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      Gauging the impact of the COVID-19 pandemic on tuberculosis services: a global study

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          Abstract

          The effects of the coronavirus disease 2019 (COVID-19) pandemic on tuberculosis (TB) disease and TB services emerged in the beginning of 2020 [1, 2]. Epidemiological and clinical studies, including mortality rates of the first cohort of patients with COVID-19 and TB co-infection were described [3, 4]. Several reports from individual countries suggested that the COVID-19 pandemic significantly affected TB services [5–9], including validation by modelling studies [10]. The Global Tuberculosis Network (GTN) reported that the COVID-19 pandemic affected TB services in 33 TB centres from 16 countries in the first 4 months of 2020 [11]. An increased use of telehealth during the COVID-19 pandemic was observed in some TB centres [11]. The major limitations of that study were the short period of observation (January to April 2020 compared to the same period in 2019) and the limited number of variables analysed [11–14].

          Abstract

          This global study of 43 TB centres from 19 countries demonstrates the impact of COVID-19 pandemic on TB services. Newly diagnosed TB disease, drug-resistant TB, TB deaths, outpatient clinic attendances and newly diagnosed TB infection were reduced. https://bit.ly/3sdHbfk

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          Most cited references15

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          Active tuberculosis, sequelae and COVID-19 co-infection: first cohort of 49 cases

          The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) pandemic has attracted interest because of its global rapid spread, clinical severity, high mortality rate, and capacity to overwhelm healthcare systems [1, 2]. SARS-CoV-2 transmission occurs mainly through droplets, although surface contamination contributes and debate continues on aerosol transmission [3–5].
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            The potential impact of the COVID-19 pandemic on the tuberculosis epidemic a modelling analysis

            Background Routine services for tuberculosis (TB) are being disrupted by stringent lockdowns against the novel SARS-CoV-2 virus. We sought to estimate the potential long-term epidemiological impact of such disruptions on TB burden in high-burden countries, and how this negative impact could be mitigated. Methods We adapted mathematical models of TB transmission in three high-burden countries (India, Kenya and Ukraine) to incorporate lockdown-associated disruptions in the TB care cascade. The anticipated level of disruption reflected consensus from a rapid expert consultation. We modelled the impact of these disruptions on TB incidence and mortality over the next five years, and also considered potential interventions to curtail this impact. Findings Even temporary disruptions can cause long-term increases in TB incidence and mortality. If lockdown-related disruptions cause a temporary 50% reduction in TB transmission, we estimated that a 3-month suspension of TB services, followed by 10 months to restore to normal, would cause, over the next 5 years, an additional 1⋅19 million TB cases (Crl 1⋅06–1⋅33) and 361,000 TB deaths (CrI 333–394 thousand) in India, 24,700 (16,100–44,700) TB cases and 12,500 deaths (8.8–17.8 thousand) in Kenya, and 4,350 (826–6,540) cases and 1,340 deaths (815–1,980) in Ukraine. The principal driver of these adverse impacts is the accumulation of undetected TB during a lockdown. We demonstrate how long term increases in TB burden could be averted in the short term through supplementary “catch-up” TB case detection and treatment, once restrictions are eased. Interpretation Lockdown-related disruptions can cause long-lasting increases in TB burden, but these negative effects can be mitigated with rapid restoration of TB services, and targeted interventions that are implemented as soon as restrictions are lifted. Funding USAID and Stop TB Partnership
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              Tuberculosis, COVID-19 and migrants: preliminary analysis of deaths occurring in 69 patients from two cohorts

              Little is known about the relationship between the COVID-19 and tuberculosis (TB). The aim of this study is to describe a group of patients who died with TB (active disease or sequelae) and COVID-19 in two cohorts. Data from 49 consecutive cases in 8 countries (cohort A) and 20 hospitalized patients with TB and COVID-19 (cohort B) were analysed and patients who died were described. Demographic and clinical variables were retrospectively collected, including co-morbidities and risk factors for TB and COVID-19 mortality. Overall, 8 out of 69 (11.6%) patients died, 7 from cohort A (14.3%) and one from cohort B (5%). Out of 69 patients 43 were migrants, 26/49 (53.1%) in cohort A and 17/20 (85.0%) in cohort B. Migrants: 1) were younger than natives; in cohort A the median (IQR) age was 40 (27-49) VS. 66 (46-70) years, whereas in cohort B 37 (27-46) VS. 48 (47-60) years; 2) had a lower mortality rate than natives (1/43, 2.3% versus 7/26, 26.9%; p-value: 0.002); 3) had fewer co-morbidities than natives (23/43, 53.5 % versus 5/26- 19.2%) natives; p-value: 0.005). The study findings show that: 1) mortality is likely to occur in elderly patients with co-morbidities; 2) TB might not be a major determinant of mortality and 3) migrants had lower mortality, probably because of their younger age and lower number of co-morbidities. However, in settings where advanced forms of TB frequently occur and are caused by drug-resistant strains of M. tuberculosis, higher mortality rates can be expected in young individuals.
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                Author and article information

