Breathe in and breathe out, then repeat.
But what if you can’t? Tuberculosis, a serious infectious bacterial disease that mainly affects the lungs, affects an estimated 10 million people globally. Till 2019, it held its undisputed position as the most common cause of death from a single infectious pathogen, dislodged only by COVID-19 in 2020. Despite various global resolutions around this disease, such as the WHO 2035 TB Care and Prevention Targets, efforts were falling short when COVID-19 took over the world.
With India facing a higher number of TB cases than any other country in the world, the problem is going to get worse. Challenges to TB treatment continue to remain the same like screening and diagnostics, non-adherence to prescribed treatment, with additional factors like malnutrition, poverty, diabetes, tobacco smoking, and household air pollution will only complicate the epidemiology.
There is no doubt that the COVID-19 pandemic has slowed down years of progress in providing essential TB services and reducing TB disease burden. The most obvious impact is sudden disappearance of a chunk of TB cases indicated by a colossal global drop in cases diagnosed. According to the Global Tuberculosis Report released by WHO in 2021, this number fell from 7.1 million in 2019 to 5.8 million in 2020. Far from the possibility of reduction in cases, this simply showed a drastic reduction in people accessing the healthcare facilities due to lockdown that could have diagnosed new cases. 16 countries accounted for 93% of this reduction, with India contributing a large proportion at 41%. To make this more alarming, estimates suggest that the number of undiagnosed patients stand at around 4.1 million people. This staggering number is more than the population of Pune!
The challenge that lies before us is enormous. Not only the direction of progress got deviated, but the criss-crossing of COVID-19 has derailed the momentum towards TB goals. We are yet to fathom the full extent of complications that COVID-19 will wreak on people who are susceptible to TB. In these times, we must rely strongly on 3 Cs – Compliance to medical protocols and advancements, Communication, and Cutting-edge technology.
Compliance to medical protocols and advancements
The adage ‘prevention is better than cure’ stands as true today as it ever did. Children can be vaccinated with the BCG (Bacille Calmette-Guérin) vaccine, which can confer protection from severe forms of TB in young people. Additionally, in August 2021, there were 14 vaccine candidates in clinical trials for adults.
There is an urgent need to adopt widespread use of rapid diagnostic tests, the success of which has been indisputably seen during the ongoing pandemic. With quick diagnosis, first-line regimens can be initiated in patients with potentially higher success rates. As of August 2021, there were 25 drugs for the treatment of drug-susceptible TB in trials.
We must also be cognizant of new, drug-resistant strains of TB. Right from detection to treatment, doctors must be on high alert and ensure that the correct regimen is followed with ultimate rigour.
It is crucial that the primary care physicians are in the drivers’ seat when it comes to their patients’ treatment plan. In addition, the information burden on doctors can also be alleviated. Apart from creating resources for the common man in the form of posters, pamphlets, apps, and websites, the healthcare industry can also adopt new-age communication methods such as QR codes, interactive patient platforms or chatbots, which will facilitate stronger communication, transparency, and information-sharing between healthcare providers, caregivers, and care recipients.
These can be used both ways – by the doctor: to share reading or video material about TB with the patient and their family, and by the patient: to share updates about their medical history, current status, and more. This would also help make information more accessible and offer it in a variety of languages.
The End TB Strategy targets set by WHO for 2030 and 2035 as well as India’s vision to be TB-free country by 2025 cannot be met without a renewed interest and investment in innovation. What could these technologies be?
Well, it starts with the patient – in situations where patients are unable to physically visit doctors, video-observed therapy (VOT) and medication monitors (MMs) can go a long way in supporting treatment for active TB. Phone apps can help patients update their own health based on pre-defined parameters, flagging off to doctors when additional interventions are required. Text messages can be employed to send out reminders to patients to ensure that treatment plans continue to remain on schedule.
Each of these will serve medical professionals as well – improving efficiency especially in areas where the ratio of doctors to patients is low. Additionally, technology can be employed in data services, health systems, and resource management, to alert governments about spikes in cases or urgent infrastructure requirements in particular regions.
All in all, there is no doubt that the healthcare ecosystem needs to come together in the fight for TB eradication. Funding in low- and middle-income countries (LMICs) that account for 98% of reported TB cases is inadequate for what is needed. Treatment must be made accessible and regimented despite the challenges like lockdowns and financial constraints faced by patients. With stigma around tuberculosis being a long-standing issue, and the symptoms being similar to COVID-19, we must unite to end the stigma and bring rational healthcare back on track to reduce the devastating impact that Tuberculosis has on India and the world.