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

Abstract

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.

Impact of the COVID-19 pandemic on tuberculosis services

“… 1 In England, the latent TB program was paused in response to the pandemic, 32 and in China, many TB-directed services were closed and reorganized into COVID-19 centres, and presumptive TB patients could not seek medical assistance due to movement restrictions. 33 This contrasts with what happened in Portugal: OTBC were kept open, latent TB screening and treatments continued throughout the pandemic, and mobility for health reasons was permitted.…”

“…Overall, fewer patients accessed the OTBC, which matches what is described in published literature. 1 , 5 , 14 , 15 , 33 Lower referrals from primary care units and patient's fear of contracting the disease were referred to as possible causes. The Regulatory Authority for Health report confirmed that the number of face-to-face appointments in primary care units in Portugal decreased substantially during the 1 st State of Emergency (33%, 73%, and 66% during March, April, and May 2020, respectively) 34 .…”

“…On the other hand, patient fear was often interpreted as the general decrease in healthcare service's use. 1 , 33 , 35 Other plausible reasons for this reduction include movement restrictions, enforced isolation measures, and widespread discouragement to seek medical care in health facilities if only mild symptoms were present. 1 , 5…”

Increased Healthcare Delays in Tuberculosis Patients During the First Wave of COVID-19 Pandemic in Korea: A Nationwide Cross-Sectional Study

“…For example, patient’s delay in seeking healthcare providers was significantly longer during the pandemic in China. 20 Local authorities need to collect their own data in order to implement public health interventions to minimize disruptions in TB care. Second, our study population was recruited from PPM-participating hospitals in Korea.…”

Cut-off Points of Treatment Delay to Predict Poor Outcomes Among New Pulmonary Tuberculosis Cases in Dalian, China: A Cohort Study

“…The delay in treatment during this period was significantly longer than that noted before the pandemic. 33 The COVID-19 pandemic has resulted in more patients not receiving timely and effective treatment, resulting in TB community spread and increasing the burden of TB control. 2 Under these circumstances, those with undetected TB will continue to experience worsening symptoms and take longer to start treatment, adding to difficulties of TB treatment.…”