That other epidemic: TB

The Philippines is among “high-burden” countries that continue to struggle with tuberculosis, a highly infectious but curable disease — and the mobility restrictions brought about by the COVID-19 pandemic has not helped.

The Global Tuberculosis Report 2020 by the World Health Organization (WHO) showed that the Philippines had the highest TB incidence rate in Asia in 2019, with 554 cases for every 100,000 Filipinos. In addition, according to the Department of Health (DOH), TB is among the top 10 causes of death in the country, with about 74 Filipinos dying from the disease every day, despite treatment being free in public health facilities nationwide.

“TB remains the deadliest infectious killer and a major public health issue,” said the WHO on World Tuberculosis Day last March 24.

In its global TB report, the UN agency said the Philippines was among seven countries that accounted for more than 60 percent of the global gap between the estimated incidence of TB cases and the actual number of people diagnosed with the disease, which kills 1.4 million people every year.

This simply means there has been a lag in detecting and treating TB cases. Worse, the country also accounted for the highest number of patients that did not return for follow-up evaluation or treatment. The COVID-19 lockdowns that limited people’s access to health facilities have only exacerbated the situation.

The DOH saw a drastic drop in the number of TB cases reported by the end of last year, with 268,816 new and relapse TB cases reported as of end-December representing a 35-percent decrease from 2019 figures.

Good news? Not quite: The decrease does not mean recovery from the disease, but is more an indication of how the coronavirus has impacted the health-seeking behavior of Filipinos. Citing the 2016 National TB Prevalence Survey where only 19 percent of people with TB symptoms sought treatment and care while the rest did nothing or resorted to self-medication, the DOH said these same behaviors have possibly prevailed during the pandemic.

The decline in diagnosed cases will likely cause the DOH to miss its target of finding and treating 1.4 million more cases by 2022. A single TB case left untreated or undiagnosed will spread and infect at least 10 more people; the infectious bacterial disease usually attacks the lungs and is spread through the air once an infected person coughs, sneezes, shouts, or spits — not too different from how COVID-19 is spread. Unless this worrying gap is addressed and the government’s care and services get back on track, about 100,000 Filipinos will end up dying from TB in the next five years, said the department.

Last June 4, the US Agency for International Development (USAID) announced that the Philippines is one of the recipients of a $57-million facility dedicated to boosting urgently needed TB recovery efforts in seven “high-burden” countries, which also include Bangladesh, India, Indonesia, South Africa, Tajikistan, and Ukraine. With about 1 million people globally not having access to TB diagnosis and treatment in 2020 compared to 2019 as a result of the pandemic, the program aims to help reduce the underreporting of TB cases as well as improve access to health services.

The impact of COVID-19 on global TB response will sicken an estimated 6.3 million people with TB and cause an additional 1.4 million TB-related deaths by 2025, warned USAID. “The pandemic’s toll puts the world’s poorest and most vulnerable populations at even more risk for both TB and COVID-19. People with COVID-19 and TB are about three times more likely to die than those with only TB,” it said in a statement. “Alongside COVID-19, TB is the leading infectious disease killer, particularly in low- and middle-income countries, sickening ten million people and taking 1.4 million lives every year.”

National Tuberculosis TB Control Program head Anna Marie Celina Garfin earlier said that the COVID-19 pandemic has already set back the fight against TB by at least five to seven years. It is thus imperative to provide Filipinos with access back to TB treatment services amid the continuous threat of COVID-19, the vaccines for which are not yet available to everyone.

TB treatment, on the other hand, is available and free. “TB is a treatable disease, and we can prevent deaths and possible outbreaks if TB is detected and treated early,” said Health Secretary Francisco T. Duque III. “Let us end the stigma associated with tuberculosis.”