Union article analyses impact of COVID-19 lockdown on TB incidence and mortality in India

An article co-authored by The Union has estimated that 186,000 new tuberculosis (TB) cases and 88,000 additional TB deaths could be expected in India in 2020 as a consequence of the COVID-19 lockdown. These estimates are based on modelling data from other studies.

The lockdown in India has been associated with worsening poverty, undernutrition and under-detection of TB in the country. These developments may have serious implications for TB progression and transmission in India, where TB is still strongly associated with poverty, and have the potential to reverse the gains made in the fight against TB over the past five years.

The findings, published in the Indian Journal of Tuberculosis, show that there was a 59 percent under-detection of TB during the eight week lockdown period between March and May 2020,  when compared to an eight week pre-lockdown period. The national lockdown, in response to the COVID-19 pandemic, caused a disruption in TB services that is expected to result in a delay in TB diagnosis, meaning more people are presenting with severe disease at diagnosis. If people with TB remain undetected, then they have high chances of dying in the absence of anti-TB treatment.

The authors recommend the urgent need for restoring TB services, ramping up enhanced and active case finding in high risk populations and systematic identification (at diagnosis), referral and clinical management of severe TB among notified patients.

The COVID-19 lockdown has also resulted in an economic crisis which may double the level of poverty and has exacerbated food insecurity in the country. The nutritional status of a population is a strong determinant of TB incidence with undernutrition in adults alone accounting for 32-44 percent of TB incidence in India. A systematic review shows that a 14 percent increase in TB incidence can occur per one unit decrease in body mass index (BMI), which corresponds to a two to three kg weight loss. Furthermore, a one unit decrease in BMI may occur as a result of lockdown and its aftermath amongst the populations in India most affected by poverty. The increase in TB incidence as a consequence of the reduction in BMI, may be further exacerbated by a reduced dietary protein intake.  

The authors refer to similar previous situations following socio-economic crises in Cuba and in Zimbabwe, and subsequent increases in TB incidence. The authors stress the need for enhanced food rations, including pulses, through a public distribution system and direct cash transfers for those most in need.

Dr Hemant Deepak Shewade from The Union’s Centre for Operational Research co-authored the paper with Prof Anurag Bhargava from Yenepoya Medical College, Mangaluru, India. Read the article in full: The potential impact of the COVID-19 response related lockdown on TB incidence and mortality in India.