41% fewer TB cases reported in April in Maharashtra amid second Covid-19 wave
The second wave of the Covid-19 pandemic has once again hit tuberculosis (TB) treatment in the state. Data from the state health department shows that TB cases plunged by 41% in April as compared to those recorded in January. Health activists said that amid the pandemic, many cases remain undiagnosed or are not treated or appropriately notified on diagnosis.
TB is an infection caused by a bacterium called Mycobacterium Tuberculosis and spreads through air to another person when an infected person coughs, sneezes or laughs.
In January, with the flattening of the pandemic curve, the number of TB notifications stood at 16,969. But with the start of the second wave in mid-February, the cases started to dive gradually. The total notification decreased to 15,610 in February, which further dropped to 15,436 in March. In April, when the state was clocking a daily surge in Covid-19 cases, individuals diagnosed with TB dropped to 10,036.
“We are aware of the sizeable drop in the notification of TB cases. We have tied up with Asha (Accredited Social Health Activist) workers who are reaching out to patients in rural parts of the state. We have also engaged with private set ups to follow-up on patients. This has helped reduce the dropout rate of patients compared to last year,” said Dr Archana Patil, director, Directorate of Health Services.
The decline in cases is seen at the out-patient department (OPD) of civic and government-run hospitals. “TB patients with compromised lungs are the most susceptible to Covid-19 infection. In April, as the city started recording over 8,000 cases daily, many decided to stay indoors and delayed their follow-ups. A similar trend was observed last year,” Dr Ranjit Mankeshwar, dean, JJ Hospital said, adding, “In fact, many preferred going to nearby private hospitals for diagnosis or check-ups.”
However, data shows that registration of TB cases at private health establishments has also declined between January and April. In January, 9,797 cases were recorded at private hospitals, which dropped to 9,110 in February, and then to 8,596 in March and 5,346 in April.
“As compared to last year, we are witnessing a fall in the number of TB cases. I believe that the second wave of the pandemic has overshadowed the diagnosis this year,” said Dr Behram Pardiwala, head of medicine department and director of academics, Wockhardt Hospital, Mumbai Central.
Many health activists fear that this trend would have a ripple effect on diagnosis in Maharashtra, which constitutes almost 9% of the total drug-sensitive TB patients in the country. In fact, as per data shared by the state health department, Maharashtra recorded 19% of the total MDR-TB cases in India in 2020.
“TB is the biggest killer in the state, especially in Mumbai which has over 20 million population. While the situation was worst between May and July during the national lockdown last year, the numbers increased after easing of restrictions. But the second wave has slowed down the diagnosis once again,” said TB activist Ganesh Acharya.
Before the outbreak of the pandemic in March 2020, the state used to record around 20,000 cases on an average every month. But thereafter in April, the notification dropped from 15,759 to 8,915 in the state. In May, it increased to 9,164, and then to 10,914 in the following month. In July, it dropped to 10,583, which plunged further to 9,531 the next month. However, since September 2020, with the relaxation of the lockdown, the number of notifications of TB patients started increasing gradually. In September, 11,538 cases were recorded, which rose to 13,095 in October, 13,322 in November and 20,212 in December.
Despite the gradual surge in the registration of cases, the overall registration of TB cases has fallen by 29.5% in 2020 as compared to 2019, when a total of 227,000 cases were recorded. In 2020, 160,000 cases were recorded, which is the lowest in the past four years. (See box).
In 2021, till April, only 59,000 cases have been recorded.
“The most major side-effect of the pandemic was that people avoided visiting hospitals even when they needed to. We are seeing several patients with advanced diseases because they refrained from the necessary diagnostic evaluation,” said Dr Harshad Limaye, senior consultant, Internal Medicine at Nanavati Hospital.
However, state TB officer Dr Adkekar said that Maharashtra would soon be able to revive the anti-TB programme to pre-Covid-19 levels and achieve the goal of a TB-free Maharashtra by 2025.