Tuberculosis rises for first time in decades after COVID-19 disrupts public health interventions, widens inequalities

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Tuberculosis is a dangerous bacterial infection of the lungs.
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Before SARS-CoV-2, the virus that causes the novel coronavirus disease (COVID-19), spread around the world in 2020, tuberculosis killed more people worldwide than any other infectious disease. was However, thanks to targeted public health efforts in the United States and around the world, tuberculosis cases had been steadily declining for decades.

I am an infectious disease clinician and public health professional who has cared for underserved communities in the United States for over 20 years.

During the pandemic, like many other common illnesses such as influenza, it initially appeared that tuberculosis cases were down due to COVID-19 prevention efforts. But tuberculosis numbers have quickly returned to pre-pandemic levels, marking the first time in decades that global infections and deaths have risen.

The pandemic has not only disrupted critical health interventions against tuberculosis, but has also caused diminished social and economic opportunities for marginalized populations around the world. Taken together, these effects appear to have a profound impact on the fight against tuberculosis.

Tuberculosis before and during COVID-19

Tuberculosis is a contagious bacterial infection of the lungs that is usually spread through the air. Most tuberculosis infections are asymptomatic and not contagious.

About 5% to 10% of infected people develop active tuberculosis, which is characterized by cough, fever, loss of appetite and weight loss. Tuberculosis is a highly contagious and dangerous disease that can be fatal if left untreated.

The estimated number of tuberculosis infections worldwide has declined in recent years. According to the World Health Organization, the lowest number of cases was 10.1 million in 2020. In 2021, the number of infected people will increase significantly to 10.5 million, the first increase in more than 10 years. Global tuberculosis deaths follow a similar pattern, reaching a low of 1.4 million estimated deaths in 2019, rising to 1.5 million in 2020 and 1.6 million in 2021. increased.

The number of confirmed cases of tuberculosis (infections detected by direct testing) tells another part of the story. As testing efforts improved, the number of infected cases increased globally, reaching a peak in 2019. The number of tuberculosis cases dropped significantly in 2020 as the coronavirus disrupted life, but it will rise again rapidly in 2021.

A similar pattern unfolded in the United States. The number of confirmed cases in 2020 declined sharply, largely due to a lack of testing, before returning sharply to pre-pandemic levels.

In a hospital, a man stands next to a sign that says tuberculosis ward.
Regions with limited access to health care, economic mobility and social stability, including much of sub-Saharan Africa and India, have the highest number of tuberculosis cases each year.
Shami Mehra/AFP via Getty Images

Tuberculosis is a social disease

Tuberculosis is a preventable disease thanks to effective vaccines, testing and treatment. Yet millions of people around the world still suffer from this disease, not because of lack of medical knowledge, but because of persistent social inequalities.

Inequal access to economic opportunities, limited health care, poor sanitation, crowded living conditions, malnutrition and diseases such as diabetes and HIV are all associated with an increased risk of TB.

Racial and ethnic minorities accounted for over 85% of tuberculosis cases in the United States in 2021, and 71% of cases were in people born outside the United States.

Growing inequalities cause tuberculosis to rise

Even as the world witnessed a rapid decline in the number of infected people in 2020, experts feared that interruptions in prevention and treatment efforts would lead to an increase in TB cases.

A sign announcing that the emergency room is closed due to the pandemic.
The COVID-19 pandemic has disrupted many health systems, exacerbated inequalities more broadly, and led to an increase in tuberculosis cases globally.
J. Conrad Williams Jr./Newsday RM via Getty Images

These concerns were justified. Many health experts and the US Centers for Disease Control and Prevention acknowledge that the pandemic has disrupted access to TB testing and diagnosis. Many cases may have been missed due to the disruption of TB control activities as funds, resources and staff were reallocated to support COVID-19 control efforts. Furthermore, during physical examinations, the similarity of symptoms between COVID-19 and tuberculosis may have led to missed diagnoses.

The decline in the number of infected people appears to be largely due to a lack of testing. The rapid increase since the pandemic, especially in deaths, confirms that progress in TB control over the past two decades has stalled, slowed, or reversed. These two troubling trends are almost certainly also related to the rising inequality brought on by the pandemic.

The presence of multi-generational households, overcrowding in low-income neighborhoods, lack of paid sick leave, inability to protect against the pandemic, access to public transportation, and lack of health insurance have all combined to increase the spread of COVID-19 among the population. The risk of both disease and tuberculosis is increasing. the most vulnerable people.

Of course, pandemics are not the only factor that has increased human suffering and tuberculosis in recent years. For example, as a result of Russia’s aggression and the resulting damage to Ukraine’s medical, social and economic systems, Ukraine is now one of the countries with the highest burden of tuberculosis disease in the world. The broader social and political determinants of tuberculosis are expected to exacerbate due to ongoing conflicts, energy shortages and climate change impacts in other parts of the world and their associated impacts on food security.

Many diseases are neglected because of poverty, but tuberculosis is a good example of how social forces can create human disease. With one-third of the world’s population currently estimated to be at risk of tuberculosis, promoting social justice interventions to reduce health inequalities will help reduce the global impact of this relentless disease. This is a very important step in reducing the burden of medical care.conversation

This article is republished from The Conversation under a Creative Commons license. Please read the original article.

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