TB patients begin slow return to Mumbai hospital
In Mumbai, till Wednesday, 18 of the 135 active TB patients co-infected with Sars-CoV-2, the virus that causes Covid-19, have died.
Footfall of patients at the city’s civic-run Sewri Tuberculosis (TB) Hospital, the country’s largest such facility, is slowly returning to pre-Covid levels, thanks to the easing of curbs imposed since March.
In Mumbai, till Wednesday, 18 of the 135 active TB patients co-infected with Sars-CoV-2, the virus that causes Covid-19, have died. Every year, around 45,000 people are diagnosed with TB in Mumbai. Due to the restrictions imposed during the national lockdown and fear of getting exposed to the novel coronavirus, TB patients couldn’t visit the hospital for diagnosis. As per data provided by the hospital, before Covid-19, the hospital used to receive more than 1,400 patients in their OPD every month. Since April, however, there was a drastic decline in the number of patients. In February, 1,405 patients visited the hospital’s OPD for consultation. The following month, when the first Covid-19 case was reported in Mumbai, the number dropped to 1,235. In April, it further dipped to 996. With the gradual spread of the virus, the numbers dived to 749, 708, 879 and 688 in May, June, July and August. Last month, with the relaxation in lockdown, the number of patients’ visits rose to 979 for the first time since May.
Doctors have cautioned that the next few months will be crucial to gauge the adverse effect of delay in diagnosis and treatment of suspected TB patients owing to the lockdown. “We have started getting more patients with the opening up of public transport. Also, as Covid-19 cases have come under control in the city, the fear of transmission has decreased,” said Dr Lalit Anande, medical superintendent of the hospital. “However, we are yet to start getting patients from far-off areas.”
For instance, a 39-year-old Borivli resident was diagnosed with multiple-drug resistant TB in November 2019. She also lost her job due to her illness, following which she sought treatment at Sewri TB Hospital. “Soon, the lockdown was declared and I had to stop going to the hospital as I couldn’t afford to travel in rented vehicles. My relatives pooled in money to help with my follow-ups at a private clinic. Last week, for the first time since April, I visited the hospital in a public bus, as I was feeling breathless,” she said.
Admissions at the hospital have also increased by 51% –196 patients in April, which rose to 296 in September. Along with public hospitals, private hospitals have also started to witness a spike in the number of TB patients. “During the initial month of the pandemic, we received less than 2,000 cases. But last month, we recorded 2,785 patients. From July onwards, the number has started to rise,” said Dr Pranita Tipre, deputy health officer, TB, BMC.
At Sewri hospital
Since the outbreak of Covid-19, 128 TB patients co-infected with the coronavirus have undergone treatment at the hospital. Of these, half were recovered or latent (when the bacteria remain dormant in the body) TB patients. At the hospital, 14 patients have succumbed to the infection. This takes the mortality rate at the hospital to 11%, which is much higher than the city’s death rate (2.2%).
According to officials at the hospital, most deaths were a result of delayed diagnosis and treatment. As both Covid-19 and TB affect the lungs, it often leads to misdiagnosis. “Of the 14 deaths, eight were reported during the initial days of the pandemic. All patients who died were either brought or transferred to the hospital when they were extremely critical. This week, one co-infected patient died due to acute pneumonia. He was also referred from a private hospital,” said Dr Anande.
Next few months crucial
Due to their compromised lung condition, TB patients are most vulnerable to Covid-19 infection. When the outbreak was reported in the city’s slums, health experts feared the spread among TB patients. Seven months on, even though Sars-CoV-2 has infected less than 1% TB patients in Mumbai, doctors said there are chances that TB cases might spike due to irregularities in the treatment of TB patients.
“Globally, Covid-19 has had an enormous impact on the number of people seeking and receiving healthcare for TB. India is now dealing with a large-scale syndemic (cluster of epidemics) of TB and Covid-19. Both respiratory infections need attention. Delayed TB diagnosis and treatment might substantially increase TB mortality in the future,” said Madhukar Pai, director, McGill International TB Centre, Canada, in an email interview to HT.
When TB patients don’t take their medicines regularly, they can develop multiple-drug resistant TB, where the chances of mortality are higher. Also, if a person gets delayed in diagnosis, it cannot only lead to his death, but also infect others. “We don’t know to what extent the pandemic has delayed the treatment of patients. It will take at least five-seven months for the symptoms of drug resistance to show. Also, we have to check if family members of delayed patients also contract the infection,” said Dr Yasin Dholakia, secretary, Maharashtra State Anti-Tuberculosis Association. In September, the National TB Elimination Programme announced a Rapid Response Plan to mitigate the impact of Covid-19 pandemic on TB epidemic. “In the immediate term, I hope the Indian government will fully fund and rapidly implement this rapid response plan,” said Pai.
TB co-infected patients cured with vitamin and antioxidants
At a time, when doctors across the city are treating Covid-19 patients with promising drugs, Remdesivir and Tocilizumab, the Sewri TB Hospital cured 104 patients with vitamins and antioxidants. “For years, we have been dealing with TB, which is also an air-borne infection. So, we know the technique of how to treat a patient with lung infections. Since the beginning of the pandemic, we have been treating patients with vitamin C dosage. Later, we added antioxidants, an effective therapeutic solution for treatment of hyper inflammation that occurs due to Sars-CoV-2 virus,” said Dr Anande. “It also protects patients from cytokine storms (when the body’s immune system attacks its own cells),” he said.
Centre directs RT-PCR test on newly diagnosed TB patients
In September, the Union health ministry ordered state governments to mandatorily test all newly diagnosed TB patients for Covid-19 with reverse transcription polymerase chain reaction (RT-PCR). Health activists said the state is yet to implement the directive. In Maharashtra, almost 20,000 new patients get diagnosed with TB every month. “This (test) would have been able to identify active and latent TB patients who are more susceptible to Covid-19 infection. But even after a month, it is still on paper,” said Dr Abhijit More, a health activist. “Field workers are not even aware of the new rule.” As per the new rule, all suspected Covid-19 patients with symptoms have to undergo chest X-ray. RS Adhikari, acting joint director (TB) in the state, said, “We will be holding meetings with the district TB officers about the circular and take a call on it.”