A Tale of Two Pandemics: a plea on World TB Day 2020

UKAPTB members have co-authored an article in The Lancet Respiratory Medicine, comparing and contrasting the COVID-19 and TB pandemics. An abridged version of the article is below.

It is the worst of times. We are facing a pandemic.

A quarter of the world’s population is estimated to be infected. By the end of 2020, it is likely that 10 million people will have fallen ill, three million will not have been tested and treated, and over 1 million, mostly vulnerable people, will die.

This pandemic is not caused by the novel coronavirus, SARS-CoV-2, which leads to COVID-19.

It is caused by tuberculosis (TB).

On World TB Day, March 24 2020, and amid this unprecedented outbreak, we and others think it is vital to compare and contrast the TB and COVID-19 pandemics – one old, one new – to remind ourselves why it’s still time to end TB. We have written a related comment that has been published here in The Lancet Respiratory Medicine and made a video with LSTM’s Prof Sally Theobald and the ARISE and Slum/Shack Dwellers International (SDI) consortia giving practical COVID-19 advice tailored towards people in low- and middle-income countries with whom we need to increase our solidarity. Please feel free to share among your networks as necessary, the video is currently in the process of being integrated with the International Union Against TB and Lung Disease’s Covid-19 online guidance.

So what is a pandemic? A pandemic is defined as a disease that spreads over a whole country or the whole world. TB and COVID-19 both fit this definition, affecting people across all six continents. No country is TB free and COVID-19 has now reached more than 180 of the nearly 200 countries on the planet.

There are striking similarities between the two pandemics. Both are a huge cause of illness and death around the world. TB is the single biggest infectious diseases killer, ending the lives of 1.2 million people in 2018. This is more than HIV and malaria combined. COVID-19 has infected nearly 250,000 people and caused nearly 10,000 deaths in the first quarter of 2020 alone. Both cause symptoms of fever, cough and shortness of breath. In countries with escalating COVID-19 cases, this is likely to mean that people with TB presenting to clinics and hospitals may go unrecognised or misdiagnosed. A similar pattern emerged in West Africa when cases of malaria were missed during the Ebola outbreak. Another similarity is that those at higher risk of more severe TB and COVID-19 disease and outcomes are older people and those with chronic illnesses. And, as we are discovering for COVID-19, both diseases lead to significant social impact including stigma, discrimination, and isolation; and economic impact related to country productivity losses and catastrophic costs to individuals and households.

There are also stark differences, the first being time. TB has accompanied us for thousands of years even being found in Egyptian mummies. SARS-CoV-2, on the other hand, is a new coronavirus that has spread rapidly around the world since December 2019. TB, previously known as consumption or The White Plague, is used to being labelled a pandemic.

This is the first COVID-19 pandemic humankind has ever seen. Second, most children with COVID-19 will have only mild symptoms. The same cannot be said for TB, which in 2018 killed one in five of the 1.1 million children who became ill with TB. Finally, over 90% of TB cases and deaths occur in low- and middle-income countries. In contrast, Europe has been called the second epicentre of COVID-19 after China. Among other factors, this may explain why more funding and person-power will be put into the COVID-19 response in a year than TB has received in decades. However, modelling studies show us that vulnerable countries in sub-Saharan Africa and the Americas will soon be dealing with their own COVID-19 epidemics. We must all act together now to prevent a catastrophe.

There remain many unknowns. How TB and COVID-19 may interact is not understood. Put simply, TB rates could go up due to more people coughing due to COVID-19 who also have TB or go down due to self-isolation and quarantine. The risk factors for getting COVID-19 and having more severe disease appear to overlap and be similar to those for TB. These include being older, a smoker, male, having other chronic illnesses such as lung disease, and being poor. Undoubtedly, COVID-19, like TB, will be associated with the medical poverty trap, in which poorer people have a higher likelihood of infection, disease, and adverse outcomes. Also, unemployed people, informal or zero-hour contract workers, will experience further impoverishment, which increases TB risk.

The best of times would be to live in a COVID-19 and TB-free world. But this is a long way off and there is much to do. So, as we work together to control COVID-19, let’s not forget the ongoing TB pandemic; still the biggest infectious diseases killer. We need to markedly increase funding to strengthen healthcare systems to address TB and to support research for a vaccine, better tests and medicines, equitable access to care, and socioeconomic support for people affected by TB. We need to continue to inform, advocate for, and empower local communities and to lobby governments and policymakers, to ensure that TB, as well as COVID-19, remain high on the global agenda. The lessons we have been taught by pandemics, old and new, are to be proactive, long-sighted, to plan ahead, and to not become complacent.

Let’s look forward to the best of times.

World TB Day Symposium 2020 – booking now open

Image © Dr Mishal Khan, reproduced with permission

The running order and booking details for the popular annual World TB Day symposium have been announced.

The event will take place in central London on Tuesday, 24th March, coinciding with other activities worldwide.

UKAPTB members are involved in running the symposium, which provides the London tuberculosis community with the opportunity to gather and hear about the latest research in the fight against the world’s deadliest infectious disease.

Representatives from University College London, the London School of Hygiene and Tropical Medicine, the Francis Crick Institute and Birkbeck, University of London have been planning the programme to provide a wide range of talks to appeal to a diverse audience.

Tickets are free but early booking is essential. The symposium will also be streamed live; details will be published closer to the event date on the UCL-TB website.

To see the line-up and reserve your place, visit Eventbrite.

Reflections on World TB Day 2019

Three UKAPTB member organisations joined forces on 22nd March 2019 to host a World TB Day symposium featuring talks from a wide range of tuberculosis researchers.

The symposium attracted a packed house of over 300 attendees who came to hear over 20 speakers present and discuss their work. Now in its tenth year, the symposium, co-organised by UCL, LSHTM and this year’s hosts, the Francis Crick Institute, gives the TB community an annual opportunity to catch up on the latest research, and with each other!

2019’s symposium was further enhanced by a two-hour live link-up with the University of California San Francisco, including a lively transatlantic debate. Hundreds more who couldn’t get to London or San Francisco watched the live stream online and the recordings, along with the full programme, are available via the UCL-TB website.

Earlier that week, UKAPTB members took part in a reception held by the All Party Parliamentary Group on Global TB.

UCL’s Neil Stoker was among those who managed to attend both events. Neil has written a fascinating blog which summarises key messages and his personal reflections from the APPG-TB reception and London symposium.

TB research shared with MPs on LSTM visit

In November, UKAPTB member the Liverpool School of Tropical Medicine hosted a memorable visit from four Members of Parliament.

Three local MPs, Dame Louise Ellman (Liverpool Riverside), Angela Eagle (Wallasey) and Dan Carden (Liverpool Walton), were joined by All Party Parliamentary Group on Global TB co-chair Nick Herbert (Arundel and South Downs).

A full report of the visit is on the APPG’s website.  A recording of Nick Herbert’s lecture from the day is available here.

MPs visiting Liverpool institutions on 16th November to promote TB research

The co-chair of the All Party Parliamentary Group on Global Tuberculosis  and Global TB Caucus, Nick Herbert MP, and other local MPs (including Louise Ellman MP, Dan Carden MP, and Angela Eagle MP) will be visiting Liverpool School of Tropical Medicine (LSTM) on Friday 16th November 2018. Continue reading &raquo

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