The impact of the COVID-19 epidemic on tuberculosis control in China

Huang Fei; Xia Yinyin; Chen Hui; Wang Ni; Du Xin; Chen Wei; Li Tao; Huan Shitong; Sun Miaomiao; Chen Mingting; Salmaan Keshavjee; Zhao Yanlin; Daniel P Chin; Liu Jianjun

doi:10.1016/j.lanwpc.2020.100032

The impact of the COVID-19 epidemic on tuberculosis control in China

Lancet Reg Health West Pac. 2020 Oct:3:100032. doi: 10.1016/j.lanwpc.2020.100032. Epub 2020 Sep 24.

Authors

Huang Fei¹, Xia Yinyin¹, Chen Hui¹, Wang Ni¹, Du Xin¹, Chen Wei¹, Li Tao¹, Huan Shitong², Sun Miaomiao³, Chen Mingting¹, Salmaan Keshavjee⁴, Zhao Yanlin¹, Daniel P Chin⁵, Liu Jianjun¹

Affiliations

¹ Chinese Center for Disease Control and Prevention, Beijing, China.
² China office, The Bill & Melinda Gates Foundation, Beijing, China.
³ China office, PATH, Beijing, China.
⁴ Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.
⁵ The Bill & Melinda Gates Foundation, Seattle, USA.

Abstract

Background: In response to the COVID-19 epidemic, China implemented a series of interventions that impacted tuberculosis (TB) control in the country.

Methods: Based on routine surveillance data and questionnaires, the study analyzed TB notification, follow-up examinations, and treatment outcomes. The data were split into three phases in relation to outbreak, lockdown and reopen when the nationwide COVID-19 response started in 2020: control (11 weeks prior), intensive (11 weeks during and immediately after), and regular (4 additional weeks). Data from 2017-2019 were used as baseline.

Findings: The notified number of TB patients decreased sharply in the 1^st week of the intensive period but took significantly longer to rebound in 2020 compared with baseline. The percentages of TB patients undergoing sputum examination within one week after 2 months treatment and full treatment course in the intensive period were most affected and decreased by 8% in comparison with control period. 75•2% (221/294) of counties reallocated CDC and primary health care workers to fight the COVID-19 epidemic, 26•9% (725/2694) of TB patients had postponed or missed their follow-up examinations due to travel restrictions and fear of contracting COVID-19.

Interpretation: In the short term, the COVID-19 epidemic mostly affected TB notification and follow-up examinations in China, which may lead to a surge of demand for TB services in the near future. To cope with this future challenge, an emergency response mechanism for TB should be established.

Funding: National Health Commission of China-Bill & Melinda Gates Foundation TB Collaboration project (OPP1137180).

Keywords: COVID-19; China; Impact; Tuberculosis.