Covid-19 can increase susceptibility to developing active tuberculosis: Health Ministry

An Indian doctor examines a tuberculosis patient in a government TB hospital on World Tuberculosis Day in Allahabad, India, Monday, March 24, 2014. India has the highest incidence of TB in the world, according to the World Health Organization's Global Tuberculosis Report 2013, with as many as 2.4 million cases. India saw the greatest increase in multidrug-resistant TB between 2011 and 2012. The disease kills about 300,000 people every year in the country. (AP Photo/Rajesh Kumar Singh)

Covid-19 can make a person more susceptible to developing active tuberculosis as it is an “opportunistic” infection like black fungus but currently there is not enough evidence to suggest TB cases have risen due to the viral disease, the Union Health Ministry said on Saturday.

The ministry said notification of tuberculosis cases had decreased by about 25 per cent in 2020 due to Covid-related restrictions and special efforts are being made to mitigate this impact through intensified case findings.

In a statement, the Health Ministry said there have been some news reports alleging that a sudden rise in TB cases have been noticed among patients infected with Covid-19 recently, leaving doctors, who have been receiving around a dozen similar cases every day, worried.
“It is clarified that tuberculosis screening for all Covid-19 patients and Covid-19 screening for all diagnosed TB patients has been recommended by Ministry of Health and Family Welfare,” it said.

The ministry said SARS-CoV-2 infection can make an individual more susceptible to developing active TB disease, as it is an “opportunistic infection like black fungus”.

There is not enough evidence currently to suggest that there has been an increase in TB cases due to Covid-19 or due to increased case finding efforts, it said, adding states and Union Territories have been asked for convergence in efforts for better surveillance and finding of TB and Covid-19 cases as early as August 2020.

Also, the health ministry has issued multiple advisories and guidance reiterating the need for bi-directional screening of TB-Covid and TB-ILI/SARI.

“Due to the impact of Covid-related restrictions, case notifications for TB had decreased by about 25 per cent in 2020 but special efforts are being made to mitigate this impact through intensified case finding in OPD settings as well as through active case finding campaigns in the community by all states.”

The dual morbidity of tuberculosis and Covid-19 can be further highlighted through the fact that both diseases are known to be infectious and primarily attack the lungs, presenting similar symptoms of cough, fever and difficulty in breathing. But TB has a longer incubation period and a slower onset of disease, the health ministry said.

“Furthermore, TB bacilli can be present in humans in a dormant state and has the potential to start multiplying when the individual’s immunity is compromised for any reason.

“The same is applicable in a post-Covid scenario when an individual may develop decreased immunity due to the virus itself or due to the treatment, especially immune-suppressants like steroids,” the Health Ministry said.