Tuberculosis (TB) remains one of the leading causes of mortality worldwide, with 1.3 million deaths annually. Rapid diagnosis and proper disease control are crucial for preventing the spread of infection and for saving the lives of People with TB (PwTBs) who have a short life expectancy if not treated properly. Therefore, use of the most rapid methods of identification, administration of appropriate treatment regimens and ensuring that patients complete the whole treatment course are advocated.
This year however, the COVID-19 pandemic has currently overtaken every other existing health issue throughout the world, impacting in numerous ways including TB. Currently, TB control programs were strained due to diversion of resources, an inevitable loss of health system focus and the public has been asked to shelter-in-place.
In the Philippines, although the number of TB cases reported in the first three months of 2020 has drastically declined by almost 20%, this does not necessarily mean good news according to the Department of Health (DoH). “We see this as a direct effect of the COVID-19 pandemic on a critical disease prevention and control program like TB,” said Health Secretary Francisco T. Duque III. “The quarantine has extremely affected and limited the health seeking behaviors of our fellow Filipinos.”
And Ivy*’s case is one example; as during the pandemic, she faced many barriers before she was diagnosed with TB disease and received proper treatment.
The 27 y/o housewife was able to seek proper diagnosis and medication in a hospital only after almost 6 months when she began feeling ill. According to her, while admittedly she felt reluctant to get medication on the onset of her pulmonary disease, the community lockdown further hindered her from seeking medical checkup. She said: I just opted to ask for medical advice from an online doctor and was prescribed to just antacid for one week.
It was only this July 2020 when she finally decided to visit a community health clinic, concerned that she had moments of “coughing up blood” over the previous months. In addition to hemoptysis, she also revealed that she had been having trouble breathing. She was also originally prescribed to take amoxiclab for a week but felt no better. After a week, during the reading of her tests, It was the hospital which eventually tested her for pulmonary TB. She was given a 2-month regimen of fixcom 4 and vitamin B complex. She was advised to return after two weeks for a follow up checkup.
“However, I was able to return to the hospital only after two months,” she revealed. That time, she was already complaining about knee pain.
Currently, Ivy is on the 4th month of her antibiotic medication (plus pain reliever and vitamin).
According to Secretary Duque, unlike other health programs, having fewer cases is not an indicator of success for the TB program. “Our goal for our TB program is to find and treat as many TB cases as possible. Only by finding and treating these cases can we limit its spread and achieve our dream of a TB-free Philippines.”
The worldwide spread of COVID-19 has indeed implications for core public health surveillance functions. For TB, with an untreated case fatality rate of around 10%, the potential consequences of delayed or missed diagnoses may increase TB-related hospitalizations and death. Therefore, health services, including national programs to combat TB, need to be actively engaged in ensuring an effective and rapid response to COVID-19 while ensuring that TB services are maintained.
This series/story is a part of the #TBFreePH campaign, the official TB health promotion and communication strategy of the Department of Health which aims to help the National TB Control Program (NTP) in finding and treating 2.5 million Filipinos with TB by 2022. With the support of the US Agency for International Development (USAID) and other development partners, #TBFreePH hopes to convince more Filipinos in knowing their TB status, and getting tested and treated for TB. Follow #TBFreePH on https://www.facebook.com/TBFreePH.
*Name has been changed at the patient’s request