Initial expectations of existing TB and HIV patients being at high risk for COVID-19 were pleasantly dashed
“Initially we were very apprehensive that we were going to have more mortality,” Dr Asha Frederick, Joint Director of Medical & Rural Health Services (TM) who is part of the National Tuberculosis Elimination Programme’s Tamil Nadu TB Cell, admitted to The Lede.
Her patients already had lung disease – tuberculosis. COVID-19 attacks the lungs primarily. It seemed to be a cocktail for disaster.
“But we are all surprised,” said a relieved Dr Asha.
Relieved too, at least cautiously so, is Dr R Sridhar, Superintendent of the Tambaram Sanatorium, the hope for multitudes of tuberculosis patients in Chennai, Kanchipuram and surrounds.
“What we have observed so far is that in those patients who are on treatment for TB and those who are known HIV, the COVID incidence is not alarming, it is very minimal,” said Dr Sridhar. “There is no significant association between TB and COVID as of now.”
As per data available with the State TB Cell, the total number of tuberculosis patients in the registry in the first quarter of the calendar year (January to March) was 40,807. Of these, 27,809 were notified as new patients.
In the second quarter (April to June), the total number of TB patients notified was 11,997.
A day ahead of World TB Day which falls on March 25, the country went into lockdown. “On March 24, I was talking on Doordarshan about World TB Day. And I was telling them in those days we used to have the pox so people had to do social distancing. We used to do home quarantine when anyone had chicken pox. During flu seasons, we tell TB patients to be home quarantined,” recounted Dr Asha.
So home quarantine had to be exercised yet again for TB patients and this time, it had to be strictly adhered to.
“Myself and Dr Senthil Raj (Mission Director) - we immediately drafted a protocol – two months worth of medicines to all TB patients were packed and sent. We sent medicines from Chennai to all other districts too. The Centre asked us to do this until April but we decided to provide medicines for an extra month anyway,” she said.
Dr Asha’s team then began calling up existing tuberculosis patients and checking up on their health and symptoms over phone.
“We requested those patients who came to hospitals with SARI (Severe Acute Respiratory Illness) to be tested not just for COVID-19 but also to test them for TB.
After a patient was discharged, if they were still symptomatic, we asked for sputum and tested for TB. This was conducted in Trichy and some other places.
We also got 14 X-Ray vans sanctioned by the government in May. We then began calling patients in blocks where the vans went and told them where the vans would be parked and to go to these vans if they had symptoms of COVID-19. In May and June we were doing this in five districts. Post this, we gave the vans to the health authorities for generic COVID-19 testing,” she added.
So far, Dr Asha’s team has called nearly 9500 known tuberculosis patients in the state. As on date, 86 TB patients have tested positive for COVID-19 out of the 3276 who took the test.
Dr Sridhar’s data from the Tambaram Sanatorium tells a similar tale. And the pleasant surprise extends to HIV patients as well.
“We have managed more than 1000 cases of COVID in the hospital to date,” said Dr Sridhar. “Patients who are on TB treatment or who have had TB in the past – less than 5% of these patients tested positive for COVID-19.
As for HIV positive patients, we had been in regular touch with them over phone to monitor treatment. Only six out of about 3900 patients who are on anti-retroviral therapy (ART) had tested positive for COVID,” he said.
“As you can see, it (COVID-19 infections) has not been very dramatic. It is not in alarming figures,” said Dr Sridhar.
The answer to this from both doctors is – We are not sure what exactly worked.
“The one possibility is that HIV positive patients are already on anti-retroviral drugs like tenofovir, lamivudine, dolutegravir, which might play a role,” said Dr Sridhar.
Dr Asha agrees.
“There is no scientific evidence for what has worked. For sensitive TB, we prescribe four medicines – isoniazid, rifampicin, pyrazinamide and ethambutol. There is no scientific evidence that these act against COVID-19. The only plausible explanation is that when we treat with medicines, the patient’s immunity is enhanced. We don’t know what is working,” she said.
Both doctors though caution that it is still early days yet and rejoicing is still a few months away.
“We have to wait and watch what happens when TB patients come out into the society and start interacting with people. It is still early days,” she said.
“When public transportation opens up, we may be in a better place to say whether tuberculosis patients have COVID or not,” said Dr Sridhar. “This is because many of them may not have access to reach the Sanatorium. Right now, all of this is a hypothesis,” he said.