key: cord-0849571-1x2a6chv authors: Migliori, Giovanni Battista; Tiberi, Simon; Duarte, Raquel title: Investigating the response to COVID-19 and understanding severe TB cases: the 2022 Pulmonology TB series date: 2022-02-08 journal: Pulmonology DOI: 10.1016/j.pulmoe.2022.01.018 sha: cb242029dbdb89bae6136f0cee7172555f4288e5 doc_id: 849571 cord_uid: 1x2a6chv nan Pulmonology was in the frontline of the fight against TB with its TB series published in 2018 [3] [4] [5] [6] [7] [8] [9] [10] [11] and in 2021 [12] [13] [14] , the latter focused on the COVID-19 pandemic and its relationship with TB. TB is essentially one of the main 'victims' of the COVID-19 pandemic, for several reasons including the direct interaction between the two diseases in terms of morbidity and mortality 12, [15] [16] [17] [18] [19] , the shifting of specialised staff from TB services to manage the COVID-19 emergency and the effects of fear on patients and staff, the impact of lockdown/social distancing measures and the re-organization of health services among others [20] [21] [22] [23] [24] . Importantly, the further perspective of this deadly interaction, including the potential risk of developing post-TB and post-COVID-19 sequelae hampering the quality of life and requiring rehabilitation services must be considered 12, [25] [26] [27] [28] [29] . The topic of the 2022 World TB day is "Invest to end TB. Save lives" 30 . Pulmonology is happy to contribute to the fight against TB by publishing three relevant articles, which complete what was done in previous years, by covering the area of health services organization and management of severe cases of TB. The first article of the series by Rodrigues I. et al. is aimed at investigating how infection control norms and standards were applied during the different waves of the COVID-19 pandemic in the out-patient centres in Portugal and globally, and how these centres, which are responsible for diagnosis, treatment, screening and prevention of TB responded during the pandemic 31 . The study is comprehensive and representative, and offers the possibility of reflecting on the need for health services to adapt in order to prevent further transmission of COVID-19 (but also of TB) while continuing to manage and control TB to prevent a future resurgence and increased mortality from the disease, a scenario which the World Health Organization has forecasted 1 . An area that is still poorly understood is how to optimise management of severe cases of TB with or without COVID-19, admitted to an Intensive Care Unit (ICU), given their challenging management and poor prognosis 32 . Pulmonology has previously published an interesting contribution from developing countries to create a simple score to predict which patients are likely to deteriorate and die rapidly if not transferred to ICU 33 . The second paper of the Pulmonology TB series 2022 is a systematic review by Galvin J. et al. which investigated 529 articles in the literature to raise important questions on the topic 34 . The study identified an average mortality rate exceeding 50% among the severe TB patients admitted to ICU, ranging from 29% to 95%. In addition, the study demonstrated that mortality in high TB prevalence/limited-resource settings is 23.4% higher than in low TB prevalence ones. Interestingly, the existing severity scores investigated underestimate the actual mortality. Other significant findings of the study are that acute respiratory failure is the leading cause of admission to ICU and that negative predictors of outcome exist, including hospital-acquired infections, the need for mechanical ventilation and vasopressors, delay in anti-TB treatment, more than one organ failure and worse severity scores. The study demonstrated a positive correlation between the predictive scores and the patients' mortality in terms of prognosis. The probability of treatment success was significantly associated with a longer duration of intravenous anti-TB treatment. This is the most extensive study on the topic so far, its strengths being also in its global representativeness. We hope this contribution of Pulmonology to the World TB Day and the fight against the White Plague will be appreciated by our readers and that the findings of these three studies will help to end TB in the COVID-19 pandemic era. Declarations of interest: none. World Health Organization. Global tuberculosis report 2021. Geneva: World Health Organization History of prevention, diagnosis, treatment and rehabilitation of pulmonary sequelae of tuberculosis Strengthening tuberculosis control to advance towards elimination: the Tuberculosis inthe news: how do Portuguese media cover New drugs and perspectives for new anti-tuberculosis regimens Migration, TB control and elimination: whom to screen and treat Managing latent tuberculosis infection and tuberculosis in children Tuberculosis, social determinants andco-morbidities (including HIV). Pulmonology Non-tuberculous mycobacterial pulmonary infections Team approach to manage difficult-to-treat TB cases: experiences in Tuberculosis and COVID-19 interaction: A review of biological, clinical and public health effects Different disease, same challenges: Social determinants of tuberculosis and COVID-19 contributing members of the Global Tuberculosis Network. Tuberculosis, COVID-19 and hospital admission: Consensus on pros and cons based on a review of the evidence Active tuberculosis, sequelae and COVID-19 co-infection: first cohort of 49 cases Tuberculosis, COVID-19 and migrants: Preliminary analysis of deaths occurring in 69 patients from two cohorts Gauging the impact of the COVID-19 pandemic on tuberculosis services: a global study Tuberculosis and COVID-19 co-infection: description of the global cohort The impact of COVID-19 on TB: a review of the data COVID-19 related hospital re-organization and trends in tuberculosis diagnosis and admissions: reflections from Portugal Countryspecific lockdown measures in response to COVID-19 pandemic and its impact in tuberculosis control: a global study The impact of COVID-19 on the TB response: data from the field Impact of COVID-19 on TB services in Korea Early COVID-19 pandemic's toll on tuberculosis services, WHO European Region Clinical standards for the assessment, management and rehabilitation of post-TB lung disease Pulmonary rehabilitation is effective in patients with tuberculosis pulmonary sequelae Post-tuberculosis sequelae: the need to look beyond treatment outcome The need for pulmonary rehabilitation following tuberculosis treatment Posttuberculosis lung disease: comparison of Brazilian, Italian, and Mexican cohorts Impact of the COVID-19 pandemic on tuberculosis services Characteristics, risk factors and outcomes of critically ill patients with active tuberculosis Risk factors for early mortality in patients with pulmonary tuberculosis admitted to the emergency room Pulmonary Tuberculosis in Intensive Care Setting, with a Focus on the Use of Severity Scores, a Multinational Collaborative Systematic Review