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Opinion Tuberculosis deaths are rising again — and covid is to blame

A relative adjusts the oxygen mask of a tuberculosis patient at a hospital in Hyderabad, India, on March 24, 2018. (Mahesh Kumar A./AP)

The global pandemic has already killed a population larger than that of Los Angeles, but the 4.8 million deaths so far are not all. The knock-on effects of covid-19, which are becoming more and more evident, will be far greater in loss of life and well-being. The latest evidence: Estimated deaths from tuberculosis increased last year for the first time in more than a decade, and more cases went undetected and untreated.

What’s happening is that covid is squeezing out or putting immense pressure on health care around the world for all other maladies. When hospital wards and clinics are full and turn people away, and when routine children’s vaccines are postponed, they are an indirect casualty of the pandemic but no less a result of it.

Before the coronavirus, tuberculosis was the world’s leading cause of death from a single infectious agent, taking more lives each year than HIV/AIDS and malaria combined. But tuberculosis is also curable and preventable, caused by a bacillus, Mycobacterium tuberculosis, and spread when people who are sick expel bacteria into the air, usually by coughing.

A key indicator is the number of people newly diagnosed with the disease and reported. This fell from 7.1 million in 2019 to 5.8 million in 2020, back to the level of nine years ago. It means there is a widening gap of people who have the disease but are not detected or treated; fewer people are getting checked out and more are staying away from health-care systems overloaded with pandemic patients. Overall, 10 million people are estimated to have developed tuberculosis last year. The World Health Organization says that only 16 countries accounted for 93 percent of this shortfall in cases diagnosed and reported, with India, Indonesia and the Philippines most severely affected.

With reduced access to diagnosis and treatment, deaths are on the rise. The WHO’s annual tuberculosis report, released Thursday, estimates that last year there were 1.3 million deaths, marking a return to the 2017 level and the first year-on-year increase since 2005. Also worrisome is that treatment for drug-resistant tuberculosis fell, as well as preventive treatment. Global spending on tuberculosis diagnostics, treatment and prevention declined, too.

The tuberculosis story is almost certainly going to be repeated with other global health campaigns, including the fights against polio, malaria, HIV/AIDS and more. The WHO and UNICEF report that 23 million children missed out on basic vaccines through routine immunization services last year, which is 3.7 million more than in 2019. Most of these, up to 17 million children, probably did not receive a single vaccine during the year.

The pandemic tears at the fabric of life well beyond those infected with the virus. When and if covid subsides, those suffering these other diseases will await — and deserve — a major effort at treatment and attention.

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