Over 10k TB cases found in state after Centre’s 2020 notification

As per the state TB department, 1,33,319 Covid patients were tested for TB in 2020 and 2,163 (1.62%) were positive

Mumbai 15 months after the Ministry of Health and Family Welfare (MoHFW) instructed states to conduct tuberculosis (TB) tests on Covid patients and vice versa, Maharashtra recorded 10,831 new TB infections. The number in Mumbai stands at 1,022.

As per the MoHFW, there was an overall decline of 26% in TB notification from January to June 2020 due to the pandemic (Hindustan Times)

As per the state TB department, 1,33,319 Covid patients were tested for TB in 2020 and 2,163 (1.62%) were positive. In 2021, 8,668 (0.68%) were diagnosed with TB after testing 12,74,206 Covid patients. In Mumbai, the percentage of TB among Covid patients stands at 0.87% in 2020 and 0.63% in 2021.

As per the MoHFW, there was an overall decline of 26% in TB notification from January to June 2020 due to the pandemic. According to a World Health Organisation (WHO) report released last year, India accounted for 41% of the global dip in reporting TB cases during the pandemic.

“Since both diseases affect the lungs and have overlapping symptoms, screening Covid patients for TB helped in new diagnosis,” said Dr Ramji Adkekar, state TB officer.

According to the MoHFW guidelines, a Covid patient will be tested for TB if they have symptoms like cough for more than two weeks, persistent fever for more than two weeks, significant weight loss, night sweats. The guideline also mentions screening Covid patients who have been in contact with TB cases.

Dr Aniruddha Kadu, consultant, Tuberculosis (World Health Organisation) to the Revised National TB Control Programme (RNTCP) of the Central Government, said, “There was restriction of movement, fear among people to step out of their homes. TB services were affected as the focus was on Covid. Though the cases were prevalent, there were gaps in diagnosis. Therefore, screening Covid patients for TB helped.”

Both TB and Covid primarily attack the lungs. While Covid is caused by SARS-CoV-2 virus, TB is caused by a bacterium called Mycobacterium tuberculosis.

Dr Lancelot Pinto, pulmonary medicine specialist, PD Hinduja Hospital said, “Bi-directional screening for tuberculosis among patients who present to healthcare with respiratory illnesses should be encouraged as it can help diagnose undetected cases of TB. It will improve TB case detection.”

Low detection of Covid cases among TB patients

While health experts had initially predicted that Covid would be catastrophic for TB patients as their immune system and lung condition are compromised, data from Mumbai TB office says otherwise.

Data by the Brihanmumbai Municipal Corporation (BMC) shows that 560 or 1.50% of the 37,216 tuberculosis (TB) patients in the city who underwent RT-PCR tested positive for Covid and 37 of them died. In 2020, 298 (2.26%) of the 13,155 TB patients tested positive for Covid and 25 died while in 2021, 232 (1.11%) TB patients tested positive and 12 died. In 2022, till date, 30 (0.91%) TB patients have tested positive.

Medical experts said that the low numbers could be a consequence of underreporting.

Dr Rajendra Nanavare, pulmonologist and ex-medical superintendent of BMC’s Sewri TB Hospital, said there have been under-reporting of TB cases. “TB already has a stigma attached to it and so did Covid. With the lockdown and fear of contracting Covid, many potential TB patients avoided testing, which has likely led to low co-infection rates,” he said.

An official from the TB department of the civic body attributed low infection rates to wearing masks and TB medication.

Dr Kadu said that while it is true that not many Covid cases were detected among TB patients, he said that there is no scientific reason behind it. He further said that it is difficult to say Covid caused the 37 deaths in TB patients. “Covid is an opportunistic diagnosis in a TB patient. It is difficult to label it as Covid death. It can be called TB death too,” he explained.

Dr Pranita Tipre, Mumbai TB officer, said that one of the reasons behind less Covid cases in TB patients could be an outcome of following Covid-appropriate behaviour and the antibiotic regimen they are on.

“Like Covid, pulmonary TB too is infectious and airborne diseases. Our TB patients are instructed to wear masks at home and follow hand hygiene. Their extra precaution and antibiotic regime could have played a role in this population seeing less number of Covid cases,” she explained.