Doctors stress the need to track migrants who left without following up on their TB treatment, and check on use of steroids
The guideline was to advise COVID patients to check themselves for TB if cough persists for two to three weeks. Representation pic
While the Union Health Ministry has issued directives asking health experts to check on Tuberculosis amid persistent coughs, health experts have welcomed the move, stating that TB cannot be ignored amid the Covid-19 pandemic and it has always been a major silent killer in India too. Recent data published by WHO also highlights the concern globally.
mid-day was the first to highlight the issue of a tuberculosis outbreak amid the pandemic in an article on June 25, 2020, wherein thousands of migrant workers had to quit taking their multidrug resistant (MDR) TB medicines midway due to the lockdown, increasing the spread of TB in remote villages and rural india.
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Dr Wiqar Shaikh, professor of Medicine, Grant Medical College and Sir J J Group of Hospitals, has welcomed the new guidelines from the Ministry of Health. The new guidelines say that there is no evidence for the use of injectable steroids in patients who do not require oxygen supplementation or continuing steroids after the patient has been discharged.
Agreeing with this, Dr Shaikh said that, on the contrary, the indiscriminate use of steroids should certainly be discouraged. He recalled that the extensive use of steroids during the first two waves had resulted in a massive surge in the number of cases of fungal infections, also called mucormycosis. Dr Shaikh said that the guideline was to advise Covid patients to check themselves for TB if cough persists for two to three weeks.
He said that WHO said in 2019, 7.1 million people were diagnosed with TB and in 2020, the figure fell to 5.8 million. WHO estimated that currently, 4.1 million people suffering from TB have not been diagnosed or have not reported to the authorities. He said that India has the highest number of patients suffering from MDR TB as well as deaths.
Chronic cough new dilemma
“Since the Covid-related nationwide shutdown in March 2020, most migrants returned with their families to their native places. This was evident in Mumbai in crowded slum settlements of Dharavi where almost 80 per cent of migrants moved out. Tens of thousands of migrants who were on TB-DOTS and MDR TB treatments returned to native places without following up on treatment… The public health experts are concerned that major pandemics of HIV/AIDS, TB, malaria, reproductive infections, preventable childhood immunisations etc have suffered immense damage, and the people need to be rehabilitated to prevent upsurge in cases of TB and other infectious diseases,” said Dr Subhash Hira, professor of Global Health at University of Washington-Seattle, and advisor to WHO-TDR-Geneva.
‘Stay hydrated’
“Cough is one of the most common symptoms of post-Covid syndrome. Fatigue, dyspnoea, pain, and so-called brain fog (cognitive impairment, including confusion and memory loss) are associated accompaniments. Usually, it subsides with time. However, if it persists beyond three weeks then a pulmonologist consultation is advisable to rule out other causes such as TB and COPD, especially when the patient is diabetic and on steroids. Simple measures may be very helpful in controlling cough such as adequate hydration with warm water and soups, periodic steam inhalation, lying on one side,” said Dr Ketan Vagholkar, professor of surgery attached to D Y Patil Medical College.
‘Screen those who missed TB treatment’
“TB was a major health concern in India even before the pandemic. Many workers and poor people who went to their hometowns in the lockdown were taking TB medicines from government centres. Now since they are coming back to the city. Again, we must screen them about their TB status and see if they continued their treatment. If we lose track of them, TB can spread to others,” said Dr Santosh Bansode, Head of the Department, Emergency Medicine, Wockhardt Hospitals, Mumbai Central. Dr Lalitkumar Anande, Medical Superintendent at Sewri TB Hospital, a wizard, who has dedicated his experience of over three decades handling only TB cases, expressed similar concern and said, “Many migrant workers, who were under treatment for TB and have left the city, carry a high risk of spreading the same in the state they have headed to. If they are not traced and given medication, they may slip into MDR-TB.”
‘Boost immunty naturally’
“The pandemic has brought the immunity of the most vulnerable humans to the lowest edge, who are already stressed out mentally due to issues at both personal and professional front. And the Mycobacterium (mtCP), known for causing tuberculosis, usually is a silent killer; it attacks the human body, when the immunity level falls. The spread of tuberculosis has already become rampant, and we are now coming across new mutants of TB including the Beijing strain, which only indicates that more and more research needs to be done,” said Dr Anande. When asked about the promise to eradicate TB from the country by 2025, Dr Anande said, “It is the vision of our country’s prime minister and it could be accomplished, provided collective efforts are pumped into the said direction.”
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