                Journal
                Eur Respir J
                Eur Respir J
                ERJ
                erj
                The European Respiratory Journal
                European Respiratory Society
                0903-1936
                1399-3003
                November 2021
                11 November 2021
                : 58
                : 5
                : 2101786
                Affiliations
                [1 ]Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
                [2 ]Dept of Medicine, Infectious Disease Translational Research Programme, National University of Singapore, Yong Loo Lin School of Medicine, Singapore
                [3 ]The University of Sydney, Pharmacy School, Sydney, Australia
                [4 ]Westmead Hospital, Sydney, Australia
                [5 ]Marie Bashir Institute of Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia
                [6 ]Melbourne Health Victorian Tuberculosis Program, Melbourne, Australia
                [7 ]Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
                [8 ]Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
                [9 ]Dept of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
                [10 ]TB and Acute Respiratory Diseases Section, Dept of Communicable Diseases, Directorate General of Disease Surveillance and Control, Ministry of Health, Oman
                [11 ]Centre Hospitalier Universitaire, Nantes, France
                [12 ]Dept of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
                [13 ]Parramatta Chest Clinic, Parramatta, Australia
                [14 ]TB Reference Centre, Villa Marelli Institute, Niguarda Hospital, Milan, Italy
                [15 ]Clinic of Chest Diseases, Immunology and Allergology, Vilnius University Medical Faculty, Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
                [16 ]National Reference Centre for MDR-TB, Hospital Centre Vila Nova de Gaia, Dept of Pneumology, Public Health Science and Medical Education Dept, Faculty of Medicine, University of Porto, Porto, Portugal
                [17 ]Tuberculosis Research Programme (PII-TB) SEPAR, Barcelona, Spain
                [18 ]National Institute for Infectious Diseases (INMI) ‘L. Spallanzani’ - IRCCS, Rome, Italy
                [19 ]Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias CIPTIR, University Hospital of Monterrey UANL (Universidad Autonoma de Nuevo Leon) Monterrey, Monterrey, Mexico
                [20 ]Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, Brasil
                [21 ]Damien Foundation, Niamey, Niger
                [22 ]Division of Infectious Diseases, Dept of Medicine, National University Hospital, Singapore
                [23 ]Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
                [24 ]Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK
                [25 ]Royal London Hospital, Barts Health National Health Service Trust, London, UK
                [26 ]P.D. Hinduja National Hospital and Medical research Centre, Mumbai, India
                [27 ]Public Health Consulting Group, Lugano, Switzerland
                [28 ]Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
                [29 ]National University of Singapore Institute for Health Innovation & Technology (iHealthtech), Singapore
                Author notes
                Author information
                https://orcid.org/0000-0002-2597-574X
                https://orcid.org/0000-0001-7644-2188
                https://orcid.org/0000-0001-8567-2639
                https://orcid.org/0000-0002-0735-4691
                https://orcid.org/0000-0003-2257-3099
                https://orcid.org/0000-0002-2809-6230
                https://orcid.org/0000-0002-9645-1994
                https://orcid.org/0000-0002-0738-4276
                https://orcid.org/0000-0001-8360-4376
                https://orcid.org/0000-0002-8551-3598
                https://orcid.org/0000-0002-7000-5777
                https://orcid.org/0000-0002-1600-4474
                https://orcid.org/0000-0003-1103-0451
                Article
                ERJ-01786-2021
                10.1183/13993003.01786-2021
                8581650
                34446465
                01deda5d-63eb-4eab-a87d-f3771b549ff3
                Copyright ©The authors 2021.

                This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions@ersnet.org

                History
                : 24 June 2021
                : 29 July 2021
                Funding
                Funded by: National Center for Advancing Translational Sciences, doi 10.13039/100006108;
                Award ID: UL1TR003015
                Funded by: Ricerca Corrente
                Award ID: GR-2018-12367178, GR-2016-02364014, Progetto 19. D
                Categories
                Agora
                Research Letters

                Respiratory medicine
                Respiratory medicine

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