Why cough due to TB, COVID-19 is different — Experts

Despite significant progress over the last decades, tuberculosis remains the world’s deadliest infectious killer. However, in this article by Sade Oguntola, experts say many Nigerians now miss out on the free test and treatment for tuberculosis because all cough cases are assumed to be due to COVID-19.

If you don’t think that coughing is a common complaint, just head to the nearest drugstore. You’ll find a bewildering array of syrups, sprays, tablets, and lozenges designed to control coughing. A cough for a day or two may be easily assumed to be cold or the flu, but a week or two of recurrent cough may make worry mount that it could be tuberculosis or COVID-19.

Now, cough due to tuberculosis and that from  COVID-19 is different.  Although cough is a common symptom to both diseases, there are slight differences.

“The cough in tuberculosis produces sputum or what many may refer to as very thick saliva, but in the case of COVID-19, the cough is usually dry, unless the individual has some other lung conditions,” said Dr Joseph Edor, a senior programme officer for tuberculosis with USAID/Breakthrough Action- Nigeria.

He spoke at the virtual media training by USAID/Breakthrough Action – Nigeria in collaboration with the National TB & Leprosy Control Programme (NTBLCP) for selected media practitioners in Akwa Ibom, Benue and Oyo states.

Dr Edor declared, “Cough, fever and difficulty in breathing are common to both diseases; but the cough which is common to them is the most stigmatised symptom because if somebody is coughing, people usually think about COVID- 19.”

Most people infected with the bacteria that cause tuberculosis don’t have symptoms. When symptoms do occur, they usually include a cough (sometimes blood-tinged), weight loss, night sweats and fever. People may also experience pain while breathing. Also, individuals may also experience chills, fatigue and shortness of breath.

COVID-19 affects different people in different ways. Most infected people will develop mild to moderate illness and recover without hospitalisation. Most common symptoms of COVID-19 include fever, dry cough and tiredness. Less common symptoms include aches and pains, sore throat and diarrhoea. Serious symptoms can include difficulty breathing or shortness of breath.

Recently, researchers in a study said the likely order in which COVID-19 symptoms will appear in patients is fever, followed by cough, muscle pain, and then nausea, and/or vomiting, and diarrhoea. This advance, they said, may help clinicians rule out other diseases, and help patients seek care promptly or decide sooner to self-isolate.

In the current study, published in the journal Frontiers in Public Health, the scientists predicted the order of symptoms from data on the rates of symptom incidence of more than 55,000 confirmed coronavirus cases in China, all of which were collected from February 16 to 24 by the World Health Organisation (WHO).

While fever and cough are frequently associated with a variety of respiratory illnesses, including Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS) which caused the 2002 – 2003 pandemic, they said the timing and symptoms in the upper and lower gastrointestinal tract set COVID-19 apart.

Dr Edor, however, added that some other differences in these diseases can help individuals to guess if the cough is due to tuberculosis or COVID-19.

“In tuberculosis, the fever will cause a marginal increase in body temperature, while in COVID-19, it is a high fever and it is very obvious. That is why an individual’s body temperature is taken with the infrared thermometer to pick possible cases of COVID-19,” he added.

Also, “TB symptoms manifest gradually often over a period of weeks, but for COVID-19, the onset of symptoms is usually rapid, and it can occur within a few days after exposure.”

Dr Edor, however, declared that the stigma and fear around COVID-19 had resulted in a reduction in the number of people going to health facilities to complain of cough as well as the detection of new TB cases.

“TB is still the leading cause of death from an infectious agent globally. There is a significant reduction in people with a cough now seeking care due to the stigma of being considered a COVID-19 patient. There is evidence that a lockdown for two months would reverse progress recorded in TB elimination for the past five years.

“So, if we don’t start zooming in on TB, years after we may have addressed the COVID-19 issue, a lot of people will still be dying from these other public health diseases like TB and malaria because they are not given the level of attention that COVID-19 is being given.”

Is TB deadlier than COVID-19? Should people coughing be stigmatised or left unattended to in the community? Mrs Itohowo Uko, a director and head of the NTBLCP Advocacy Communication and Social Mobilisation in the Federal Ministry of Health, Abuja, stated that TB is more deadly as 157,000 persons in Nigeria died of the disease alone in 2018, far more than COVID-19.

Mrs Uko added, “No fewer than 18 Nigerians die every hour of TB and 47 Nigerians develop active TB every hour, seven of whom are children. In 2018, we were only able to detect and treat 106,533 persons with TB people, representing only 26 per cent of the people that are estimated to have had TB.

“One case of untreated pulmonary TB can infect between 10 and 15 persons per year. So, if we have 74 per cent of people with TB that are supposed to be placed on treatment still in the community,  you can imagine the huge number of people busy transmitting this disease to other innocent Nigerians.  They need to be identified and placed on treatment.

“That is why everyone needs to know those simple signs and symptoms of TB, so that when they see such symptoms, rather than sit at home or visit a chemist to treat and they end up dying, they should go to health facilities where they can be tested and if found positive with TB treated for free.”

Mrs Uko declared that in 2018, about 157,000 persons in Nigeria died of TB, making it a bigger killer than even COVID-19 that has taken centre stage in the world.

According to her, these deaths were because knowledge of Nigerians on TB transmission, its symptoms and prevention is low across all strata of the society.

Mrs Uko added, “TB is completely curable if detected and treated early, so nobody needs  to die in Nigeria because of TB. Its treatment is also free in designated health facilities. This is a problem that has a solution, so you should look for its solution.”

Ensuring appropriate response to the neglect of TB cases in the community, Mr Eze Eze, a senior programme officer-Media, BA-N, said will require taking a human-centred approach to solve.

According to Mr Eze, “through the media, individuals need to be informed about TB, especially during this COVID-19 pandemic. Individuals need to know, that having a cough does not mean that one has COVID-19;  and that early testing of the cough is the best way and what to do if someone has contracted TB.

“Communities have a strong role to play in ensuring that TB is not driven underground due to stigma because TB is curable and not a death sentence.”



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