Impact of the COVID-19 pandemic on tuberculosis management in Spain

Abstract

Background: The impact of COVID-19 on the diagnosis and management of tuberculosis (TB) patients is unknown. Methods: Participating centres completed a structured web-based survey regarding changes to TB patient management during the COVID-19 pandemic. The study also included data from participating centres on patients aged !18 diagnosed with TB in 2 periods: March 15 to June 30, 2020 and March 15 to June 30, 2019. Clinical variables and information about patient household contacts were retrospectively collected. Results: A total of 7 (70%) TB units reported changes in their usual TB team operations. Across both periods of study, 169 patients were diagnosed with active TB (90 in 2019, 79 in 2020). Patients diagnosed in 2020 showed more frequent bilateral lesions in chest X-ray than patients diagnosed in 2019 (P = 0.004). There was a higher percentage of latent TB infection and active TB among children in households of patients diagnosed in 2020, compared with 2019 (P = 0.001). Conclusions: The COVID-19 pandemic has caused substantial changes in TB care. TB patients diagnosed during the COVID-19 pandemic showed more extended pulmonary forms. The increase in latent TB infection and active TB in children of patient households could reflect increased household transmission due to anti-COVID-19 measures.

Impact of the COVID-19 pandemic on tuberculosis services

“…Contact tracing was compromised during the 1 st State of Emergency in 41.9% of the OTBC. In comparison Aznar et al 14 investigated 13 Spanish centres during the same period and reported slightly worse results, with 53.8% of centres reporting changes in contact screening programs. Additionally, follow-up of patients was either cancelled or delayed by 76.9%.…”

“…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 .…”

“…A study carried out in Spain compared data from March-June in 2019 and 2020 and described an increase in latent and active TB in children of patient households (5.3% vs 7.7% in 2019 and 2020, respectively, p < 0.001); additionally, patients with the active disease diagnosed during the pandemic showed more severe manifestations. 14 …”

Retrospective Cohort Study of Effects of the COVID-19 Pandemic on Tuberculosis Notifications, Vietnam, 2020

“…Both Vietnam and South Korea had smaller COVID-19 outbreaks, measured as total cases and per capita, in 2020 compared with other settings globally ( 18 ). However, a much smaller study in Spain, a country with a high COVID-19 burden, reported more advanced radiologic findings for TB notifications in 2020 ( 32 ). Further global data from settings with high COVID-19 burdens will be needed to appreciate the effects of the COVID-19 pandemic on delayed TB case finding.…”

Strengthening Tuberculosis Services for Children and Adolescents in Low Endemic Settings

“…Unfortunately, the recent COVID-19 pandemic has significantly diminished public health resources in many low-burden settings, and TB programs have suffered some deleterious consequences [20,21]. As TB caseworkers are skilled in contact tracing, many were recruited early in the pandemic to perform contact tracing for COVID-19 patients.…”