Tuberculosis at the time of Coronavirus disease (COVID-19) lockdown - Back to the days of yore!!!

Background: The coronavirus disease (COVID-19) pandemic and the lockdown imposed due to it have served as a major setback to tuberculosis (TB) control. We therefore conducted this study to assess the profile of TB patients presenting to our department immediately after COVID-19 lockdown, which was imposed in India from 24 March 2020 and continued for >3 months, and to compare it with the pre-pandemic pattern. Methods: This was an observational study conducted at the pulmonary medicine department of our tertiary care institute. We evaluated the consecutive cases of TB referred to or diagnosed new by our department as soon as the lockdown was lifted and non-COVID services resumed. The data of 2020 and 2019 during September and October month were gathered and analysed retrospectively. Results: A total of 162 patients were hospitalised from September to October 2019, while 40 non-COVID patients were hospitalised during September to October 2020 in our unit. The mean duration of symptoms was 1 month in both the groups. The incidence of TB cases amongst the patients needing hospitalisation after lockdown was more in 2020 [57.5%; 23 diagnosed TB cases (12 males and 11 females) out of 40 non-COVID hospitalised cases] than in 2019 [13.5%; 22 diagnosed TB cases (13 males 9 females) out of 162 hospitalised cases], and this was statistically significant (chi-squared test: p < 0.00001). There was a statistically significant increase in transfers to the TB hospital where patients requiring further long-term medical care were referred to; in 2020 (12.5%; 5 out of 23 diagnosed TB cases) as compared with those in 2019 (0 out of 22 diagnosed TB cases) (p = 0.049, Fischer’s exact test). There was a statistically significant increase in the duration of hospital stay in 2020 than that in 2019 (p = 0.0076, unpaired t-test). There was no statistical difference in occurrence of pulmonary versus extrapulmonary TB (EPTB) or in occurrence of complications of TB in the two years. Conclusion: The COVID-19 pandemic and its lockdown have skewed the profile and pattern of the clinical manifestations and the complications of TB with a more severe trend.