key: cord-0786743-6kxv1hlv
authors: Chopra, K.K.; Matta, S.; Arora, V.K.
title: Impact of COVID- 19 and Tobacco on TB control
date: 2021-08-25
journal: Indian J Tuberc
DOI: 10.1016/j.ijtb.2021.08.012
sha: 3833241c6332cf43bd94670fe2d0a04ddce057fd
doc_id: 786743
cord_uid: 6kxv1hlv

nan

The prevalence of TB among COVID-19 patients has been found to be 0.37 to 4.47% in different studies. There has been an overall decline in TB notification by 26% during January to June 2020 as compared to previous year, due to the COVID-19 pandemic 1 . In nine countries with a high tuberculosis burden, which contribute 60% of the world's tuberculosis cases, its diagnosis and treatment declined by 23%, meaning thereby to 1 million missed cases. 2 Another high risk factor for TB is smoking. As per studies smoking has been associated with impaired lung function, reduced immunity and making it harder for the body to fight off various diseases.

Other tobacco products like e cigarettes, smokeless tobacco etc can increase risk and severity of pulmonary infections because of damage to upper airways and a decrease in pulmonary immune function. 3

Worldwide, approximately 1.3 billion people currently smoke cigarettes or use other tobacco products, with more than 900 million tobacco users living in developing countries 4 . Global prevalence of smoking is 29% (47.5% for men and 10.3% for women over 15 years of age). Tobacco use is the second major cause of death in the world. Available data suggests that smoking kills half of all lifetime users and half of those die in middle age (35-69 years) and is responsible for the death of one in ten adults worldwide. Every 6.5 seconds, one tobacco user dies from a tobaccorelated disease somewhere in the world 5 . If action is not taken to curb the spread of tobacco use, annual deaths are expected to reach 8.3 million by 2030, of which more than 80% will be in developing countries 6 . As per research, smoking may increase the chance of adverse health outcomes for J o u r n a l P r e -p r o o f COVID-19 patient when compared with non smokers .Another study concluded that Current smoking status was associated with a lower risk of developing Covid-19 but cannot be considered as an efficient protection against infection. 7 Alternatively another study concluded that Tobacco use in all forms, whether (smoking / chewing) is significantly associated with severe COVID-19 outcomes 8 . Smoking is a known risk-factor for many other respiratory infections, including colds, influenza, pneumonia and tuberculosis. Smoking has been associated with increased development of acute respiratory distress syndrome, a key complication for severe cases of COVID-19 , among people with severe respiratory infections .Any kind of tobacco smoking is harmful to bodily systems, including the cardiovascular and respiratory systems and this has been supported by other studies 8 . COVID-19 can also harm these systems. Data from China shows that people who have cardiovascular and respiratory conditions caused by tobacco use, or otherwise, are at higher risk of developing severe COVID-19 symptom. As per a research report on 55,924 laboratory confirmed cases show fatality rate for COVID-19 patients is much higher among patients with cardiovascular disease, diabetes, hypertension, no preexisting chronic medical conditions . This concluded that pre-existing conditions may increase the vulnerability of such patients to Although experience on COVID-19 infection in TB patients is limited, it is presumed that people ill with both TB and COVID-19 may have poorer treatment outcomes 5 , especially if TB treatment is interrupted. Diabetes, geriatric age group and chronic obstructive pulmonary disease (COPD) have been linked with severe COVID-19. They are also risk factors for poor outcomes in TB. TB patients should take precautions to be protected from COVID-19 and continue their TB treatment as prescribed.

Research models suggest 5 that COVID-19 pandemic has led to a global reduction of 25% in expected TB detection for 3 months, hence a 13% increase in TB deaths are expected. This brings us back to the levels of TB mortality that we interrupted. Both the diseases (COVID-19 and TB) have the capacity to stress health systems, they are airborne transmissible diseases, can be diagnosed rapidly (although implementation of rapid testing is not yet available in all settings), they cause stigma and need public awareness and cooperation to allow prevention, diagnosis and treatment to be effective. Although surveillance is able to report on TB, in many countries, information on COVID-19 is still incomplete .Information on TB do not contain many clinical parameters, that would help understand the interaction between the two diseases. COVID-19 pandemic has also led to a significant drop in TB notifications 10,11 .

