In India, Tuberculosis is the biggest infectious disease killer which has more than a quarter of the global burden of disease. It has accounted for 27 lakh cases in 2019 and claims around 4.8 lakh lives each year. Regular medication for diagnosed TB patients is a necessity. However, amidst the pandemic, the availability of essential medicines and injections has been slowed down. Moreover, the healthcare services by Directly Observed Therapy(DOT) centres and TB hospitals got replaced with COVID-19 centres on a priority basis.

Before the pandemic, there were improvements seen in the TB surveillance program. Further, TB incidences and mortality were also steadily declining. However, the impact of the pandemic has led to a reduction in detection and diagnosis. This was because of the fear that has affected the routine TB services.

The status of recorded notification of people newly diagnosed with TB rose from 12 lakh to 22 lakh between 2013 and 2019. However, since the beginning of the lockdown, the estimated number of new cases in healthcare centres had dramatically dropped. At present, it has reached 12 lakh according to the Central TB Nikshay portal of the Government of India. The significant fall in notifications of more than 50 per cent, is an estimated number of the diagnosis that were badly hit due to the pandemic.

During the lockdown, there was a significant increase of 50 per cent in travel, further, a drop of 70 per cent of healthcare staff which delayed the patient diagnosis, and treatment initiation. The number of people admitted for inpatient TB treatment in these facilities fell to less than a third of the number in the course of the covid crisis.

In India, there was a three-month lockdown followed by a ten-month recovery period has led to 16.5 lakh incident TB cases and 1.3 lakh deaths that would result in an increase of 7.9 per cent of average annual health spending on tuberculosis by 2025.

TB is one of the top 10 causes of death. India has committed itself to the ambitious goal of meeting the SDG targets in 2015 of reducing TB incidence rate to 142 per lakh by 2020 and 44 per lakh population by 2025. However, as per the WHO tuberculosis profile for 2019, the estimated TB incidence in India is still 193 per lakh population in 2019.

Studies show that the fear of crowded healthcare centres and many government containment measures among people have changed health-seeking behaviour in India. In contrast, some countries have adopted strategies for the continual services of TB through telephone helplines. In Sri Lanka, the TB treatment cards have given access to the patients to travel in lockdown areas. A study suggested that private health sector deployment and non-government health organizations jointly could play an important role in mitigating these challenges.

Impact of COVID-19 on TB patients in India
By Shipra Agarwal, Senior Qualitative Health Analyst, Sanrachana