welfare has today July 17 recommended tuberculosis (TB) screening for all COVID19 positive patients and COVID19 screening for all diagnosed TB patients. This decision came after media reports claimed that cases of tuberculosis were on the rise among patients infected with COVID19.

In effect to the decision, the ministry has asked the states and Union Territories for better surveillance and case finding of TB and COVID19.

Due to the impact of COVID19 related restrictions, TB case notifications had decreased by about 25 per cent last year. The health ministry assured that special efforts were being made to mitigate this impact through intensified case finding in OPD settings as well as through active case finding campaigns in the community by all states.

Also Read: Explained: Double burden of COVID19 and Tuberculosis

However, the health ministry has also clarified that so far there is not enough evidence to suggest that there has been an increase in TB cases due to COVID19.

But, the ministry also warned that SARS-CoV-2 infection can make an individual more susceptible to developing active TB disease as the latter is an opportunistic infection like black fungus.

Early this year on January 5, Gaon Connection had published a detailed report that showed that because of COVID19 pandemic, TB care across the country was affected. There were fewer and late diagnoses. Accessing health care for tuberculosis in the country became a serious struggle last year, as frontline health workers, healthcare centres and resources were deployed on COVID-19 duty.

Also Read: Testing Times: Screening, diagnosing and treating tuberculosis in 2020 took a backseat in India which has the world’s highest burden of TB cases

Double burden of TB and COVID

With an estimated 2.69 million new cases every year, India has the world’s highest burden of tuberculosis, according to the World Health Organization (WHO) report 2019. Every fourth Multi Drug Resistant-TB patient is from India. 

According to the WHO, tuberculosis and COVID-19 are both infectious diseases that attack primarily the lungs. Both diseases have similar symptoms such as cough, fever and difficulty breathing. TB, however, has a longer incubation period with a slower onset of disease. Incubation period refers to the time gap between contracting an infection and experiencing its symptoms.

“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,” the WHO had warned.

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Meanwhile, a September 2020 article published in BMJ Journals  stated that there was a sharp decline in the vaccination of children against TB in India as the medical infrastructure was hugely concentrated on containing and treating COVID19.

“TB bacilli can be present in humans in a dormant state and has the potential to start multiplying when the individual’s immunity is compromised for any reason,” reads the press statement issued today by the health ministry.

“The same is applicable in post COVID scenario, when an individual may develop decreased immunity due the virus itself or due to the treatment, especially immune-suppressants like steroids,” it explained.

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Last September, the health ministry had informed that the prevalence of TB among COVID19 patients was found to be 0.37 per cent to 4.47 per cent in different studies.