Before SARS-CoV-2, the virus that causes COVID-19, spread globally in 2020, tuberculosis killed more people globally than any other infectious disease.
Release date – 12:00 PM, Sunday – July 9
Fort Collins: Before SARS-CoV-2, the virus that causes COVID-19, spread globally in 2020, tuberculosis killed more people globally than any other infectious disease. But thanks to targeted public health efforts in the United States and globally, TB cases have been declining steadily for decades.
I am an infectious disease clinician and public health practitioner who has been caring for America’s underserved communities for over two decades. During the pandemic, it initially appeared that COVID-19 prevention efforts have reduced TB cases, as have many other common diseases such as influenza.
But TB numbers have quickly returned to pre-pandemic levels, the first rise in global cases and deaths in decades. Not only has the epidemic interrupted vital health interventions against TB, but it has also resulted in reduced social and economic opportunities for marginalized populations around the world.
Taken together, these effects appear to have severely weakened TB control efforts. Tuberculosis before and during COVID-19 Tuberculosis is a contagious bacterial infection of the lungs, usually airborne. Most TB infections are asymptomatic and not contagious.
About 5% to 10% of infected people develop active TB disease, which is characterized by cough, fever, decreased appetite, and weight loss. Tuberculosis is a highly contagious and dangerous disease that can lead to death if left untreated.
The estimated total number of TB infections worldwide has been declining for many years. 2020 saw the lowest number of cases at 10.1 million, according to the World Health Organization. Infections will rise sharply in 2021 to 10.5 million, the first rise in more than a decade.
Global TB deaths follow a similar pattern, reaching a low of an estimated 1.4 million deaths in 2019, before rising to 1.5 million in 2020 and 1.6 million in 2021. The number of confirmed TB cases (infection detected by direct testing) suggests a different part of the story.
The number of confirmed cases worldwide peaked in 2019 as testing improved. As the coronavirus disrupted people’s lives in 2020, confirmed cases of tuberculosis fell sharply, but rose rapidly again in 2021.
A similar situation was seen in the United States, where confirmed cases fell sharply in 2020 (mainly due to a lack of testing) before rising sharply back to pre-pandemic levels.
TB is a social disease
TB is a preventable disease thanks to effective vaccines, testing and treatment. But millions of people around the world still suffer from the disease, not because of a lack of medical knowledge, but because of persistent social inequalities.
Inequality of economic opportunity, limited health care, poor sanitation, overcrowded living conditions, malnutrition and diseases such as diabetes or HIV are all associated with an increased risk of TB.
In the United States, ethnic minorities accounted for more than 85% of TB cases in 2021, with 71% of cases occurring in people born outside the United States.
Rising inequalities lead to rise in TB Despite a rapid decline in confirmed cases globally in 2020, experts remain concerned that disruptions to prevention and treatment efforts could lead to an increase in TB.
These concerns are justified. Many health experts, as well as the U.S. Centers for Disease Control and Prevention, have confirmed that the epidemic has disrupted access to TB testing and diagnosis.
Disruption of TB control activities may result in many cases being missed as funds, resources and personnel are reallocated to assist COVID-19 control efforts.
In addition, the similarity of COVID-19 and TB symptoms may lead to missed diagnosis during health contacts.
The decline in confirmed cases appears to be largely due to a lack of testing. The rapid increase in deaths since the pandemic, especially the rise in deaths, confirms that the progress made in TB control over the past 20 years has stalled, slowed or reversed.
Both troubling trends are almost certainly also linked to the rising inequality brought on by the pandemic. The presence of multigenerational families, overcrowding in low-income neighborhoods, lack of paid sick leave, inability to withstand pandemics, use of public transportation, and lack of health insurance all increase people’s risk of contracting COVID-19 and tuberculosis. the most vulnerable.
Of course, the pandemic is not the only factor that has exacerbated human suffering (and thus tuberculosis) in recent years. Ukraine, for example, now has one of the highest burdens of tuberculosis in the world due to the Russian invasion and the damage done to its medical, social and economic systems.
Ongoing conflict in other parts of the world, energy shortages, the effects of climate change, and related impacts on food security are expected to exacerbate broader social and political determinants of TB.
There are many diseases that are neglected because of poverty, and tuberculosis is a good example of how social forces create human disease. With an estimated one-third of the world’s population at risk of tuberculosis today, promoting social justice interventions to reduce health inequalities is a vital step toward reducing the global healthcare burden of this stubborn disease.
