Tuberculosis-Associated Hospitalizations and Deaths after COVID-19 Shelter-In-Place, San Francisco, California, USA

Abstract

A mandated shelter-in-place and other restrictions associated with the coronavirus disease pandemic precipitated a decline in tuberculosis diagnoses in San Francisco, California, USA. Several months into the pandemic, severe illness resulting in hospitalization or death increased compared with prepandemic levels, warranting heightened vigilance for tuberculosis in at-risk populations.

Keywords: COVID-19; California; SARS-CoV-2; San Francisco; TB; United States; bacteria; coronavirus disease; deaths; epidemiology; hospitalizations; mortality rate; respiratory diseases; respiratory infections; severe acute respiratory syndrome coronavirus 2; tuberculosis and other mycobacteria; viruses; zoonoses.

Figure

Comparison of TB cases pre-SIP (January 1, 2019–March 15, 2020) and after SIP (March 16, 2020–January 31, 2021), San Francisco, California, USA. Scales for the y-axes differ substantially to underscore patterns but do not permit direct comparisons. Total TB cases indicates total number of case-patients receiving TB treatment, by month. Cases were counted according to the month when TB was diagnosed. In the first months of the pandemic after SIP was implemented (March 16–June 30, 2020), numbers of patients newly diagnosed with TB decreased compared with the 14.5 months prior. In early July 2020, the number of patients newly diagnosed with TB began to increase, with a higher proportion requiring hospitalization or having a TB-related death. SIP, shelter-in-place; TB, tuberculosis.