The impact of the COVID-19 epidemic on tuberculosis control in China

Abstract

Background: In response to the COVID-19 epidemic, China implemented a series of interventions that impacted tuberculosis (TB) control in the country.

Methods: Based on routine surveillance data and questionnaires, the study analyzed TB notification, follow-up examinations, and treatment outcomes. The data were split into three phases in relation to outbreak, lockdown and reopen when the nationwide COVID-19 response started in 2020: control (11 weeks prior), intensive (11 weeks during and immediately after), and regular (4 additional weeks). Data from 2017-2019 were used as baseline.

Findings: The notified number of TB patients decreased sharply in the 1^st week of the intensive period but took significantly longer to rebound in 2020 compared with baseline. The percentages of TB patients undergoing sputum examination within one week after 2 months treatment and full treatment course in the intensive period were most affected and decreased by 8% in comparison with control period. 75•2% (221/294) of counties reallocated CDC and primary health care workers to fight the COVID-19 epidemic, 26•9% (725/2694) of TB patients had postponed or missed their follow-up examinations due to travel restrictions and fear of contracting COVID-19.

Interpretation: In the short term, the COVID-19 epidemic mostly affected TB notification and follow-up examinations in China, which may lead to a surge of demand for TB services in the near future. To cope with this future challenge, an emergency response mechanism for TB should be established.

Funding: National Health Commission of China-Bill & Melinda Gates Foundation TB Collaboration project (OPP1137180).

Keywords: COVID-19; China; Impact; Tuberculosis.

Fig. 1

TB notification breakdown by three time periods, 2017-2020. TB Notification refers to TB cases newly diagnosed by health facilities. The lower part of the figure shows TB notification 11 weeks before and 15 weeks after the Chinese Spring Festival for the years of 2017-2020. The upper part of the figure shows the two periods (intensive and regular) of 2020 with different responses to COVID-19 epidemic and potential impact on TB control in China.

Fig. 2

TB notification in 11 weeks before and 15 weeks after the Chinese Spring Festival, 2017–2020 in China.

Fig. 3

The percentage of laboratory confirmed cases in 11 weeks before and 15 weeks after the Chinese Spring Festival, 2017–2020 in China. Laboratory confirmed cases: Mycobacterium tuberculosis was detected in the patient's sputum specimen by smear, culture and other diagnostics.

Fig. 4

The percentage of migrant TB cases in 11 weeks before and 15 weeks after the Chinese Spring Festival, 2017–2020 in China. Migrant cases: The patient's current residence address and household registration do not belong to the same county (patient floats to the place rather than his/her origins).

Fig. 5

TB patient delay in China breakdown by three time periods, 2017–2020. Patient delay: from date of first symptom onset to date of first seeking medical care. Boxplot was used for describing the distribution of delay along y axis, the junction of different colors in the box was median. p value: Kruskal-Wallis Test, p value <0∙05 is considered significant.

Fig. 6

TB diagnosis delay in China breakdown by three time periods, 2017–2020. Diagnosis delay: from date of first seeking medical care to date of confirmed diagnosis. p value: Kruskal-Wallis Test, p value <0∙05 is considered significant.

Fig. 7

The percentage of sputum examination within 7 days after 2 months treatment in the period of 11 weeks before and 15 weeks after the Chinese Spring Festival, 2017–2020.

Fig. 8

The percentage of sputum examination within 7 days after the full treatment course in the period of 11 weeks before and 15 weeks after the Chinese Spring Festival, 2017–2020.

Fig. 9

Sputum conversion rate after 2 months treatment for smear positive patients in the period of 11 weeks before and 15 weeks after the Chinese Spring Festival, 2017–2020. Sputum conversion rate after 2 months treatment: the result of sputum smear microscopy is converted from positive to negative after 2 months treatment.

Fig. 10

Cured rate for smear positive patients in the period of 11 weeks before and 15 weeks after the Chinese Spring Festival, 2017–2020. Cured rate: TB patients complete the full treatment course, and the results of two consecutive smears (one is at the end of treatment course) are negative.