Covid clouds TB with fewer ‘reported’ cases, say Pune doctors

With the city in the grip of Covid, tuberculosis (TB), another respiratory ailment, has missed the spotlight with fewer cases being reported. The city saw less than 1,000 TB cases reported his year as compared to the previous year, not due to an improved situation, but because of lack of healthcare facilities or Covid-19 scare.

Although Covid has caused more deaths in absolute number as compared to TB, the case fatality rate (CFR) of TB is 5.63% which for Covid is 2%. TB is another respiratory ailment which is also infectious, which raises questions on whether there is an underreporting of the cases and whether the patients got access to medical facilities.

PM Narendra Modi launched a TB free India campaign in 2018 in which he said that the country would be free of TB by 2025. Under this campaign various initiatives were launched, including door-to-door survey and target to local authorities to detect TB cases based on population. However, this year, due to the Covid pandemic most hospitals had to be converted into dedicated Covid-19 hospitals and due to the scare people did not step out for their regular treatment.

PMC assistant health chief and TB programme head Dr Vaishali Jadhav said, “We have seen a drop in the notifications from private hospitals because of the lockdown. Every city is given a target which we could not meet this year due to multiple reasons mainly Covid and lockdowns. Although we do get all TB patients who visit government hospitals notified, we do not get them from private hospitals.”

Dr Sanjay Darade, district tuberculosis officer with Pune zilla parisahd said, “We have seen a drop of almost 40% of TB cases being reported this year. Due to Covid, we had to convert our rural hospitals and primary healthcare centres into dedicated Covid flu clinics or hospitals. We have reported about 167 deaths due to Covid this year.”

TB causes millions of deaths in the country and is also highly infective. Dr Abhijit More, public health expert, said, “The pandemic has certainly put a lot of pressure on the government machinery and so the non-Covid ailment programmes have been affected, including TB. It is also true that 50% of TB patients take treatment in private hospitals and so notifications from private hospitals were not reported properly mainly as half of them were shut for most time of this year, while the other half became dedicated Covid hospitals. TB although does not spread as fast at Covid-19, but the proportion of people who lose lives due to TB vis-à-vis Covid, then TB is definitely more fatal.”

With over 4,600 deaths out of 1.67 lakh cases, Covid CFR is around 2.75% which means 2.75 people died due to Covid for every 100 infected people while TB reported a CFR of about 5.63% deaths for every 100 TB infected people.

The district administration will now kick-start their annual campaign to detect the “hidden” TB cases through their door-to-door survey. Dr Darade said, “We will start the campaign by December 1 to December 16 during which we will cover 100% of the population in rural areas and 30% of the population in city areas and from December 17-31, we will focus on treatment and follow-up of patients.”

A welcome sign

Drop in TB cases reported by PMC from Pune city in 2020

2015: 4,465

2016: 5,074

2017: 5,401

2018: 6,171

2019: 6,632

In 2020, as of November 24, 5,074 TB cases have been notified from both private (36) and public (189) hospitals and 286 deaths recorded in Pune city which takes the case fatality rate due to TB to about 5.63%

Deaths due to TB from January- November 24, 2020

Drug Sensitive TB:

Public - 45

Private - 225

Total = 270

Drug Resistant TB

Public- 13

Private - 3

Total = 16