mid-day special: Mumbai sees few casualties among those with both TB and COVID-19

Updated: 16 October, 2020 07:16 IST | Arita Sarkar | Mumbai

Doctors had expected TB patients to be among the worst hit by COVID, but say they have seen a low number of such cases

A separate ward was set up at the Sewri TB hospital for patients who have both TB and COVID-19
A separate ward was set up at the Sewri TB hospital for patients who have both TB and COVID-19

During the pandemic, while symptoms like cough and fever are being flagged as suspected cases of COVID-19, city doctors are also dealing with cases where patients who test positive for the virus, are also suffering from tuberculosis (TB). However, experts say the number of such cases are fewer than expected. Since March, there have been 135 cases of COVID-19 and TB together, many of which were new detections.

Since both diseases are communicable, majority of the patients with both COVID and TB were treated at the Sewri TB Hospital, where a separate ward was set up for such patients a few months ago. Dr Lalitkumar Anande, medical superintendent of Sewri TB hospital, said that the ward has a capacity of 60 beds where roughly half the patients are COVID positive while the other half are suspected cases. "Many healthcare workers had also tested positive, and as the references started coming in, we had more patients suffering from COVID and TB," he said.

So far, more than 120 COVID patients have been treated at the Sewri TB hospital. Officials from the civic health department said that among the 135 confirmed cases of COVID and TB, 18 died.

Doctors maintain that while they had expected TB patients to be among the worst hit by COVID, they have seen a low number of such cases. Dr Vikas Oswal, a chest physician who has been treating patients in TB hotspot areas like Shivaji Nagar, Govandi and Mankhurd said hardly any TB patients have been infected by COVID. "We have seen an overlap between the two diseases, but they are fresh cases of both TB and COVID, and most have mild symptoms. The TB patients who are on treatment are largely not contracting COVID, and it may have something to do with host immunity," he said. Dr Oswal added that out of 8,000 TB patients in M East ward only around eight have tested positive for COVID.

Key factors for diagnosis

Since COVID and TB both have symptoms like cough and fever, doctors say the duration of their symptoms and the part of the lung that is infected are two key factors during diagnosis. Dr Rajendra Nanavare, a chest physician who deals with drug resistant TB cases has seen four cases of TB with COVID in the past six months and all of them were new detections. "The patients had come thinking that they had COVID and after examining their X-Rays, they were diagnosed with both COVID and TB. While the symptoms are the same the duration of the onset differs and while it's slow in TB, in COVID, symptoms show within a week," he said.

BMC staff conduct an antigen test on a Mumbai police personnel at Police Colony in Ghatkopar East.
BMC staff conduct an antigen test on a Mumbai police personnel at Police Colony in Ghatkopar East. 

Dr Nanavare explained that patches seen in the upper part of the lung indicate TB while infection in the lower part is a sign of COVID. These patients had patches on both parts of their lungs. Patients are first treated for COVID while their sputum is sent for culture reports. While the use of Remdesivir and Tocilizumab is common while treating severe COVID patients, some doctors feel that high doses of vitamin C and D3 have been effective as well. Dr Anande said that he hasn't used Remdesivir or Tocilizumab to treat COVID patients. "We have given doxycycline (used for treating respiratory infections), the maximum dose of vitamin C besides other medications, and glutathione (used in anti-aging creams) and patients have responded very well to the treatment," he said.

Also Read: Amid pandemic, battle against tuberculosis regains ground

'Need to monitor patients'

Pulmonologist Dr Lancelot Pinto, of Hinduja hospital pointed out that since TB medication is metabolised by the liver, and drugs like Remdesivir can cause liver damage, doctors have to monitor patients with COVID and TB closely. Dr Pinto highlighted the need of isolating such patients from other TB patients. "One has to ensure that there is no cross infection and the patient doesn't infect others with TB," he said. Following the directions issued by the Central TB Division last month, the civic body issued a circular on October 6 to all the medical health officers of 24 wards asking them to carry out bi-directional screening of TB-COVID patients. In the circular, executive health officer Dr Mangala Gomare stated that district TB officers will have to ensure that all COVID patients are telephonically screened for symptoms like a cough and fever that lasts longer than two weeks, weight loss of more than 10 kgs and night sweats.

Another police staffer is tested at Pantnagar police station, Ghatkopar PICS/Sayyeed Sameer Abedi
Another police staffer is tested at Pantnagar police station, Ghatkopar Pics/Sayyeed Sameer Abedi

After identifying such patients, their sputum will be collected for tests. Similarly, all TB patients (newly diagnosed or those on treatment) will be screened and tested for COVID symptoms. Community health workers roped in for the My Family, My Responsibility campaign have also been asked to inquire about TB symptoms during the survey.

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First Published: 16 October, 2020 07:05 IST

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