Covid-19 presents both challenges and opportunities for TB management
23 March 2021
Statement by the Mayoral Committee Member for Community Services and Health, Councillor Zahid Badroodien
As we prepare to mark World TB Day on Wednesday, 24 March 2021, it is important to consider how the worldwide Covid-19 pandemic has impacted on the fight against another pandemic – Tuberculosis.
One year on since the imposition of the Alert Level 5 national lockdown restrictions in South Africa to mitigate the impact of Covid-19, it is clear that the social determinants of health in many of our communities have deteriorated as a result of the lockdown, with widespread unemployment, increased poverty and food insecurity among others.
Covid-19 has had an enormous impact on the number of people seeking and receiving healthcare. It has been noted that significantly fewer people are being tested for TB.
In 2019, City Health facilities conducted 42 828 TB tests. This figure dropped to 29 082 in 2020.
People with TB or a history of TB are likely to be vulnerable to Covid-19.
In a recent study conducted in Cape Town, TB was independently associated with increased Covid-19 mortality.
In an effort to minimise the risk of clients’ exposure to Covid-19, health services have made modifications to patient flow and treatment practices and where possible, reduced the number of unnecessary patient visits to health facilities.
On a positive note, Covid-19 has highlighted behavioural practices around infection prevention and control, and cough etiquette, including the de-stigmatisation of mask wearing and social distancing, which may contribute to reducing TB transmission.
What are the similarities between Covid-19 and TB?
Both Covid-19 and Tuberculosis (TB) are respiratory diseases, with similar symptoms and transmission patterns.
The novel coronavirus is a new coronavirus that was only recently discovered in 2019 and causes coronavirus disease (Covid-19).
Tuberculosis (TB) is caused by Mycobacterium Tuberculosis, a bacteria known since 1882, but there is historical evidence of TB in humans for thousands of years.
TB is the world's leading infectious disease, with around 1,5 million people dying each year.
Are the symptoms of TB and Covid-19 similar?
Both Covid-19 and TB cause respiratory symptoms – cough and shortness of breath. Both cause fever and weakness. One of the biggest differences is the speed of onset. TB symptoms do not tend to occur immediately after infection and when they develop, are of a gradual onset, often over a period of weeks or longer, unlike Covid-19, where symptoms can occur within a few days.
How infectious is Covid-19 compared to TB?
When one looks at infectivity, it refers to how many people a person can infect with the disease. Data on Covid-19 is still emerging, but it is thought that on average, each person with Covid-19 passes the infection on to an additional 2,2 individuals. It is thought in countries with a high incidence of TB, that a person with infectious TB, on average, passes the infection on to an additional four individuals, however there are many variables that can affect the risk of developing TB infection and disease.
For Covid-19, the risk of developing disease is not yet so well-known, but evidence to date, suggests that older age and having comorbidities, such as hypertension, diabetes, coronary heart disease and smoking are important risk factors of a poor outcome.
How does Covid-19 affect patients with tuberculosis?
While experience on Covid-19 infection in TB patients remains limited, patients with TB should be considered a high-risk group for Covid-19 management, especially if they have other comorbidities2. TB patients should take precautions as advised by health authorities to be protected from Covid-19 and continue their TB treatment as prescribed.
If you have recovered from TB, are you at greater risk of getting infected with Covid-19?
People with TB or a history of TB are likely to be vulnerable to Covid-19. People who have had TB, should consider limiting their exposure to high risk environments, such as health care settings, and practice more stringent social distancing than the general population.
The key ways to protect yourself from Covid-19 include:
Social distancing - maintain at least a 1,5 metre distance between yourself and others
Wearing a mask
Good respiratory hygiene by covering your mouth and nose with your bent elbow or tissue when you cough or sneeze
Avoid touching your face, mouth, or eyes
Regular handwashing, using soap and water or an alcohol-based hand rub
Do I need to wear a mask?
Wearing a mask creates a barrier for the spread of both TB and Covid-19 pathogens as masks prevent them from being distributed into the air. Masks have been used in TB infection prevention and control for many years to reduce the risk of further spread. There is evidence that voluntary wearing of masks by healthy or asymptomatic people in the community, can help decrease the spread of Covid-19. Mask wearing is part of infection prevention and control interventions.
How have health services tried to reduce the impact of the Covid-19 epidemic on TB prevention and care services?
In an effort to minimise the risk of TB clients’ exposure to Covid-19 in health care facilities, health services have made modifications to treatment practices and have reduced the number of patient visits to health facilities
Patients are provided with medication to ensure they can complete their treatment at home
All TB clients should wear a mask when visiting a health care facility
All TB clients visiting a health care facility will be screened for Covid-19
All TB clients on treatment should have the telephone number of their TB clinic should they have any concerns about their treatment or other issues that could compromise their care
Source:
1. International Union Against Tuberculosis and Lung Disease (The Union): Frequently Asked Questions: Covid-19 and Tuberculosis; Version 2, 22 April 2020.
2. Boulle, Andrew, et al. "Risk factors for Covid-19 death in a population cohort study from the Western Cape Province, South Africa." Clinical infectious diseases: an official publication of the Infectious Diseases Society of America (2020).
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Published by:
City of Cape Town, Media Office
