Patient, Diagnosis, and Treatment Delays Among Tuberculosis Patients Before and During COVID-19 Epidemic - China, 2018-2022.

What is already known about this topic?: The coronavirus disease (COVID-19) pandemic could have a damaging impact on access to tuberculosis (TB) diagnosis and treatment. What is added by this report?: The overall delay experienced by TB patients during the COVID-19 pandemic has shown a modest decrease in comparison to the period before the pandemic. Notably, higher patient delays were observed among agricultural workers and those identified through passive case-finding methods. Furthermore, the patient delay in eastern regions was shorter compared to western and central regions. What are the implications for public health practice?: The observed increase in patient delay in 2022 should be of concern for ongoing TB control efforts. Health education and active screening initiatives must be enhanced and broadened among high-risk populations and regions characterized by extended patient delays.

Global control of tuberculosis: current status and future prospects

Tuberculosis is a zoonotic disease that is caused by mycobacterium tuberculosis complex and can infect humans, livestock, and wildlife. It spreads primarily through the respiratory tract and was the leading cause of death due to a single infectious disease before the COVID-19 pandemic. TB is a global public health emergency that has reemerged over the past few decades. Substantial efforts are needed to achieve the goals of the End TB Strategy. The World Health Organization has estimated that approximately 9.9 million people worldwide contracted TB in 2020 and that approximately 140,000 of the 10 million new cases of active TB in 2019 were zoonotic TB. During the COVID-19 pandemic, the number of new TB diagnoses and reports decreased sharply, from 7.1 million in 2019 to 5.8 million in 2020, returning to 2012 levels far below the approximately 10 million TB cases in 2020. Simultaneously, the global decrease in the absolute number of TB deaths until 2019 was followed by an increase in 2020 in four of the six WHO regions and most of the 30 high-TB-burden countries. Therefore, extensive immediate actions worldwide are required to restore the health system, and innovations are needed to accelerate progress toward a tuberculosis-free world.

The Impact of COVID-19 on Tuberculosis Patients' Behavior of Seeking Medical Care - China, 2020.

What is already known on this topic? The coronavirus disease 2019 (COVID-19) pandemic has disrupted the tuberculosis (TB) service system. However, the impact on TB patients in China remains unknown. What is added by this report? This report firstly addressed the impact of COVID-19 on TB patients in China. About half of TB patients did not revisit the hospital due to personal reasons. The reasons for irregular medication and postponing or cancelling examination after full treatment course were different. What are the implications for public health practice? Health education and risk communication should be strengthened for better TB patient management and treatment adherence, especially in light of the COVID-19 pandemic.

Impact of COVID-19 Pandemic on Pre-Treatment Delays, Detection, and Clinical Characteristics of Tuberculosis Patients in Ningxia Hui Autonomous Region, China.

Background: To contain the pandemic of COVID-19, China has implemented a series of public health interventions that impacted the tuberculosis control substantially, but these impacts may vary greatly depending on the severity of the local COVID-19 epidemic. The impact of COVID-19 on TB control in Ningxia Hui Autonomous Region is little known. Methods: Based on the national TB Information Management System (TBIMS), this study accessed the actual impact of COVID-19 on TB by comparing TB notifications, pre-treatment delays, and clinical characteristics of TB cases between 2020 COVID-19 period and 2017-2019 baseline. The data were divided into three periods based on the response started to fight against COVID-19 in Ningxia Hui Autonomous Region, including the control period (10 weeks before the pandemic), intensive period (10 weeks during the Ningxia Hui Autonomous Region lockdown), and regular (10 additional weeks after Ningxia Hui Autonomous Region reopen). Results: TB notification dropped sharply in the first week of the intensive period but took significantly longer to return to the previous level in 2020 compared with the 2017-2019 baseline. Totally, the TB notification rates decreased by more than 60% in the intensive period of COVID-19 compared with the average level of 2017-2019. The sputum smear-positive rate of TB patients diagnosed in intensive period of COVID-19 was significantly higher than that in the corresponding periods of 2017-2019 (P < 0.001). The rate of cavity on X-ray inspection of TB cases diagnosed in the intensive period of COVID-19 was significantly higher than that in period 2 of 2017-2019 (23.5 vs. 15.4%, P = 0.004). The patients' delay in the intensive period was significantly longer than that before the pandemic (P = 0.047). Conclusions: The TB notification in Ningxia was impacted dramatically by the pandemic of COVID-19. To compensate for the large numbers of missed diagnosis as well as delayed diagnosis during the intensive period of COVID-19, an urgent restoration of normal TB services, and further emphasis on enhanced active case finding and scale-up of household contact tracing and screening for TB-related symptoms or manifestation, will be essential.

Predicted Impact of the COVID-19 Responses on Deaths of Tuberculosis - China, 2020.

WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: The World Health Organization has estimated the impact of reductions in the performance of global tuberculosis (TB) detection and care on TB deaths. However, the actual impact of COVID-19 pandemic on TB deaths in China remains unclear. WHAT IS ADDED BY THIS REPORT?: The stringent public interventions to fight COVID-19 including lockdown led to more than 20% decrease of TB detection in China. It was predicted that the reduction of TB detection might result in 11,700 excess deaths based on assumption of no detection rebound. Based on the prediction the total deaths will be 51,100 in 2020 which might surpass the deaths in 2011. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?: Rapid restoration of TB diagnosis and care services is critical for minimizing the potential effects on TB-related deaths and bringing TB burden back to control. It is urgent to ramp up case detection including active case finding and to provide an uninterrupted supply of quality-assured treatment and care for TB cases in post-COVID-19 outbreak.