Covid-19 hinders SA’s fight against tuberculosis

In South Africa Covid-19 disruptions led to a 40% reduction in tuberculosis (TB) notifications between March and September 2020, data from the Stop TB Partnership shows.

The World Health Organisation (WHO), in marking World TB Day on 24 March 2020, ranked South Africa as one of the nine countries with the highest TB burdens in the world. 

The Coronavirus pandemic has had a devastating impact on the number of people getting tested and treated for TB, not only due to lockdown restrictions and health workers being in quarantine, but also due to fear of contagion at healthcare facilities.

South Africa’s much anticipated tuberculosis prevalence survey results were released on 22 February and show that South Africa has a far higher number of people with TB than previously thought. Many people are living with TB who have not been diagnosed or treated. This survey’s results also show that TB is still one of the leading causes of death in South Africa. It claims more lives annually than the Coronavirus pandemic has so far. 

According to Dr Helene-Mari van der Westhuizen, board chairperson of the advocacy organisation TB Proof, there is an opportunity to integrate efforts to diminish these two airborne infections, as both TB and the Coronavirus present and transmit in a similar fashion and affect health workers and those living with other diseases. 

“Through changing public messaging about masks during the Coronavirus pandemic to include TB, we can harness an additional preventative tool for TB that was previously not utilised due to negative perceptions around mask use. We want to see the president and ministers of his cabinet speak about Covid-19 and TB in the same breath, and act as if our lives depended on urgently containing both these lethal pandemics. Because they do,” she said. 

The TB prevalence survey’s results also show 58% of people who were diagnosed with TB reported no symptoms, and were only picked up after mass screening with chest X-rays. “If focusing only on TB symptom screening to identify people with TB in South Africa, we will continue to miss people with TB,” Van der Westhuizen said.

This means that we need new diagnostic tools for TB that can help screen large numbers of people, even those who do not have the classic symptoms.

Van der Westhuizen explained that people with TB who are missed or whose treatment is delayed may suffer prolonged ill health. They may be unable to work, resulting in economic hardship. Also, the longer a person has untreated TB, the more likely they are to pass the infection to other people and continue the cycle.

Goodman Makanda, TB survivor and advocate with TB Proof said, “when you have a disease like TB, you are not supposed to go to work for a certain amount of time.”

“We encourage students to continue mask-wearing as an infection control measure of both TB and Covid-19,” she said.