Problems faced by tuberculosis patients during COVID-19 pandemic: Urgent need to intervene.

Sir

Coronavirus disease (COVID-19) is an infectious disease caused by novel coronavirus named as SARS Cov-2. It originated in the city of Wuhan, the capital of Hubei province of China in December 2019 and has been declared pandemic by the World Health Organisation [1, 2]. The disease has now spread in more than 200 countries and even our country has been badly affected. More than 85000 cases and more than 2500 deaths have occurred till date (15th May 2020). Honourable Prime Minister announced a ‘Janta curfew’ on 22nd March 2020. Thereafter, a nationwide ‘Lockdown’ was ordered which has been effective in slowing down the growth rate of pandemic.

The unprecedented COVID-19 pandemic has seriously impacted people with pre-existing health conditions and has adversely affected the management of other diseases. Tuberculosis (TB) is the world's biggest killer among infectious diseases, claiming more than 4000 lives each day. India has the greatest number of both drug sensitive and drug resistant TB [3]. Patients who are under treatment from tertiary care hospital are badly affected due to lockdown implemented to contain coronavirus infection.

Primary objective of the study is to assess the difficulty faced by TB patients due to lockdown implemented to contain the coronavirus infection.

Method

Patients getting treatment for drug sensitive pulmonary or extra-pulmonary tuberculosis who were in the intensive phase of treatment from AIIMS-Patna were included for survey. Anti-tubercular drugs (4FDC+3FDC) were provided by the Government at our centre. We developed oral questionnaire which included 7 questions to assess the problems faced by TB patients. Response to each question was recorded as dichotomous variable (Yes/No).

Result

The survey was conducted telephonically by the Upper divisional clerk of our department. Out of 175 patients, survey could be conducted in 150 patients (73 male and 77 female) as the call was not responded in remaining 25 patients. The result of the survey is summarised in Table 1 .

Table 1

Result of survey among 150 patients of Tuberculosis.

S. No.	Questionnaire	Response
Q1	Are you taking anti-tubercular drugs -
	Yes	124 (82.66%)
	No	26 (17.33%)
Q2	Out of 124 patients, patients takinga. Government supplied medicine	98 (79.03%)
	b. Purchased Medicine from private pharmacy	26 (20.96%)
Q3	Out of 98 patients, those taking medicines froma. Primary treating centre	37 (37.75%)
	b. Local health centre	61 (62.24%)
Q4	Patients who have visited primary treating centre for consultation during lockdown (out of 150 patients)	44 (29.33%)
Q5	Patients who have visited primary treating centre by their own vehicle (out of 44)	37 (84%)
Q5	Patients who required local consultation during lockdown (Out of 150 patients)	13 (8.66%)
Q6	Patients agreeing to Government's decision of lockdown	108 (72%)
Q7	What precautionary measure are you taking to avoid corona infection?
	Restrict ourselves to home	91 (60.66%)
	Using Mask	21 (14%)
	Hand washing	15 (10%)

26 (17.33%) out of 150 patients defaulted treatment as they could not come to their primary treatment centre or couldn't get the medicine from local health centre due to lockdown. This is a terrifying scenario as these patients continue to disseminate infection. It may also lead to treatment failure and emergence of drug resistant TB. Among 124 patients taking anti-tubercular drugs, 26 (20.96%) patients purchased the medicine from private pharmacy while 98 (79.03%) patients were getting government supplied drugs, either from primary treating centre (37.75%)) or local health centre (62.24%).

Almost one third, 44 (29.33%) patients visited the institute but could not succeed in getting consultation as outpatient department was closed. 37 (84%) among these patients used their own vehicle to visit the institute. 13 (8.66%) patients have consulted local doctor for new symptoms or persistence of symptoms.

Few questions were asked regarding awareness about COVID-19 infection. Only 72% of TB patients were satisfied with the Government's decision of lockdown. Query was made regarding precautionary measures taken by patients to avoid corona infection. Restricting themselves to home as preventive measures was practised by 91(66.66%) patients while 21(14%) patients use mask and 15(10%) patients practised hand washing only as measures to avoid the corona infection.

There are certain suggestions by STOP-TB partnership in this COVID-19 pandemic era for better care of TB patients. There should be proper communication between people affected by TB and all stakeholders using virtual means of communication. They should be provided with anti-tubercular drugs for at least two months. Anti-tubercular drug availability should be ensured at every level and properly monitored. TB care providers should be well briefed and use essential personal protective equipment.

This survey highlights that, almost one fifth patient (17.33%) defaulted tuberculosis treatment due to lockdown as they could not get the medicine and one fifth (20.96%) required purchasing the medicine from private pharmacy. Most of the patients agree that staying indoors is the most effective strategy to avoid infection by corona infection. There should be adequate co-ordination and communication among all those involved with treatment of TB patients.

Conflicts of interest

The authors have none to declare.