As against a total of 12.50 lakh TB cases that were notified to the National TB Elimination Programme from January till June in 2019, this year, from January till June, a total of 9.15 lakh TB cases were notified. (Representational)

There has been a drop of 3.4 lakh tuberculosis (TB) cases reported from January to June this year as against the same period in 2019. Experts attribute the decline to the inability of TB patients to avail health services during the lockdown months and caution that TB control programmes must prepare themselves for major difficulties ahead as a consequence of the Covid-19 pandemic.

As against a total of 12.50 lakh TB cases that were notified to the National TB Elimination Programme from January till June in 2019, this year, from January till June, a total of 9.15 lakh TB cases were notified.

“TB notification rates have fallen across the country,” Dr K S Sachdeva, deputy director general and head of Central TB Division, Union Ministry of Health and Family Welfare, told The Indian Express.

While each state has varying TB burdens, almost all saw a dip in notifications from the private and government sector. For instance, Gujarat reported 82,817 TB case notifications from January to June in 2019. In the same period this year, the number of TB notifications was 64,141. Maharashtra reported 1,15,082 TB case notifications from January to June in 2019 but this year, the figure dipped to 78,454 TB notifications.

According to Central TB Division data, there were a total of 52,766 TB notifications in Andhra Pradesh from January till June in 2019. This fell to 33,781 during the same period this year. Tamil Nadu reported 58,522 TB case notifications from January till June last year, which dipped to 37,456 this year. There were 2,50,843 TB case notifications last year from January to June in Uttar Pradesh, which came down to 1,74,543 this year.

Dr Sachdeva said it was too early to generalise as to how many persons with TB may have been missed during lockdown months.

“Updated data is awaited. Due to the impact of the pandemic emergency and larger external environmental factors, we anticipate a reduction, but it may be premature to assess the quantum of decline in TB case findings. However, the notification/registration is likely to improve in the subsequent months once the situation normalises,” Dr Sachdeva told The Indian Express.

In 2019, the Central TB division could reach 24 lakh TB patients, as against an estimated 26.90 lakh patients in the country. According to officials, missing cases have reduced from 10 lakh (2017) to 2.9 lakh last year.

Missing cases refer to the difference between the estimated cases and the number reported to the TB programme, assuming an incidence of 199 cases/one lakh population as stated in the India TB report 2020. TB had become a notifiable disease in 2012 and overall, there has been a 14 per cent increase in TB notifications to the National TB Elimination Programme, with 6.78 lakh notified from the private sector.

According to a report in the Indian Journal of Tuberculosis, in India, weekly counts of reported cases dropped by 75 per cent in the three weeks following the first lockdown, compared to an average of 45,875 weekly cases during the previous weeks of 2020 . TB patients are less likely to venture out of their houses to visit chemists, DOTS centers, and private doctors.

At Mumbai’s Hinduja Hospital, a large and very busy tertiary care hospital, the total number of OPD visits fell by 85 per cent from 32,000 in the month of April 2019 to just 4,800 in April 2020.

This drop was attributable to a combination of factors including delays in entering the data onto the real-time national online TB surveillance system, reduced attendance to health services, reassignment of health personnel, and a reduction in TB testing and detection, said Dr Zarir Udwadia, consultant pulmonologist at P D Hinduja Hospital and Medical Research Centre, Mumbai.

Dr Udwadia and other experts, in a new report, `Covid-19 -Tuberculosis interactions: When dark forces collide’, published in the July edition of the Indian Journal of Tuberculosis, said the two respiratory epidemics – Covid 19 caused by the novel SARS CoV-2 virus and TB, are bound to collide and impact one another adversely.

According to modelling data released recently by STOP TB Partnership – a Geneva-based UN-hosted organisation ,worldwide, up to 6.3 million more people are predicted to develop TB between now and 2025 and 1.4 million additional deaths expected, as cases go undiagnosed and untreated during lockdown. A study by the STOP TB Partnership, in collaboration with Imperial College and Johns Hopkins University, modeled that each month of lockdown in India could cause an additional 40,685 cases annually from TB over the next five years, adding up to a total of 151,120 (5.7%) increase in TB deaths in India.

“The impact of a novel viral infection, SARS-CoV-2, on an ancient bacterial disease, tuberculosis, is likely to be devastating,” Dr Udwadia said adding that the effect of SARS-CoV-2 is likely to set back global TB control by several years.

“TB is a challenge for the entire health system,” Dr Sachdeva admitted and said that they have taken up several proactive measures with the onset of Covid, so that TB care continues unabated despite the lockdown.

“Advance directives were sent to states and districts to ensure continuity of TB services, provision of supply of drugs was made for an extended period and door-step delivery of medicines taken up to ensure uninterrupted supply of medicines to TB patients,” said Dr Sachdeva.

TB officials also said that dual screening of TB and Covid in active case finding exercise, has started resulting in more TB notifications. “We also hope that due to adoption of new behaviours, use of masks, social distancing and cough etiquettes, there might be a reduction of transmission of TB during the pandemic,” said Dr Sachdeva.