TB services too were adversely affected when COVID-19 lockdown was clamped in March 2020. After an initial couple of months of hiccups, Kangra's dynamic District TB Officer Dr RK Sood led from the front in mobilising his team to rise up to the challenge. Home delivery of TB medicines was an important activity of Dr Sood's team to help people with TB stay on treatment. Uninterrupted treatment is essential to prevent emergence of any further anti-TB drug resistance, as well as for better treatment outcomes. Dr Sood has been instrumental in strengthening TB, HIV and related health responses in this part of the state since decades.
Kangra's District Strategic Plan to end TB provides an important roadmap. More importantly, Kangra is among those districts that are aspiring to achieve sub-national TB-free certification from authorities (including WHO). Despite mountainous terrain and extreme climate, the state has significantly contributed towards making healthcare accessible to its people. But no less mountainous challenges remain if the state is to keep the promise of eliminating TB in next 21 months.
Dr Sood shared that notification of new TB cases had significantly declined in the state when COVID-19 lockdown was imposed. So, his team tried to find new ways of making TB programme work even in the time of COVID-19 crisis.
By mid-2020, Sood's team dedicated their Sundays in actively testing people for TB at people's doorsteps. People were more likely to be home on Sundays. This house to house screening every Sunday also helped build and/or regain institutional trust of people in public health services. New TB case notifications went up, but they still remained way below the numbers diagnosed in 2019. Dr RK Sood said that "We do not know the reason. It could be the effect of mask or COVID-19 restrictions but we do not know."
COVID-19 adds to the risk of progressing from latent TB infection to active TB disease
One-third of the world's population is estimated to be infected with latent TB. Latent TB is where bacteria are in the human body but do not cause the disease and it cannot spread to others. However, latent TB in some people may progress towards active TB disease. So, every case of active disease comes from this pool of people with latent TB. The good news is that there are effective treatments available (TB preventive therapy) for those with latent TB so that their risk of converting into active disease is decimated.
The risk factors that make latent TB progress into active TB disease include COVID-19. Tobacco smoking, diabetes, HIV, malnutrition, are some of the other major risk factors that cause the latent TB infection to progress to active disease.
With a large part of the population estimated to be exposed to COVID-19, Dr Sood is right in alerting that it could lead to more people with latent TB presenting with active TB disease.
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