Home Tuberculosis TB surveillance is Covid-19’s unwitting casualty in Gujarat

TB surveillance is Covid-19’s unwitting casualty in Gujarat


With the lockdown confining people to their homes and state machinery engrossed in Covid-19 duties, the tuberculosis active case search and identification in Gujarat — a leader in battle against TB— has been pushed backwards by six months

The past 10 months of Covid-19 pandemic have pushed the tuberculosis active case search and identification backwards by almost six months in the state, delivering a massive blow to the health department’s efforts thus far. Gujarat has been leading the battle against TB, according to India TB report 2020. However, with the entire machinery pressed into Covid duties, the officials have been struggling to make up for lost time.

Last week, Gujarat Health Commissioner Jai Prakash Shivahare ordered a statewide hunt for active and presumptive TB cases which has suffered due to the diversion caused by Covid- 19. Citing ‘poor performance’ in TB reporting this year, officials have been ordered to conduct a fortnight’s drive from December 14 to 31 to make sure that as many active cases as possible are traced and TB reporting is brought up to par by the end of the year.

The order states that Gujarat has been able to achieve only 59% of its TB case search target till November 2020. Notably, TB statistics are counted for the calendar year.

The Health Commissioner ordered that even if sputum results of presumptive patients come negative, their X-ray had to be conducted within a week to rule out any possibility of infection. The state has also ordered district-wise data of reportage on a daily basis.

The fortnight-long drive will be heavily concentrated in 13 peripheral districts that have registered extremely low reporting.

Data analysis

Data on TB case reporting in Gujarat from Nikshay shows drastic reduction in cases this year. The number of cases detected from January to November 2020 are lesser than those even three years earlier.

Gujarat reported 1,07,815 (1.07 lakh) TB cases from January 1 to November 30, 2020, against 1.59 lakh in the whole of 2019, 1.53 lakh in 2018 and 1.38 lakh in 2017.

Month wise data for the year 2020 shows reporting above 10,000 cases only in the months of January, February, March and June. The spike in June came after the central government’s order to test Covid negative patients for tuberculosis.

However, due to widespread Covid-19 testing in the months after June, TB reporting went down again. In November, Gujarat reported just 7,771 new TB cases.

‘Need six months to get back on track’

Officials said that while it was expected that after Unlock-1 in June, TB patients and suspects would begin visiting hospitals and getting tests done, things did not exactly pan out very well. The fear of visiting major public sector hospitals which were Covid-designated followed by the inclusion of major private facilities in big cities into this ambit led to fewer OPDs than expected.

Further, officials said that the fear of being quarantined and the fear of being stigmatised seems to have kept people largely at bay.

Dr Pranav Patel, head of the IRL in Ahmedabad, told Mirror, “When we began our active case search earlier in June, we identified areas with high caseloads and began contact tracing TB patients to see if those in their vicinity had contracted it. We faced a lot of resistance from localities because of the prevailing Covid fears.”

Further restriction was caused by lack of identification of TB symptoms, said Dr Patel. Potential TB patients kept going home after their Rapid Antigen tests came back negative for Covid. Most don’t realise that the symptoms are the same and that they should get an x-ray done.

Tech support to aid TB reporting

Gujarat now has 117 machines to accurately detect tuberculosis, said officials of the health department. There are 57 new TrueNAAT machines for TB reporting in addition to 60 CBNAAT 4-module machines.

The state is expecting the arrival of eight more CBNAAT machines with 16-module capacity each by January 2021, which will increase the testing capacity. These are to be deployed in Ahmedabad and Surat.

Unanswered questions

Even as the state is going into overdrive to search for active TB cases at the end of the year, officials are yet to investigate cases of abnormal HRCT scans which have come negative for Covid-19 but could be TB. The very beginning of Covid-19 in Surat was traced by Radiologists using HRCT scans and the municipal corporation has collected all data. Using this tool could be potentially beneficial to find TB cases.

Further, there is little clarity on the effect of the pandemic lockdown on TB cases and whether relatives and neighbours of TB patients who have been constantly remained locked in their homes, have contracted the disease or not. This is because most healthcare staff are busy in active case finding and Covid duty.


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