Fighting Two Airborne Pandemics in India: TB and COVID-19

By The Global Fund

March 24^th, 2021

The COVID-19 pandemic is having a devastating impact on the fight against tuberculosis worldwide, as many of the resources required to fight TB – labs, testing machines, health workers – have been diverted to fight COVID-19.

But India’s experience shows the COVID-19 pandemic also provides an opportunity to fight both diseases at the same time by increasing investments in the common tools, health workers and systems for health needed to fight TB and COVID-19.

Because of lockdowns and other restrictions in the early months of the COVID-19 pandemic, diagnosis and enrollment for TB treatment fell dramatically in India, which has the highest TB burden in the world.

Visitors get registered for COVID-19 testing in a temporary shelter at Nair Hospital in Mumbai.

Determined to protect its gains, India responded with a plan to integrate TB and COVID-19, including screening programs and laboratory services. Efforts to find TB and COVID-19 cases intensified across the country. Screening of TB patients for COVID-19 and COVID-19 patients for TB (known as bi-directional screening) was implemented to increase surveillance.

By December 2020, India had almost closed the gap on TB treatment enrollment, reaching the same levels of TB testing and notification the country had achieved before the COVID-19 pandemic hit.

A doctor examines a patient at Nair Hospital's TB outpatient department in Mumbai.

Over the last few years, India has scaled up TB investments with the goal of eliminating TB by 2025. India has been using lessons learned from the fight against TB to fight COVID-19, including infection control measures such as tracing, testing, isolating and treating, but also drawing from the experience of communities.

Officials and health community workers say the fight against COVID-19 is now providing an opportunity to better fight TB with the expansion of molecular testing and changes in social norms.

“COVID-19 has given us the opportunity for behavioral change we always wanted in our country,” said Dr. Raghuram Rao, Deputy Director of India’s National TB Elimination Program. “People are more aware now about the importance of wearing masks, washing hands and social distancing.”

Health workers from Mumbai Municipal Corporation do contact tracing of COVID-19 patients in the slums of Mumbai.

In Mumbai, a diagnostic tool devised and manufactured in India called Truenat is allowing hospitals to do co-testing for both COVID-19 and TB. The technology allows for rapid, onsite COVID-19 testing for symptomatic people and also facilitates tuberculosis screening of people with COVID-19 symptoms. It has the potential to be used around the world.

“The capability of doing co-testing for both COVID-19 and TB is a real boon for both patients and physicians,” said Dr. Jayanthi Shastri, Head of the Microbiology Department at Nair Hospital. “It allows us to better understand the two diseases and their complications.”

Dr. Shastri said the new technology could potentially be a game changer. Truenat, which delivers test results in under 60 minutes, allows clinicians to tackle both diseases with the same approach. The testing facility in her Mumbai hospital reduces waiting times for patients and limits the chances of spreading COVID-19.

Fighting Two Airborne Pandemics in India: TB and COVID-19

While the COVID-19 pandemic at first paused the fight against TB, health officials and community activists say TB programs must now adapt to a post-COVID-19 future to rebound stronger, including better implementation and digital technology.

“The good practices of COVID-19 need to be translated to TB,” said Blessina Kumar, a health activist from India. “We have the resources and the skills to end TB, but TB is the known devil.”