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Tuberculosis

Updated 18 August 2020

The forgotten killers: Covid-19 destroying gains made in the fight against malaria, TB

Disruptions in prevention schemes and treatment for other diseases, like tuberculosis, malaria and HIV, might leave more scars than Covid-19.

  • The Covid-19 pandemic is sidelining the progress made with other communicable diseases, such as malaria and tuberculosis.
  • According to experts, delays in treatment will have serious effects on mortality rates from these diseases.
  • Prevention programmes are also adversely disrupted by the pandemic, with far-reaching long-term implications.

The Covid-19 pandemic is leaving an indelible impact on the modern world, changing it forever, including healthcare systems.

While the disease is directly destroying many lives, it's also systematically erasing years of progress made in the fight against other communicable diseases – specifically tuberculosis, malaria and HIV.

Epidemics in their own right, disruptions to medication, the halting of prevention programmes and a fear of seeking medical care due to the coronavirus have severely impacted many countries' – including South Africa's – ability to sustain those fights.

READ MORE | 73 countries are running out of HIV medication due to pandemic. Is SA on that list? 

Dire outlook

According to recent modelling by the Global Fund on communicable diseases, a six-month disruption of antiretroviral medication alone can lead to more than 500 000 extra deaths from Aids-related illnesses in sub-Saharan Africa.

Despite the two billionth bed net being distributed to prevent malaria infections, Covid-19 disruptions can double malaria deaths on the continent.

For tuberculosis, the predictions are even more worrisome. The Global Fund predicts that treatment and prevention services can erase five years of progress on TB, especially worsening it over the next five years. Just a three-month lockdown can lead to 6.3 million more cases and 1.4 million deaths worldwide. 

Stall in TB diagnoses

While the increase of mask-wearing and physical distancing is expected to reduce some transmission of the respiratory ailment, the World Health Organisation (WHO) has estimated that there will be in excess of 130 000 TB deaths due to Covid-19. 

"We know that there are fewer TB tests being performed and less TB diagnosed," says Professor Keertan Dheda, director of the Centre for Lung Infection and Immunity at the University of Cape Town and a leading tuberculosis expert.

"There are many factors to consider, including possible reduced transmission, but also the increased impact of poverty due to the economic impact of Covid-19. Exactly how it will pan out will only become apparent later on. However, my expectation is that gains will be lost."

In South Africa, the number of tests requested has dropped by 50%, while the number of confirmed TB diagnoses has dropped by 33%, according to Dheda. Research and screening have also been put on hold as resources have been redirected to find and battle Covid-19.

READ | Evidence mounts that TB vaccine might help protect against Covid-19 

Need to actively find TB cases

One of the biggest problems with TB is that people generally appear to be well and have minimal symptoms. It is, therefore, imperative to actively screen for the disease through health community programmes.

Dheda has argued for this recently in a study published in Nature Medicine, where a mobile testing facility had an extremely high TB detection rate of 10% while screening more than 5 000 individuals and target investigating around 600 patients.

"Delaying the diagnosis would result in progressive and more severe lung damage, greater onward transmission of TB to those who are exposed, and increased risk of death.

"More advanced disease – down the line when the diagnosis is made – would mean less chance of an uncomplicated recovery," says Dheda.

Another Covid-19-related issue that might crop up is the BCG vaccine and its potential to combat the coronavirus. The TB vaccine is given to babies to help prevent infection and it is mandatory in South Africa.

Some studies have claimed that countries with mandatory BCG programmes are fighting Covid-19 infection and severity better than those that don't have it, which might lead to a shortage in countries where it is needed most as other richer countries stock up.

READ | Covid-19: Lockdown takes heavy toll on SA's TB response 

Don't forget prevention programmes

The best way to fight TB is through prevention, and it remains important to keep education and awareness programmes running despite a pandemic.

This includes anti-smoking campaigns – one of the leading causes of TB – improving detection of TB cases through e-health initiatives and increasing preventative therapy in HIV-positive people, who are also at high risk of the disease. 

"TB is the most common cause of death in South Africa at almost 60 000 deaths per annum," says Dheda. 

"I would support a daily TB dashboard like we have for Covid-19, as in the long term TB will cause far more deaths and cause us greater economic harm than Covid-19." 

Increased malaria deaths

Just like TB, prevention is also key in eradicating the deadly mosquito-borne disease, malaria.

According to an analysis by the WHO, 26 out of 46 countries in sub-Saharan Africa are due for an insecticide-treated nets campaign in 2020. If these programmes aren't implemented this year, malaria cases and deaths will increase by up to 10% even if proper treatment is maintained at current levels.

But if treatment is disrupted by 75% across the continent, the analysis predicts that by the end of the year there could be an estimated 769 000 malaria deaths, the majority of which would be children under the age of five. 

In South Africa, this scenario would result in a 100 to 150% increase in malaria deaths.

This can also be exasperated by the shortage of hydroxychloroquine, a malaria drug that was co-opted by certain political leaders as a "cure" for Covid-19 despite studies saying the opposite. 

READ | Covid-19: What's happening with hydroxychloroquine?

SADC's malaria situation

Right now, our country and its fellow Southern African Development Community (SADC) neighbours have already seen an increase in malaria cases and deaths in 2020 compared to the previous year, according to Professor Tiaan de Jager, Dean of Health Sciences at the University of Pretoria and director of The Centre for Sustainable Malaria Control.  

"Malaria annually affects millions of people, and puts strain on the poor health care infrastructure in especially sub-Saharan Africa," says De Jager.

"The Covid-19 pandemic is contributing to the strain. WHO has requested that malaria-endemic countries do not scale back on any planned malaria prevention, diagnostic and treatment activities. These activities help manage the strain on the healthcare systems." 

Elimination strategies stalled

The region has an ongoing initiative – the SADC Elimination 8 (E8) – which aims to eradicate malaria with its member countries, including South Africa. Its goal was to eliminate malaria completely in Namibia, Botswana, South Africa and Eswatini by this year, but these countries saw an incline in cases after 2017, reversed again in 2018, according to its latest report.

Six of the eight have already reported increases in malaria cases this year, and the first quarter report of the year stated that lockdowns have limited or even prevented surveillance teams' ability to investigate and detect malaria cases.

Malaria season starts soon

The pandemic's interruptions will become especially acute in South Africa as malaria season starts up again in September in the northern parts of the country.

De Jager urges everyone in high-risk areas, including parts of KwaZulu-Natal, Mpumalanga and Limpopo, to be vigilant when it comes to mosquito bites, especially because Covid-19 and malaria have similar symptoms.

"Malaria is both preventable and treatable, and prevention is better than cure. Most important is to seek medical diagnosis and treatment as quickly as possible if you think you may have contracted malaria," adds De Jager.

Even when numbers of Covid-19 cases start declining, it's clear that we will be feeling its effects for years to come through these diseases that have lived with us for longer, and will be staying with us for years to come, beyond the pandemic.

READ MORE | Malaria still kills 1 100 a day. It can't afford to lose resources to coronavirus

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