COVID-19 & TB - diagnosing COVID-19, the effect on TB services

Diagnosing COVID-19

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.1Stop 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-19.2https://www.thehindu.com/news/national/kerala/truenat-results-can-be-the-final-word/article31872536.ece

Does the COVID-19 virus have any effect on TB?

There are two ways in which the COVID-19 virus might have an effect on TB.

There could be a direct effect. This would be something that happens when someone with TB then becomes infected with the COVID-19 virus.

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 virus 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 COVID-19, that 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.3Hanna 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

The indirect effect as a result of there being service disruption

The World Health Organisation has emphasized that:

TB services must not be disrupted during the COVID 19 response 4Updated 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 as a result of country wide or even district wide "lockdowns".  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 whilst others may not have treatment. Disruption of treatment could result in more cases of drug resistant TB.5Liz 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 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.6The 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.

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.

Not everyone is convinced that BCG holds much promise. Dr Accili, an endocrinologist at Columbia University said that he thought that efforts to use the vaccine against COVID-19 sounds:

a bit like magical thinking

Is COVID-19 the name of the virus or the disease?

The virus that causes COVID-19 © liverpool.ac.uk

The virus that causes COVID-19 © liverpool.ac.uk

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".8Naming 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

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This page was last updated in July 2020.
Author Annabel Kanabus

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