Last month, I got a call from my elder brother that Shruti was critical. The 21-year-old daughter of his office driver was in acute respiratory distress. Being a medical doctor, I had facilitated the treatment of many such cases since the onset of the COVID-19 pandemic. Hurriedly, I referred Shruti to my friend Dr Sameer. COVID-19 creates severe complications in the elderly and those with co-morbidities. But this was a seemingly healthy young woman. The next day Sameer updated me on the diagnosis. Shruti was suffering from tuberculosis (TB).
India reported the first case of COVID-19 on January 30, 2020. In one year, the pandemic caused 10.7 million cases and 1,54,000 deaths. While social and economic life in much of the world remains paralysed due to a strong second wave of COVID-19, life in India is fast returning to normal with a consistent decline in new cases since mid-September. A wider acceptance of the preventive measures has proved to be a critical game-changer for India.
However, few are aware of the fact that India loses more than 4,00,000 lives every year due to TB. India is home to one-sixth of humanity but shares more than one-fourth of the global TB burden. The WHO reports that there are more than 10 million active TB cases in the country. The lessons learned during the COVID-19 battle can do a lot in controlling TB.
For over 3,000 years, TB has plagued mankind. It continues to wreak havoc because of its distinct features: Tuberculosis is a social disease. Due to overcrowding and malnutrition, it disproportionately affects the poor and the marginalised. The stigma and myths associated with this disease lead to underreporting and underdiagnosis. The long-drawn multi-drug treatment leads to poor compliance and drug-resistance, which hamper recovery. Complications increase with a pre-existing illness like diabetes or co-infection with HIV. Finally, the chronic nature of the disease and propensity to damage multiple organs increase mortality risk.
The Prime Minister consistently advocates community-driven efforts to address social problems. His call for Swachh Bharat galvanised the nation and increased the nationwide toilet coverage from 39 per cent (2014) to 100 per cent (2019). He knows the health and economic benefits of TB elimination and has set an ambitious target of TB-free India by 2025, five years ahead of the Sustainable Development Goal target.
When COVID-19 reached India, the PM, in his first address to the nation on March 19 last year, appealed to the public to observe physical distancing to prevent infection. Later, he urged for the universal use of face masks and emphasised rigorous testing, contact tracing, and prompt treatment. For a nation with six major religions, 28 states, 1,600 languages, and over 6,00,000 villages, inducing behaviour change amongst the masses was not easy. But Indians responded with considerable discipline. Despite a harsher winter, India has not witnessed a spike in COVID-19 like many other countries are experiencing.
India can successfully deploy lessons learned from containing the coronavirus for TB control. Since TB spreads through droplets of infected persons, physical distancing can reduce disease transmission. Patients with TB must wear a mask to prevent the spread of infection, and persons in the patient’s regular contact should wear a mask for self-protection. Early diagnosis and treatment are the keys to success. The new diagnostic techniques give rapid and ultraprecise results compared to the traditional sputum test. Finally, instant case notification helps in better case tracking and contact monitoring.
A successful community-driven strategy, as shown during the Swachh Bharat campaign or COVID-19 control, if dovetailed with the existing TB control programme, which provides free diagnosis and treatment, can accelerate TB elimination. The fight against COVID-19 has led to increased awareness of respiratory infections, which may help remove the stigma associated with TB. Further, India’s efforts to contain the coronavirus succeeded due to improved coordination among central and state governments and innovative media campaigns. This momentum should not be allowed to dissipate when India has another respiratory disease killing two-and-a-half times as many people every year.
Timely intervention saved Shruti. After discharge from the hospital, she was put on anti-TB medicines. If citizens like her can practise physical distancing, use a face mask, seek prompt diagnosis, and complete the treatment, they can surely propel the growth story of the world’s largest democracy.
The writer is a member of the Indian Administrative Service and is pursuing MPA at Harvard Kennedy School. He was involved in drafting the revised national strategy for TB control in 2017