Health Ministry recommends COVID-19 test for all tuberculosis patients: Here’s why

Tuberculosis is associated with a 2.1-fold increased risk of severe COVID19 disease according to the Union Health Ministry.

Anyone can get COVID-19, the disease caused by the novel coronavirus. But certain factors make people more vulnerable to the deadly viral disease. These include old age, obesity, and underlying health conditions, such as heart or lung disease, hypertension, diabetes, etc. While there's limited evidence on COVID-19 infection in tuberculosis (TB) patients, it is anticipated that people ill with both TB and COVID-19 may have poorer treatment outcomes. Therefore, the World Health Organization (WHO) has been stressing on monitoring and responding to TB prevention and care during the coronavirus pandemic.

For a similar reason, the Union Health Ministry has recommended COVID-19 screening for all diagnosed tuberculosis patients as well as a screening of TB for all coronavirus positive patients in India. In this regard, the Health Ministry on Wednesday released a document titled 'Guidance Note on Bi-directional TB-COVID Screening and Screening of TB Among ILI/SARI Cases.'

Dual morbidity of Tuberculosis and COVID-19

History of active as well as latent TB is an important risk factor for SARS-CoV-2 infection, the Health Ministry noted in the document, citing studies. TB not only results in increased susceptibility but also rapid and severe symptom development and disease progression with poor outcomes, it said. In fact, the Health Ministry said, tuberculosis is associated with a 2.1-fold increased risk of severe COVID-19 disease.

TB patients tend to have co-morbid or living conditions such as malnutrition, diabetes, smoking, HIV, etc and that also play a role in increasing their vulnerability to COVID-19, the Ministry explained.

"Studies have shown that history of active as well as latent TB [tuberculosis] is an important risk factor for SARS-CoV-2 [severe acute respiratory syndrome coronavirus 2] infection," the document read. "This not only results in increased susceptibility but also rapid and severe symptom development and disease progression with poor outcomes."

Different studies have also reported the prevalence of TB among COVID-19 patients, suggesting an occurrence rate of 0.37 4.47%.

Bi-directional TB-COVID screening

To address this dual morbidity of tuberculosis and COVID-19, the Health Ministry suggested that Bi-directional TB-COVID screening, TB screening for influenza-like illness (ILI) cases, and TB screening for severe acute respiratory illness (SARI) cases should be carried out.

Under the Bi-directional TB-COVID screening, it recommended COVID screening for all diagnosed TB patients and TB screening for all COVID positive patients.

"All newly diagnosed TB patients or those currently on treatment should be tested for COVID-19 as per MoHFW guidelines. Based on the result of the COVID-19 test, further management would be undertaken as per MoHFW guidelines. Even upon diagnosis of COVID, treatment of TB should continue uninterrupted," the document said.

For intensive management of TB-COVID co-morbid patients, TB service facilities will be connected with COVID Isolation facilities. If required, all COVID positive TB patients will be admitted to dedicated COVID care centers or hospitals it added.

Tuberculosis and COVID-19 are infectious diseases that primarily attack the lungs. They share similar symptoms of cough, fever, and difficulty in breathing. The difference is that tuberculosis has a longer incubation period and a slower onset of disease.

Cough for more than 2 weeks, persistent fever for over 2 weeks, significant weight loss, night sweats these are all symptoms of tuberculosis.