The ancient disease of tuberculosis has plagued humanity for over 3000 years. With attached stigmas of social disease, overcrowding and malnourishment continues to wreak havoc across different strata of society, majorly impacting the poor and the marginalized. After the country-wide lockdown triggered by the Covid pandemic was imposed, diagnosis and enrollment for TB treatment fell dramatically in many high TB-burden countries. A study also revealed that such a decrease could reverse hard-fought gains achieved in the last five to eight years and thus, it is critical for policymakers and key stakeholders to accelerate efforts to ensure that gains earned in fighting TB are not reversed due to the Coronavirus pandemic.
The disease which mostly remains undiagnosed or underreported majorly affects the lungs but can involve all organs of a patient. Caused by a type of bacteria called ‘Mycobacterium tuberculosis’, it spreads through thin droplets in the air. According to the World Health Organization, it is one of the top killing diseases in the world. TB kills over 2 million people after HIV AIDS which kills 3 million and malaria which kills 1 million globally. The burden of this disease in India is so immense that the country records 26.9 lakh cases annually with two deaths occurring every three minutes. Very few are aware of the fact that India loses more than 4, 00,000 lives every year due to TB. In 2019, TB was responsible for 1.4 million deaths around the world and India accounted for 31% of it.
It is pertinent to mention that having TB doesn’t always mean that you can be sick. The infection and symptoms develop gradually over time. The bacteria don’t thrive on surfaces and only spreads by coming in contact with aerosols of an infected person. TB is of two types- latent and active. While the former shows no symptoms, the latter include symptoms like persistent coughing for more than 3 weeks, shortness of breath, chest pain, coughing up blood, fever, loss of appetite, weight loss, chills, night sweats, etc. A person can be said to have latent TB if there are bacteria in the body but the immune system keeps them from spreading. In such a risky condition, the infection remains alive and can become active anytime later. Ninety percent of active cases in adults come from a latent TB infection. TB can only be diagnosed through simple tests which include the skin test (Mantoux), sputum microscopy, the culture test. In most cases, doctors refer to chest X-ray reports, looking for the effect of the bacteria on the patient’s lungs.
Despite being prevalent among a large population, a silver lining is that TB is preventable and curable but a patient needs to be on medications for a minimum of six months continuously because if left untreated, the bacteria can become drug-resistant.
Major challenges to control TB in India include poor primary health-care infrastructure in rural areas of many states; unregulated private health care leading to widespread irrational use of first-line and second-line anti-TB drugs; spreading HIV infection; lackadaisical attitude, and administrative challenges. But the lessons learned during the Covid-19 battle can do a lot in controlling TB. An important part of prevention is to stop the spread of bacteria among individuals. Just like tracing and testing, it can be done by finding the people who have TB and giving them timely treatment. There is also a BCG vaccine for prevention of disseminated, milliary and severe form of tuberculosis in children as it doesn’t seem to prevent the disease in adults.
Prime Minister Narendra Modi has set an ambitious target of making India a TB-free nation by 2025, five years ahead of the UN Sustainable Development Goal target. Furthermore, the launch of the National Strategic Plan (NSP) for TB Elimination is a great step that is ensuring pivotal interventions, an increase in funding, and private sector engagement to improve access to better healthcare systems. Today, India’s DOTS (directly observed treatment short course) program is the fastest-expanding and the largest program in the world in terms of patients initiated on treatment; and the second-largest, in terms of population coverage. The world is running out of time to act on the commitments to end TB. And to streamline efforts to achieve this goal, people-centered delivery of TB prevention, diagnosis, treatment, and care services through digital technologies, systematic screening, and nutrition programs should be scaled-up for a TB-free world.
(The author is Chief – Respiratory/ Pulmonology & Sleep Medicine, Artemis Hospitals. Views expressed are personal and do not reflect the official position or policy of the Financial Express Online.)