TB and COVID-19: link, risk, difference, tips

As of 17 November 2020, more than 55 million people worldwide have been infected with COVID-19, caused by a novel strain of coronavirus, across the globe. And the global death toll of COVID-19 has crossed 1.32 million.

Doctors and policymakers have been asking people to stay indoors especially those who already have a pre-existing medical condition.

During this pandemic, the World Health Organization (WHO) has asked health officials to ensure that essential services are being provided to people suffering from long-standing health problems like tuberculosis (TB).

According to the WHO Global Tuberculosis Report 2019, India accounts for 27% of all tuberculosis cases in the world. Not only that, but about 280,000 people also die from TB in India annually.

Taking these high numbers into consideration, the WHO has asked its regional and country offices to make sure that during the COVID-19 pandemic, the continuity of vital services for the people affected with TB is maintained.

There are a few questions that are being asked by people who are suffering from or who have just recovered from this infection caused by Mycobacterium tuberculosis. Here in this article, we will be addressing the concerns related to TB and COVID-19 infection.

Risk of severe COVID-19 in TB patients
How is COVID-19 different from TB?
Tips to protect TB patients from COVID-19 infection
COVID-19 TB link

Doctors for TB and COVID-19

Risk of severe COVID-19 in TB patients

Since most of the symptoms of COVID-19 are similar to that of tuberculosis, people may get anxious if they start feeling any of the signs, such as cough, fever and difficulty breathing.

Patients who already have tuberculosis have to be extra cautious as both these diseases (TB and COVID-19) primarily attack the lungs and spread via close contact. (Read more: Droplet transmission)

Doctors believe that people who are being treated for active TB and contract COVID-19 infection may have poor outcomes if the TB treatment is interrupted.

How is COVID-19 different from TB?

The differences between COVID-19 and tuberculosis are:

	TB	COVID-19
Causative agent	Mycobacterium tuberculosis	Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
Mode of spreading	It spreads through the air	It spreads through droplets
Diagnosing method	Sputum samples are collected from those who have a cough.	Nasopharyngeal and oropharyngeal swabs are taken from suspected patients.
Vaccine	Bacillus Calmette–Guérin vaccine (BCG)	No vaccine has been developed so far, though 48 vaccine candidates were in clinical evaluations as of 12 November 2020
Symptoms	Cough, fever, weight loss, loss of appetite, night sweats, fatigue	Persistent cough, high fever, difficulty breathing
Treatment plan	Antibiotics are given for at least five months. Drug-resistant TB patients may have to take antibiotics for 9-24 months	There is no cure for COVID-19; only symptomatic relief is given to the patients as of now

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Tips to protect TB patients from COVID-19 infection

There are certain measures which can be taken so that TB patients stay safe during the COVID-19 outbreak:

Though the modes of transmission of the two diseases are somewhat different, the ways to protect against both are the same. Protective measures involve:
- Infection prevention and control
- Maintaining respiratory hygiene
- Isolating suspected positive cases from healthy ones to prevent the spread of the disease
- Patients are asked to cover their noses and mouths with a mask or a tissue paper while coughing and sneezing
- Wash their hands with soap and water for at least 20 seconds and use alcohol-based hand sanitizers in the absence of water
Diagnostic tests should be available for both TB and COVID-19. This would help the health officials to differentiate between the disease that the person may be suffering from. The tests for both conditions should be done for individuals with respiratory symptoms, which may be similar for the two diseases. Early detection and efficient symptomatic treatment may help in reducing morbidity and mortality from both COVID-19 and TB.
The treatment for TB patients should be done on an outpatient basis to reduce opportunities for transmission. If possible, TB patients should be given community-based care over hospital treatment unless their condition gets serious and requires hospitalisation.
All TB patients, including those in quarantine or isolation, must get uninterrupted anti-tuberculosis treatment.
Proper preparation and monitoring should be done to ensure that the supply of TB medicines and diagnostic equipment is not interrupted during the COVID-19 outbreak.
The health officials should provide an adequate supply of TB medicines to all the patients to take home. This would ensure that their treatment is getting completed without having to visit the health centres unnecessarily to get the medicines.
All the respiratory physicians, pulmonology staff, TB specialists and health workers at the primary healthcare centres should be available for patients with pulmonary complications of COVID-19. (Read more: Can COVID-19 cause permanent lung damage?)
Doctors may also use digital health technologies to support patients by communicating, counselling, giving care tips and informing them about the disease. The doctors may use electronic medication monitors and video-supported therapy to stay in touch with their patients.

COVID-19 TB link

Scientists and researchers do not have data on whether those suffering from or having a previous history of TB are at a higher risk of contracting the COVID-19 infection. However, because both TB and COVID-19 target the lungs, this may put patients at an increased risk of developing more severe symptoms of the coronavirus infection.

Doctors also believe that people who had TB and needed lung surgery for the treatment or those who have been diagnosed with post-TB lung disease would be at a higher risk. They should consider staying home until the overall situation is brought under control.