COVID-19 -Tuberculosis interactions: When dark forces collide.

The SARS-2 pandemic which has moved with frightening speed over the last 5 months has several synergies with another older, and far more neglected airborne disease, tuberculosis. Patients with tuberculosis are not only more likely to be infected by SARS-CoV-2 but also likely to have adverse outcomes once infected. The sequelae of more severe forms of COVID-19 in patients who have recovered from TB but have residual compromised lung function, are also likely to be devastating. These diseases share almost identical bio-social determinants like poverty, overcrowding, diabetes and pollution and some clinical similarities. The consequences of the COVID-19 pandemic, and our global response to it with lockdowns, are likely to leave a profound and long-lasting impact on TB diagnosis and control, potentially leading to an additional 6.3 million cases of TB between 2020 and 2025, and an additional 1.4 million TB deaths during this time. Novel solutions will need to be urgently devised or else TB control targets will never be met and indeed may be set back by 5-8 years.

Hydroxychloroquine for COVID-19: What is our Current State of Knowledge?

Chloroquine and Hydroxychloroquine are drugs which have been widely used in malaria and rheumatoid arthritis respectively for over 50 years. There was anecdotal evidence of their efficacy in the earlier SARS outbreak in 2003. This prompted physicians from across the world to use them in the present SARS-CoV- 2 pandemic that is currently sweeping the globe, with 5 million people already infected to date. These drugs are already in widespread use for the treatment of COVID-19 in India, mainly because they are cheap and easily available, and because of the absence of any readily available alternative therapy. This timely review discusses the pre-clinical evidence, and data from the eight available clinical trials. We emphasise that careful monitoring for cardiac toxicity is required when these drugs are used. Finally, we conclude that current data does not allow us to recommend for or against the use of these drugs. Results of two large RCTs, one from the NIH and the other from WHO (Solidarity) are eagerly awaited before the role of these drugs in COVID-19 can be definitively established.