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Ensuring continuity of TB services during COVID-19 pandemic

Date: 
06 May 2020

With nations around the world confronting the COVID-19 pandemic, the fact that tuberculosis remains the world’s deadliest infectious disease – killing between 1-1.5 million people globally every year – must be highlighted. Although the spread of the COVID-19 virus in South Africa is cause for great concern, as the virus can cause severe illness in immunocompromised people (such as those who have HIV or TB, or both), because in South Africa, there are 7.7 million people living with HIV and more than 300 000 people become ill with TB each year with more than 63 000 dying from the disease. Half of the people who have TB also live with HIV. As the country comes together to tackle the COVID-19 pandemic, it is important to ensure that essential services and operations for dealing with long-standing health problems continue to protect the lives of people with TB and other diseases or health conditions. 

“It isn’t known yet whether people living with HIV or TB have a similar or higher risk for acquiring coronavirus disease 2019 than anybody else does,” says the South African National AIDS Council Co-Chair, Ms Steve Letsike. “But it does appear; however, that individuals who live with HIV or TB or both could be at higher risk of developing serious health complications as a result of acquiring the disease. This is based on what is known about other viral infections such as influenza. Recognising that people living with TB are likely to be more vulnerable to Covid-19 and its effects, it is essential to ensure that access to TB prevention, diagnosis and treatment continue in what is an unprecedented environment”.

In the 9-week period from 5 March to 5 May 2020, 7,572 people in South Africa were diagnosed with Covid-19, with 2,746 recoveries and 148 deaths, while the estimated number of people who died of TB in the same period was 11,500 (almost 80 times more than from Covid-19).

The comparison is not intended in any way to reduce alarm over Covid-19, or the response to it; rather the point is to raise concern on the TB response and the need to do more. Amongst the main concerns is the potential disruption in the provision of direct services to TB patients as the pandemic negatively impacted these efforts. The exposure of frontline health workers to COVID-19 is also another concern. Patient’s loss to follow-up is another concern and it is important to map how we’ll be able to recover patients lost to follow-up during this pandemic.

This year for World TB Day, the South African National TB Program and its partners had planned a series of events to mark the roll-out of 3HP, a new, shorter regimen expected to prevent TB in those at highest risk of developing the disease, including people living with HIV and children under the age of five. This is a moment we’ve all been looking forward to for years, and while physical events have been cancelled due to covid-19 lockdown, we wanted to make sure that effective TB prevention remains a game-changer in the global fight to eliminate TB.

As SANAC we call on;

  1. Provision of leadership, multi-sectoral collaboration, resources and real-time active surveillance seen on covid-19 for TB.
  2. Maintenance of continuity of services (treatment and follow-up) for people with TB during the COVID-19 pandemic response
  3. Integrated screening, diagnosis and contact tracing for TB & covid-19
  4. Provision of health promotion, awareness and correct information on covid-19 and TB
  5. All health-care providers, affected communities, civil society organizations, donors, partners and the business to unite forces and step up the TB response
  6. Joint collaboration on the research agenda for covid-19 and TB

“We stand in solidarity with those affected by COVID-19 and those at the frontlines of the fight to combat the disease,” said Letsike.

By: Ms Steve Letsike, SANAC Co-Chair & Chairperson of SANAC Civil Society Forum (CSF