(EXPERT ANALYSIS): Potential impacts of COVID-19 pandemic on tuberculosis care in Nigeria

COVID-19, the viral pneumonia that emerged in Wuhan, China, in December 2019, has spread throughout China and to virtually all the countries in the world. COVID-19 is a major threat to global health . The disease was declared a ‘public health emergency of international concern by the WHO on 30 Jan 2020. Till date (May 28, 2020), there have been close to six million confirmed cases worldwide.

It was not until late February when Nigeria recorded the first case of COVID-19. Since then, there have been a rapid rise in number of cases. As of May 28, 2020 there were close to Nine thousand confirmed cases and over two hundred and fifty deaths from COVID-19 in Nigeria.

The pandemic has defined life and living globally; causing disruptions to economic as well as social life. The ability and internal resilience of each country to cope will determine the impacts of the pandemic. Nigeria and indeed most African countries are still battling with the age long disease; tuberculosis.

Nigeria has the highest burden of TB in Africa and sixth globally. Case detection for TB is abysmally low, accounting for more than two-thirds of undetected cases globally. The epidemic of COVID-19, the country is currently experiencing has the potential to slow down and eliminate previous gains in TB control, if care is not taken.

Both illness are unique as they both significantly affect the lungs. Respiratory symptoms of cough with or without sputum production and difficulty with breathing and fever are hallmarks of both diseases. Both cause major infection-related morbidity and mortality around the world. Tuberculosis and COVID-19 are common among those within the economically productive age group in Nigeria. Of course the socioeconomic impacts of both diseases on the individuals, family and the country’s GDP are considerable.

There are also stark differences. While tuberculosis the oldest disease of mankind, is a chronic mycobacterial infection, COVID-19 is a new acute viral infection. Unlike tuberculosis, where the vast majority of cases and deaths occur in low-income and middle-income countries, developed countries at the moment have the highest number of cases and deaths from COVID-19.

COVID-19 pandemic has overwhelmed and subdued health system in developed countries. The effects of such a ravaging pandemic on an already overstretched health system, still facing the continuous threats of tuberculosis, HIV and other diseases,could be potentially devastating.

The COVID-19 pandemic have limited access of people with tuberculosis to diagnostic and uninterrupted treatment since lockdown introduced by the government. In Nigeria, the government is also planning to utilize GenXpert machine to aid diagnosis of COVID-19. As novel as this may sound, the resultant negative impact on the effectiveness and timeliness of TB diagnostic process is huge. It is anticipated that all these will lead to significant delay in diagnosis, with its associated consequences . During a relatively peaceful time, more than 60 per cent of patients with tuberculosis presented very late for care.

This is likely to become worse now. The current situation will make it difficult to supervise treatment and adherence to treatment is likely going to drop as an indirect impact of the COVID-19. Overall, there is a high tendency of poor treatment outcome. A worse scenario may even be seen for drug resistance tuberculosis.

A bidirectional relationship may exists between COVID and TB. While COVID -19 has both direct and indirect effect on TB, conversely, TB also has impact on COVID-19. Tuberculosis has been shown to increase the risk of contracting COVID-19 as shown in a study. Individuals with active tuberculosis have been shown to be more susceptible to SARS-CoV-2 infection. COVID-19 disease progression may be more rapid and severe in those with tuberculosis.

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An important aspect of mitigating against these impacts is education and awareness. This should be continuous and as much as possible should be done in local languages using every available media. Right information through continuous education will eliminate various myths about both diseases. Opportunities should be provided for health correspondents and editors for capacity building through some special workshops.
Healthcare workers attending to patients with tuberculosis should be provided with some form of personal protection. This will reduce the risk of infection among health workers, and ensure that patients receive optimum care. The need to ramp up testing for COVID-19 cannot be underscored. Patients with TB should have a priority access to testing as well.

It is important for health workers and patients to realise that anti tuberculosis drugs should be continued in anyone who tuberculosis and COVID-19. Except otherwise indicated, on no account should anti tuberculosis medications be stopped. In order to enhance treatment compliance and adherence, technology could be deployed to provide remote monitoring of patients thereby reducing frequency of clinic attendance. This will not only ensure treatment adherence and improved treatment outcome, it will also reduce the risk of individuals with tuberculosis contracting COVID-19.

In conclusion, these are challenging times that also present opportunities for Nigeria to revamp and upgrade her health facilities. While attentions and focus should be geared towards rapid control and eradication of COVID-19, steps and programmes must be instituted or enhanced to ensure tuberculosis care did not suffer in the country.

Adewole is a Professor of Medicine and consultant physician/pulmonologist, Obafemi Awolowo University and Hospitals Complex, Ile Ife, Nigeria


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