Flipside of Covid-19: India’s tuberculosis burden will rise due to lockdown

In what may trigger a crisis in the coming months, the Union Health Ministry has announced 26% drop in tuberculosis notifications between January and June 2020 as compared to the previous year due to the Covid-19 pandemic and lockdown that ensued.

This is likely to increase the number of tuberculosis cases and death in a big way – a public health worry, flagged by several studies in the last few months.

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At a meeting of the Group of Ministers on Covid-19, headed by the Union Health Minister Harsh Vardhan on Saturday, the ministers were briefed on how the Covid-19 pandemic impacted the revised national tuberculosis control programme and how the ministry now planned to overcome the challenge.

While concurring with the concerns expressed by the ministry, the experts point out that the numbers may be even higher.

“Compared to the last year, there is a 40% decline in tuberculosis notification between January and May. The biggest dip was seen in May and June. We have begun to see an upward trend from July onwards only. To what extent Covid-19 has impacted the tuberculosis control programme will be known by mid 2021,” said Shibu Vijayan, global tuberculosis technical director at PATH, an international NGO.

The reasons are people’s inability to travel to the health centres for testing due to the lockdown and diversion of the diagnostic machinery including the staff to tackle the epidemic. There was even a shortage of data entry staff to update the government’s tuberculosis database.

Moreover, the economic hardship faced by the people during the lockdown forced people to cut down on food and nutrition, which not only impacted the existing tuberculosis patients but also pushed those who are vulnerable to pick up the infections. Studies have shown that under-nutrition accounts for 32-44% of tuberculosis cases in India.

Taking all such factors into account, two medical researchers have estimated 59% reduction in tuberculosis case detection between March and May and 19.5% increase in tuberculosis deaths. In absolute terms, it would mean an additional 1.85 lakh tuberculosis cases and nearly 88,000 more tuberculosis deaths in 2020, they reported in a paper published in the Indian Journal of Tuberculosis.

“TB is sensitive to economic and food crises. The food insecurity and under-nourishment that people faced during the lockdown have added to India’s tuberculosis burden. Under-nourishment will cause new cases while under detection will lead to more tuberculosis deaths,” Anurag Bhargava, a coauthor of the paper and a professor at the Yenepoya Medical College, Mangalore told DH.

More than a quarter of the world's 10 million estimated cases and 449,700 of the world's estimated 1.3 million tuberculosis related deaths occur in India, which has committed itself to the ambitious goal of reducing tuberculosis incidence by 80% and tuberculosis deaths by 90% by 2025, five years before the global deadline in 2030.