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All eyes on corona, TB patients face neglect, cases may rise in Mumbai, warn experts

By Rupsa Chakraborty
UPDATED ON APR 20, 2020 12:19 PM IST

With most healthcare professionals focusing on Covid-19 cases, patients suffering from tuberculosis (TB), considered one of the biggest killers in Mumbai, are facing neglect, which doctors fear could lead to a rise in the number of cases.

The Brihanmumbai Municipal Corporation (BMC) data shows that last year, 27,664 new TB cases were found in Mumbai. According to data on the civic-run Sewri TB hospital available with HT, diagnosis of individuals with TB in outpatient department (OPD) has dropped to 1,235 in March from 1,418 in January; follow-up of old patients has dropped to 1,050 from 1,125. In the past three months, 337 patients succumbed to the infection at the hospital. Data from the civic body shows 1,601 TB patients died in 2018 in Mumbai; data for 2019 is yet to be compiled.

The situation is no different in private hospitals where footfall of patients has plunged by more than 70% since March, said health experts.

“Medical experts are neglecting the treatment of TB patients even though the death rate of TB in Mumbai is much higher than Covid-19. Every day, around three people in Mumbai die of TB,” said Ganesh Acharya, a TB survivor.

On March 24, the World Health Organization (WHO) also directed countries with high TB burden to “ensure that essential health services and operations are continued to protect the lives of people with TB”. “Patients with TB suffer from compromised lungs. If they contract Covid-19 infection, their survival chances will be extremely low. Keeping their immunity high and avoiding outside contact is therefore essential,” said Dr Lalit Anande, medical superintendent, Sewri TB Hospital.

Moreover, currently, almost 40% Covid-19 cases are reported from the slums of Malad, Dadar, Govandi, Sion, Bandra and Andheri (East), which are also TB hotspots. Maintaining social distance in these overcrowded slums with community toilets is the biggest challenge for TB patients.

“TB cases will rise drastically post this pandemic. The central government will have to take proactive steps for TB along with Covid-19 if it is serious about ending TB by 2025,” said Prabha Mahesh, TB advocate who is dealing with TB cases for 17 years.

. “With symptoms of TB similar to Covid-19, many patients in overcrowded slums may go undetected with improper screening.”

The civic body, however, has no concrete plan for hundreds of TB patients residing in Covid-19 hotspots. “We have instructed TB patients to avoid travel and home-quarantine. We are also testing TB patients for Covid-19 if he/she comes in close contact with an infected patient,” said Suresh Kakani, additional municipal commissioner, BMC.

Currently, most doctors in the city’s 250-odd health posts are on Covid-19 duty at various hospitals. Many patients – including those suffering from multidrug resistant (MDR) TB – aren’t getting their regular supply of medicines owing to the lockdown, said experts and doctors.

“For the first six months, MDR-TB patients need injections that can only be taken under the supervision of medical experts. With several private DOT clinics shut, they are unable to take the injections,” said Nandita Venkatesan, a TB survivor.

Refuting the allegation, Dr Pranita Tipre, head of TB, BMC, said, “We are providing door-to-door medicines to patients, so they don’t miss their dose. We have started an isolation ward for TB patients at Sewri TB Hospital.”

Many Covid-19 centres such as the Jogeshwari Trauma Centre and Seven Hills hospital (city’s biggest Covid-19 isolation centre) do not have sputum testing facilities, which doctors said is likely to delay treatment of suspected patients as the symptoms for Covid-19 and TB are similar.

“TB survivors and patients are living in fear. I am treating a 35-year-old woman who gets anxiety attacks even if someone around her coughs or sneezes,” said Dr Sagar Mundada, a city-based psychiatrist. “She has developed severe obsessive compulsive disorder, and keeps cleaning rooms with disinfectants.”

‘How do I administer injections without doctor?’

Last month, a 32-year-old Malad resident was diagnosed with multidrug resistant TB (MDR-TB). Her fight against the ailment has become more difficult during the ongoing lockdown, as clinics are closed and her medicines are not available easily. She needs to take Clofazimine tablets. She also needs to be administered with Mikacin injections either by a doctor or a nurse. “Finding a doctor or a nurse to administer injections has become a nightmare every day,” she told HT. The woman has been going to small nursing homes to get the injections administered but is worried as they are not following proper hygiene standards. “I develop anxiety as non-coronavirus patients walk around without masks and I am already suffering from one infection,” she said.

Doctors suspect pregnant Covid patient had TB

On April 4, a nine-month pregnant woman, who was admitted to BYL Nair Hospital with severe respiratory distress, died within hours after her admission. Doctors conducted a coronavirus test on her, but also suspected that she had TB and informed about it to Sewri TB Hospital. “I asked Nair Hospital to send her X-ray and culture test, but the hospital didn’t conduct these tests, so her TB diagnosis were never confirmed,” the Sewri hospital doctor said. Two days later, her coronavirus results came positive. “As the post-mortem is not conducted for Covid-19 patients, we didn’t get the autopsy report,” said the doctor said.

Sion woman was diagnosed after two weeks

A 35-year-old slum dweller from Sion had to wait for more than two weeks to find out that she has TB. Later, Mushtaq Ansari, a local activist, helped her get her illness diagnosed. Ansari had come across the woman while distributing food in her slum on April 7. The woman told him she had undergone a TB test at Sion Hospital on April 1, but the doctors from the chest department were assigned duty in the Covid ward. “I went to the hospital with my reports but the doctors weren’t available. All the private clinics were also closed, so I couldn’t show my reports there either,” she said. It was on April 15 that doctors confirmed she has TB.

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