Does COVID-19 have any effect on TB?
There are two ways in which COVID-19 might have an effect on TB.
There could be a direct effect. This is what happens when someone with TB then becomes infected with the virus that causes COVID-19.
There might also be an indirect effect. This could be the result of people working on TB being changed over to doing work on COVID-19 or in other ways there being a disruption of TB services.
The direct effect that the COVID-19 might have on someone who already has TB
It is not yet definitely known whether if you already have TB, and you then become infected with the virus that causes COVID-19, whether this will increase the severity of your illness.
There is though some evidence that having underlying health conditions, such as a chronic respiratory disease, will increase the chance of having more severe symptoms if you then become infected with the COVID-19 virus.1Hanna Kaur, Managing TB during the COVID-19 Pandemic, April 2020, https://www.rcn.org.uk/news-and-events/blogs/managing-tb-during-the-covid-19-pandemic
A disturbing story from India
A story has emerged from India of the body of a patient with TB and who also tested COVID positive being found in the toilet of the TB hospital in Sewri some 14 days after the patient went missing.2https://www.sentinelassam.com/national-news/mumbai-dead-body-found-in-the-toilet-after-going-missing-for-14-days-508414
The indirect effect that COVID-19 might have on TB services
The World Health Organisation has emphasized that:
TB services must not be disrupted during the COVID 19 response 3Updated WHO Information Note https://www.who.int/news-room/detail/12-05-2020-updated-who-information-note-ensuring-continuity-of-tb-services-during-the-covid-19-pandemic
But in practice there will inevitably be disruption of TB services as a result of country wide or even district wide "lockdowns" due to COVID-19. Stringent COVID-19 responses may only last for a few months but they are likely to have a lasting impact on TB in high burden settings. Some people will not be diagnosed with TB whilst others may not have TB treatment. Disruption of treatment could result in more cases of drug resistant TB.4Liz Ford, Millions predicted to develop tuberculosis as result of COVID-19 lockdown, 2020, Guardian, https://www.theguardian.com/global-development/2020/may/06/millions-develop-tuberculosis-tb-covid-19-lockdown
A recent study looking at this suggested that a 3 month lock down and a protracted 10 month restoration of TB services could result globally in an additional 6.3 million cases of TB between 2020 and 2025 and an additional 1.4 million deaths from TB.5The Potential Impact of the COVID-19 Response on Tuberculosis in High Burden Countries: A Modelling Analysis, Stop TB Partnership, 2020, http://www.stoptb.org/covid19.asp
As a result:
global TB incidence and deaths in 2021 would increase to levels last seen between 2013 and 2016, implying a setback of at least 5 to 8 years in the fight against TB.
In India the trend being witnessed across the country indicates that a large number of cases of TB in India are going undetected and many patients may be on the verge of disease progression.6Jyoti Shelar, Doctors fear disease progression, drug resistance in patients with delayed diagnosis, 2020, https://www.thehindu.com/news/cities/mumbai/states-tb-notifications-dip-drastically/article31880116.ece
Does the TB vaccine, BCG, protect people against infection with Covid-19?
At the moment there is no clear evidence that the TB BCG vaccine protects people against infection with the COVID-19 virus. However a team of researchers reviewing the results of previous trials concluded that "the BCG vaccine may well be a bridge to a specific COVID-19 vaccine". But even if it does provide some protection it cannot be given to everybody.7Hannah Lucinda Smith, Has tuberculosis jab saved Balkans? The Times, June 2 2020, https://www.thetimes.co.uk/edition/news/could-the-tubercolusis-jab-pave-the-way-to-a-coronavirus-vaccine-3tws5jlw0
In people with already weakened immune systems the vaccine can itself cause disease. So there is a need for some randomised clinical trials to investigate this. Some trials are already underway in Australia and the Netherlands.
But more research has now emerged in support of using BCG as a tool in the fight against COVID-19. Researchers have found that countries where many people have been given the vaccine have had less mortality from COVID-19.8Lauren Mascarenhas, More evidence emerges that a TB vaccine might help fight coronavirus, 2020, https://edition.cnn.com/2020/07/10/health/tb-bcg-vaccine-coronavirus-study/index.html
Is COVID-19 the name of the virus or the disease?
Viruses and the diseases they cause will often have different names. For example HIV is the virus that causes the disease AIDS. But this doesn't happen with all diseases. For example, the disease TB is caused by TB bacteria.
COVID-19 is the name of the disease. The disease is also sometimes just known as coronavirus disease.
The official name of the virus is "severe acute respiratory syndrome coronavirus 2". This is because the virus is genetically related to the coronavirus responsible for the SARS outbreak of 2003. The World Health Organisation (WHO) generally refers to the virus as either "the virus responsible for COVID-19" or "the COVID-19 virus".9Naming the coronavirus disease (COVID-19) and the virus that causes it, WHO, 2020, https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it
How do you diagnose COVID-19 in high burden TB countries?
There is now a test for the coranavirus that causes COVID-19 which is available for use on the Genexpert system. The Genexpert sytem is widely available in low and middle income countries where it is already used for diagnosing TB.10Stop TB Partnership, 2020, http://www.stoptb.org/news/stories/2020/ns20_020.html
The Truenat system which is widely used in India can also now be used to test for COVID-19.11https://www.thehindu.com/news/national/kerala/truenat-results-can-be-the-final-word/article31872536.ece
This page was last updated in October 2020.
Author Annabel Kanabus
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