key: cord-268424-5c6edaw8 authors: Behera, D. title: Tb Cotrol In India In The Covid Era date: 2020-08-28 journal: Indian J Tuberc DOI: 10.1016/j.ijtb.2020.08.019 sha: doc_id: 268424 cord_uid: 5c6edaw8 TB Control in India in the COVID era. COVID-19 pandemic has disturbed the delivery of health care in almost all countries of the world. This has affected mostly the public health control programs. Because of lock downs, restrictions in movement, psychological fear of contacting the disease in health care facilities, diversion of health care workers for containment and management of COVID-19, utilization of diagnostic facilities like CBNAAT machines for COVID work, conversion of hospitals for care of these patients, financial diversion etc has created issues in the NTEP to focuss on TB control in India. Case notification and other areas of the program to achieve End TB by 2025 have suffered. Various ways of overcoming these difficulties have been discussed. The COVID-19 pandemic caused by the novel corona virus, severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), has upset the major public health care system throughout the world. Globally, by 3 rd July 2020, there have been 10 (1) . The COVID 19 pandemic has placed unprecedented demands and pressure on the health system. Health facilities and workforce are diverted and assigned a wide variety of activities related to controlling the outbreak. In doing so, other essential health services would be severely compromised. It is likely that seeking health care may be deferred because of social/physical distancing requirements or community reluctance owing to perceptions that health facilities may be infected., Continuing to provide essential services, while focusing on COVID 19 related activities, is important not only to maintain people's trust in the health care delivery system (2), but also to minimize an increase in morbidity and mortality from other health conditions. During the Ebola outbreak in 2014-15, increased number of deaths was caused by measles, malaria, HIV/AIDS and tuberculosis because of failure in the health system and that exceeded deaths from Ebola itself (3, 4) . Prevention and treatment services for noncommunicable diseases (NCDs) are affected severely since the pandemic began. A WHO survey completed by 155 countries during a 3-week period in May 2020, confirmed that the impact is global, but low-income countries are the most affected (5 showed that 8 out of 69 (11.6%) patients died. Most of them were young migrants. It was noted that mortality was more in elderly patients with co-morbidities; TB was not a major determinant of mortality and migrants had lower mortality due to younger age and lower number of co-morbidities. However, the authors postulated that in settings where advanced forms of TB frequently occur and are caused by drug-resistant strains higher mortality rates can be expected even in young individuals (17) . In another small series of 20 TB patients (18) facilities that were not Ebola treatment units but were national hospitals and peripheral health units that were unprepared for receiving patients with EVD. In all these countries, the disruption to TB services due to the EVD epidemic would have increased Mycobacterium tuberculosis transmission, TB morbidity and mortality, and decreased patient adherence to TB treatment, and the likely impact will not be known for several years to come. Many other aspects of the dual disease have been described by different authors (22) (23) (24) (25) (26) (27) (28) (29) . The COVID-19 pandemic will impact existing and well-performing public health programs including the tuberculosis (TB) control programs (30) . There is likely to be grave consequences for the existing and yet to be diagnosed TB patients, more so in low and middle income countries (LMICs) where TB is endemic and health services are not well equipped. TB control programmes will be under severe strain due to diversion of resources, loss of focus with increased attention of COVID-19 care, constraints due to overutilization of laboratories meant for TB work, issues related to availability of TB care workers, restriction of movements of patients and contacts etc with DR-TB centres being diverted for COVID related work because of change in the priorities of health care delivery. This is going to lead to a reduction in quality of TB care and poor outcomes. The Government of India has already made these arrangements of diverting the man power and use of CBNAAT machines for COVID work. This is an enormous challenge for the Governments and societies for ensuring that the pandemic has the least possible impact on key health programs that will need continued close monitoring. 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