Quitting smoking helps lungs and heart to work better from the moment it is stopped. Elevated heart rate and blood pressure drop within 20 minutes of quitting and after 12 hours, carbon monoxide level in the bloodstream drops to normal. In 2-12 weeks, circulation improves and lung function improve. After 1-9 months, coughing and shortness of breath decrease. WHO propagates interventions like tollfree quit lines, mobile text-messaging cessation programmes, and nicotine replacement therapies (NRTs), among others, for quitting tobacco use. Measures must be implemented to limit transmission of TB and COVID-19 Administrative, environmental and personal protection measures must be adopted for both diseases.

Provision of TB preventive treatment should be maintained. Tests for TB and COVID-9 are different and both should be made available for individuals with respiratory symptoms, which may be similar for the two diseases. Testing of the same patient for both diseases should generally be indicated for three main reasons, subject to the specific setting in each country: clinical features that are common to both diseases, simultaneous exposure to both diseases and presence of a risk factor.

As the pandemic advances, more people of all ages, including TB patients, will be exposed to COVID-19. Simultaneous testing for the two diseases via cross referral between Covid screening centres and TB screening centers should be encouraged. People-centred outpatient and community-based care should be strongly preferred over hospital treatment for TB patients (unless serious conditions require hospitalization) to reduce opportunities for transmission. Anti-TB treatment must be provided for all TB patients, including those in quarantine and those with confirmed COVID-19 disease. Adequate stocks of TB medicines should be provided to all patients to reduce trips to collect medicines. Use of digital health technologies for patients and programmes should be intensified. Technologies like electronic medication monitors and video-supported therapy can help patients complete their TB treatment.

To conclude, both TB and Covid 19 are respiratory infection with same mode of transmission, similar symptoms and risk factors, although COVID 19 has shorter incubation period. Tobacco usage, specially smoking is a common risk factor for both diseases. At the same time both diseases causes a significant negative effect on our health system. Quitting smoking not only helps in preventing disease complication but also helps in overall health of community at large.

The prevalence of TB among COVID-19 patients has been found to be 0.37 to 4.47% in different studies. There has been an overall decline in TB notification by 26% during January to June 2020 as compared to previous year, due to the COVID-19 pandemic 1 . In nine countries with a high tuberculosis burden, which contribute 60% of the world's tuberculosis cases, its diagnosis and treatment declined by 23%, meaning thereby to 1 million missed cases. 2 Worldwide, approximately 1.3 billion people currently smoke cigarettes or use other tobacco products, with more than 900 million tobacco users living in developing countries 4 . Global prevalence of smoking is 29% (47.5% for men and 10.3% for women over 15 years of age). Tobacco use is the second major cause of death in the world. Available data suggests that smoking kills half of all lifetime users and half of those die in middle age (35-69 years) and is responsible for the death of one in ten adults worldwide. Every 6.5 seconds, one tobacco user dies from a tobaccorelated disease somewhere in the world 5 . If action is not taken to curb the spread of tobacco use, annual deaths are expected to reach 8.3 million by 2030, of which more than 80% will be in developing countries 6 .

Internation union against TB and lung diseases/ WHO,The Union monograph on Tb and tobacco control

Impact of Tobacco Smoking on the risk of COVID-19.A large scale retrospective cohort study

Tobacco use as a well recognized cause of severe covid 19 manifestations. Respiratory medicine

Tuberculosis and COVID-19 interaction: A review of biological, clinical and public health effects

E-mail address: chopra_drkk@yahoo.co.in (K.K.Chopra)