The potential impact of the COVID-19 pandemic on the tuberculosis epidemic a modelling analysis

TLDR

Routine tuberculosis services are being disrupted by COVID‑19 lockdowns. The study aimed to estimate the long‑term epidemiological impact of these disruptions on TB burden in high‑burden countries and to identify ways to mitigate the negative effects. Mathematical models of TB transmission in India, Kenya and Ukraine were adapted to include lockdown‑associated disruptions, based on consensus from a rapid expert consultation, and used to project incidence and mortality over five years while evaluating potential interventions. The models predict that a 3‑month suspension of TB services followed by 10 months to restore normalcy could add over 1.2 million cases and 360,000 deaths in India, 25,000 cases and 12,500 deaths in Kenya, and 4,300 cases and 1,300 deaths in Ukraine, with undetected TB driving the increase, but rapid restoration and catch‑up case detection can substantially mitigate these effects.

Abstract

Routine services for tuberculosis (TB) are being disrupted by stringent lockdowns against the novel SARS-CoV-2 virus. We sought to estimate the potential long-term epidemiological impact of such disruptions on TB burden in high-burden countries, and how this negative impact could be mitigated.We adapted mathematical models of TB transmission in three high-burden countries (India, Kenya and Ukraine) to incorporate lockdown-associated disruptions in the TB care cascade. The anticipated level of disruption reflected consensus from a rapid expert consultation. We modelled the impact of these disruptions on TB incidence and mortality over the next five years, and also considered potential interventions to curtail this impact.Even temporary disruptions can cause long-term increases in TB incidence and mortality. If lockdown-related disruptions cause a temporary 50% reduction in TB transmission, we estimated that a 3-month suspension of TB services, followed by 10 months to restore to normal, would cause, over the next 5 years, an additional 1⋅19 million TB cases (Crl 1⋅06-1⋅33) and 361,000 TB deaths (CrI 333-394 thousand) in India, 24,700 (16,100-44,700) TB cases and 12,500 deaths (8.8-17.8 thousand) in Kenya, and 4,350 (826-6,540) cases and 1,340 deaths (815-1,980) in Ukraine. The principal driver of these adverse impacts is the accumulation of undetected TB during a lockdown. We demonstrate how long term increases in TB burden could be averted in the short term through supplementary "catch-up" TB case detection and treatment, once restrictions are eased.Lockdown-related disruptions can cause long-lasting increases in TB burden, but these negative effects can be mitigated with rapid restoration of TB services, and targeted interventions that are implemented as soon as restrictions are lifted.USAID and Stop TB Partnership.