New Evidence Shows COVID’s Substantial Effect on Tuberculosis

Preliminary data published by the Centers for Diseases Control and Prevention (CDC) has revealed new evidence that COVID has a substantial, positive effect on tuberculosis (TB) trends in the U.S.

Since the start of the pandemic, TB numbers have fallen. As stated by the CDC, “In the United States, reported tuberculosis disease diagnoses fell 20% in 2020 and remained 13% lower in 2021 than TB disease diagnoses made prior to the COVID-19 pandemic.”

With regards to the U.S. documented numbers show that, 

• Reported TB disease diagnoses fell 20% in 2020 and remained 13% lower in 2021 than pre-pandemic levels 
• In 2021, a total of 7,860 cases of TB were reported 
• In 2019, 526 DEATHS were attributed to TB 
• Without treatment, 1 IN 10 people with latent TB infection will develop TB disease
• In 2020, a total of  56 cases of multidrug-resistant TB cases in the U.S. were reported. It is estimated that up to 13 million people in the United States live with inactive TB.

Before COVID-19, TB diagnoses, in general, declined between 1% and 2% every year. Now, the numbers are falling more dramatically. With this, it is believed that COVID preventative measures, including mask-wearing and social distancing, have positively contributed to this. 

While it is not yet confirmed whether this is the only factor, some believe that “widespread disruptions to healthcare during the COVID may have delayed TB diagnoses.” Others believe that the similarities in symptoms between COVID and TB may have led to missed TB diagnoses or delayed diagnoses.

How to Distinguish TB Disease From Potential COVID Cases

While TB and COVID are similar, The World Health Organization reports that “People ill with COVID and TB show similar symptoms such as cough, fever, and difficulty breathing. Both diseases attack primarily the lungs and although both biological agents transmit mainly via close contact, the incubation period from exposure to disease in TB is longer, often with a slow onset.”

COVID shows symptoms rapidly after an incubation period of one to two weeks, while manifestations of TB typically develop over a much longer period. When it comes to coughing, a TB-related cough is productive of sputum and even blood, whereas a COVID-related cough is drier. Regarding shortness of breath, this occurs early on in COVID while with TB, shortness of breath occurs much later on.  

WHO continues, “While both TB and COVID-19 spread by close contact between people the exact mode of transmission differs… TB bacilli remain suspended in the air in droplet nuclei for several hours after a TB patient coughs, sneezes, shouts, or sings, and people who inhale them can get infected. The size of these droplet nuclei is a key factor determining their infectiousness.” 

“Their concentration decreases with ventilation and exposure to direct sunlight. COVID transmission has primarily been attributed to the direct breathing of droplets expelled by someone with COVID. Droplets produced by coughing, sneezing, exhaling, and speaking may land on objects and surfaces, and contacts can get infected with COVID by touching them and then touching their eyes, nose, or mouth.”

Are You at Risk of Getting TB?

While all U.S. citizens are at risk of contracting COVID, some may be more at risk of contracting TB than others. And yes, popular belief may see TB as only related to far-off countries; still, some may be at higher risk in the U.S. Here are CDC’s at-risk pointers: 

• You were born in or frequently travel to countries where TB is common, including those in Asia, Africa, and Latin America
• You live or used to live in large group settings where TB is more common, such as homeless shelters, prisons, or jails
• You recently spent time with someone who has active TB disease
• You have a weaker immune system because of certain medications or health conditions such as diabetes, cancer, and HIV
• You work in places with a high risk for TB transmissions, such as hospitals, homeless shelters, correctional facilities, and nursing homes

How To Prevent Both COVID and TB Infections

When it comes to hospitals, individuals, and the public at large, following health and safety recommendations as suggested by health experts and authorities is of paramount importance. 

• Handwashing
• Respiratory precautions
• Social distancing
• The wearing of masks indoors 
• As WHO states, “Hospital procedures that generate aerosols predispose to infection of both conditions and should only be conducted within recommended safeguards.”

Should individuals become infected with either TB or COVID, WHO firmly suggests, “Support for uninterrupted TB preventive treatment and treatment of TB disease should be ensured alongside the COVID-19 response. It is critical that TB services are not disrupted during the COVID19 response.”