COVID-19 -Tuberculosis interactions: When dark forces collide

Abstract

The SARS-2 pandemic which has moved with frightening speed over the last 5 months has several synergies with another older, and far more neglected airborne disease, tuberculosis. Patients with tuberculosis are not only more likely to be infected by SARS-CoV-2 but also likely to have adverse outcomes once infected. The sequelae of more severe forms of COVID-19 in patients who have recovered from TB but have residual compromised lung function, are also likely to be devastating. These diseases share almost identical bio-social determinants like poverty, overcrowding, diabetes and pollution and some clinical similarities. The consequences of the COVID-19 pandemic, and our global response to it with lockdowns, are likely to leave a profound and long-lasting impact on TB diagnosis and control, potentially leading to an additional 6.3 million cases of TB between 2020 and 2025, and an additional 1.4 million TB deaths during this time. Novel solutions will need to be urgently devised or else TB control targets will never be met and indeed may be set back by 5-8 years.

Keywords: COVID-19; MDR-TB; SARS-CoV-2; Synergistic effects; Tuberculosis.

Fig. 1

TB-COVID-19 overlap.

Fig. 2

Shared BIO-SOCIAL determinants.

Fig. 3

Impact of COVID-19 on poverty in India and resulting increased vulnerability to TB. (BPL: below poverty line).

Fig. 4

Ward wise COVID-19 patients in Mumbai.