A recent study predicted at least 110,00 additional deaths from tuberculosis in China, India, and South Africa. This number of extra deaths was linked to COVID-19, and if no measures are applied, that number could go even higher.
The increase in deaths from tuberculosis (TB) due to COVID-19 in different parts of the globe was unveiled by researchers at the London School of Hygiene and Tropical Medicine (LSHTM), a public research university in London. Their findings suggested at least 110,000 extra deaths from TB could be an outcome of this pandemic. If affected countries cannot maintain services for TB patients, the increase in additional deaths could reach up to 200,000. They published the results in the European Respiratory Journal.
Tuberculosis Deaths Predicted to Surge
As a highly contagious disease, COVID-19 has severed the mobility of people in various cities. The only continent free of this illness is Antarctica, and organizations are adamant to keep it that way. Because there is no cure, vaccine, or specific treatment yet for COVID-19, people are advised to practice safety measures, including social distancing, proper handwashing, and good hygiene. Unfortunately, social distancing is bad for business and the economy. The safety measure effectively limits the number of people in a single area.
In the healthcare sector, COVID-19 substantially impacted the global burden of numerous diseases, which include chronic illnesses and other infections. The global burden of tuberculosis may surge during this pandemic and the causal factor is the disruptions to necessary health services. Since most hospitals and health facilities are dedicated to the novel coronavirus, diagnosis and treatment for other diseases are either delayed or denied. The delay or denial can be validated by the lack of healthcare workers, lack of patient rooms, and lack of resources, among other reasons.
At LSHTM, researchers connected the impact of COVID-19 on the global response against TB. Before the pandemic began, more than 4,000 people on average died every day from TB. In nations with limited medical capabilities, the average TB-related death rate was likely higher than those with sufficient health services. With this pandemic, strained nations could end up with higher deaths at the end of 2020.
In the study, researchers gathered data from China, India, and South Africa, countries with a high burden of TB accounting for around 40% of the global cases. They employed a mathematical model to estimate the relative impact of reductions in health services and social contacts. The reductions indicated in the model were associated with the pandemic. Three scenarios were considered in the forms of social contacts in different settings. The scenarios were 0%, 50%, and 100% in school setting, 30%, 60%, and 80% in transport setting, and 50%, 70%, and 80% in leisure setting.
Meanwhile, three reduction scenarios were applied in TB health services. These scenarios centered around the disruptions from COVID-19. The model showed a 20%, 50%, and 80% relative reduction. After the scenarios and the data were combined, researchers compared the different outcomes in the number of diagnoses, treatments, and deaths from TB. All scenarios in health services and social contacts were implemented in early 2020 and assumed to persist for six months.
Results showed the two possible effects of social distancing on TB cases. While the measure could benefit people with TB, the same measure could increase either the incidence or death cases. In nations with less affected health services, the TB incidence rate would likely be lower. But in nations with severely affected health services, TB deaths would balloon over the said period. As mentioned earlier, the minimum estimated additional TB deaths due to disruptions were 110,000 in China, India, and South Africa, yet the worst case could yield up to 200,000 extra TB deaths.
In the minimally reduced social contact and severely hit health services, the increase in TB deaths could be 23,516 on average in China, 149,448 on average in India, and 28,631 on average in South Africa. The range of additional deaths from that circumstance was 18,560 to 27,940 in China, 85,000 to 233,602 in India, and 19,963 to 40,011 in South Africa. Those numbers represented a cumulative increase in TB deaths between 8% and 14%. However, if respective governments could minimize the impact of COVID-19 in health services for TB, the number of additional deaths would be lower than predicted by the model.
"There is concern that the COVID-19 pandemic is resulting in decreased TB clinic attendance, delayed diagnosis, and treatment. This is especially so in low- and middle-income countries where health services, or access to them, might be substantially disrupted. Early anecdotal information from China, India, and South Africa suggests that the number of people being diagnosed and treated for TB has fallen significantly," said Dr. Finn McQuiad, first author of the study and assistant professor in Infectious Disease Epidemiology at LSHTM.
2017 Estimated Global Burden of Respiratory Diseases
In The Lancet journal, a team of experts collaborated to analyze the global burden of respiratory diseases in the world in 2017. The team selected chronic respiratory disease, which included chronic obstructive pulmonary disease or COPD, asthma, interstitial lung disease and pulmonary sarcoidosis, and pneumoconiosis. Similar to TB, these conditions might lead to a high burden due to COVID-19.
The methods they used for estimating the global burden of these illnesses were extensively applied in other studies. Factors covered by those methods included attributed deaths, prevalence, and disability-adjusted life year or DALY. Additional factors, such as behavioral, environmental, occupational, and metabolic risks, were involved in the estimates on top of the usual elements like gender, age, and location.
Results revealed that in 2017, the estimated number of people who had a chronic respiratory disease was 544.9 million worldwide. That number of affected individuals was 39.8% higher compared to the affected population in 1990. Overall, the global prevalence of chronic respiratory diseases in 2017 was 7.1%. These illnesses were highly prevalent in high-income territories at 10.6% in 2017, compared to 9.7% back in 1990. Sub-Saharan Africa was found with the lowest prevalence rate at 5.1%, followed by South Asia at 5.5%.
TB, other respiratory infections, and chronic respiratory diseases are still active in different regions. Patients with these conditions need access to health services to avoid complications and premature death. As such, governments and health organizations must not neglect these individuals, especially those who have resistant strains of infections which require longer treatment.