In the six weeks before South Africa responded its first diagnoses of COVID-19 with the start of physical distancing measures, more than 47,000 people on average there were tested for tuberculosis with the rapid and reliable Xpert diagnostic tool each week. An average of more than 3,700 of those tests identified active tuberculosis in people who could then access treatment. In the weeks that followed, as the government closed schools and restricted international travel as well as mass gatherings, before launching what Reuters news service called “one of the world’s toughest lockdowns,” restricting all but essential movement from home, and bringing public transportation to a virtual standstill, the numbers of people accessing the rapid test for tuberculosis dropped by nearly half, with an average of a little more than 24,000 tests a week. The accompanying decline in the resulting number of tuberculosis diagnoses was “less dramatic,” than the testing drop, an analysis from South Africa’s National Institute for Communicable Diseases notes, likely because people feeling sick with advanced disease were more motivated to overcome the restrictions on movement to seek care. Still tuberculosis diagnoses dropped by 33%.
The drop in testing rates was not caused by constrictions in tuberculosis services or testing capacities, the authors of the analysis write. The primary factors, they write, were caution and restrictions on movement that included “severely limited” public transportation.
In a country with some of the highest rates of tuberculosis incidence and deaths in the world, the drops in numbers getting tested and patients being referred to care will bring consequences the authors write. Undiagnosed and untreated, tuberculosis can be expected to gain ground, reversing advances against the disease that have seen illnesses and deaths drop in recent years. At the same time, the analysis notes, South Africa’s swift and stringent response to the novel coronavirus was prompted by reasonable fears of a new deadly illness that could overwhelm its health system.
With tuberculosis and COVID-19 sharing both symptoms and routes of transmission, the authors urge, a combined strategy that optimizes resources against both diseases would bring both immediate benefits, and long range returns.