Ending TB more important than ever

In 2018, Health Secretary Francisco Duque III made a commitment to the United Nations that the Philippines would do its share to find and treat 2.5 million Filipinos with tuberculosis (TB) by 2022. This commitment was raised to 4 million new cases in 2019, shortly before the first COVID-19 case was reported in the country. The Philippines is not likely to meet this commitment.

The Stop TB Partnership, a coalition of international organizations, countries, donors from the public and private sectors, governmental and nongovernmental organizations, and individuals that aim for a TB-free world, estimates that in 2020 around 591,000 Filipinos developed active TB disease, among them 73,000 are children. This is lower than the estimates from previous years, not because we have controlled the spread of TB but likely because of the pandemic situation that has driven our country to one of the longest lockdowns in the world. Mobility of people was severely cut down, including those who would have otherwise gone to health centers for screening and diagnosis of TB symptoms.

As a result of these lockdowns, reprioritization of health interventions and resources including manpower, the country further suffered a 43-percent increase in missed TB cases. Up to 334,000 patients suffering from TB were not able to receive the required treatment. Consequently, 2020 saw an increase in deaths from TB, up by 7 percent or around 31,000 Filipinos.

Why are we so concerned if individuals with TB symptoms are not diagnosed and not treated on time? Is TB as dangerous as COVID-19?

The reality is, TB can be worse for many individuals — and it is contagious. Across the world, 5,000 people die of TB everyday. But more importantly, every person who has untreated TB is likely to infect 10-15 persons in a year. Hence, it is not surprising that when one person is infected with TB in a household, if untreated, other household members may get sick as well. We all felt a similar situation with the Omicron variant of COVID-19. Pami-pamilya ang nagkakasakit. Fortunately, for most households, the Omicron infection was mild and many recovered without the need for hospitalization. This is not the case for TB.

Why is this so? Because TB is caused by a bacteria called the Mycobacterium tuberculosis, while COVID-19 is caused by a new coronavirus. Accounts of long COVID notwithstanding, viral infections generally tend to be self-limiting, meaning the infection may last a short period and the infected person may recover with enough rest. This is not true for a mycobacterial infection like TB. Such infections need an appropriate combination of medicines taken for at least six months for adequate treatment.

Moreover, TB can make people more vulnerable to COVID-19, making the need to address both illnesses, not an either-or proposition. Indeed, even in the first year of the pandemic, it has already been well established that “COVID-TB patients” have poorer prognosis and worse outcomes compared to others infected with COVID-19.

As of this writing, the Philippines has adjusted its attainment of 4 million new TB cases treated by 2025, given the context of a still ongoing COVID pandemic. We can do our part in meeting this target to end TB infection in our country. A quick check of our household members for key symptoms if they are experiencing any of the following for more than two weeks—cough, fever, unexplained weight loss, night sweats. Any one of these symptoms should prompt a visit to the doctor for adequate screening.

And of course, we should continue clamoring for and supporting public health leadership that recognizes the urgency of TB, its “syndemicity” with COVID and other diseases like HIV, and the social determinants that will ultimately determine the success of TB prevention and treatment.

Huwag matakot, nagagamot ang tuberculosis; may libreng gamot sa mga health center. Let’s help to end TB now. #WorldTBDay2022

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Mary Ann Evangelista, M.D., is an advocate of public health issues and medical director of Sandoz Philippines Corp. Gideon Lasco, M.D., Ph.D., is an Inquirer columnist, medical anthropologist, and advocate of equity in health.