Covid-19 related lockdown may potentially lead to two lakh additional TB cases in India with an estimated over 87,000 deaths in 2020. The projections are made in a study - ‘The potential impact of Covid-19 response related lockdown on TB incidence and mortality in India’ published in Indian Journal of Tuberculosis.

“We estimate a potential excess of nearly 186,000 new cases and 87,000 additional TB deaths in light of worsening poverty, undernutrition, disruption of TB services and suggest key measures that should be implemented to prevent this disaster. The article also mentions figures indicating the sharp decline in case detection as a result of the lockdown with the corresponding period last year,” said Anurag Bhargava, Professor (Medicine) in Yenepoya Medical College, Mangalore and co-author of the study.

Estimated annual incidence of TB in India considered in study is 26 lakhs. According to the latest report of the Ministry of Health and Family Welfare, in 2019, only nearly 24 lakh TB patients could be registered.

Govt estimates on TB case detection

As per government’s own admission, there is 59 per cent reduction in TB case detection between end March and May 2020, vis a vis the pre-lockdown period between January 29 to March 24. The 8-week-period lockdown data has been extrapolated by the authors to calculate subsequent increase in cases and deaths.

States like Uttar Pradesh and Bihar are the worst hit with under detection spiking up to 73 per cent, while states like Gujarat, Madhya Pradesh, Tamil Nadu, Andhra Pradesh too had under detection levels between 60 to 69 per cent, way above the national average.

The authors have argued that undernutrition which is a known cause of TB was aggravated by the lockdown. In 68 days of lockdown even a calorie deficit of 250 calories per day could potentially lead to two kilo weight loss in two months, since one kilo weight loss corresponds to a caloric deficit of 7500 calories, they have stated.

The centre has suggested that additional free rations of five kilo cereal per head and one kilo pulses per family per month should be provided. But the study argues that this quantity is inadequate to fulfil calorific and nutritional needs of a family. “The pulse ration amounts to eight gram of pulses per day in a four member household, and these allocations are unlikely to supply adequate calories, proteins and micronutrients in poor households.” the study argues.

“Some migrant workers underwent even greater calorie deprivation and in fact had to increase their activity too in the attempts to reach home, and may have experienced greater weight loss.

Assuming that half of TB is related to undernutrition and poverty and caloric deficits which may vary between 250 and 500 calories a day over two months of lockdown, we can assume an increase in incident TB by 185610 cases in a worst scenario,” the study further says.

“Benefits of Covid-19 response related to social distancing on reducing TB deaths are likely to be outweighed by health service disruption. In India an additional 1,49,448 TB deaths have been predicted during 2020-24,” the paper further says.

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