key: cord-1048974-yz8xwion
authors: Buonsenso, Danilo; Iodice, Francesco; Biala, Joshua Sorba; Goletti, Delia
title: COVID-19 effects on Tuberculosis care in Sierra Leone
date: 2020-06-06
journal: Pulmonology
DOI: 10.1016/j.pulmoe.2020.05.013
sha: c150c791556b814b47d5cd2fa8d5948f4ae5476b
doc_id: 1048974
cord_uid: yz8xwion

nan

COVID-19 is posing several challenges in the richest areas of the world which were unable to deal promptly with shortages of intensive care units, health personnel and personal protective equipment (2) leading to hundreds of thousands of severe outcome and deaths.

Whereas, in Africa, while COVID-19 cases and deaths are increasing, other major killers are still there.

Tuberculosis (TB) is still the number-one infectious disease killer in the world and containing it during the COVID-19 pandemic is seriously at risk.

Appropriate TB management comprises prompt diagnosis of active TB cases, identification of people exposed and infected people, access to treatment and drug-adherence control. With the rising number of multidrugresistant TB (MDR), direct observed therapy (DOT) is pivotal to ensuring that people regularly take medications. For appropriate care, a close link between the health centres and patients is needed. However, after the arrival of COVID-19 in Africa, this connection is at risk. Several African countries are declaring lockdown to prevent contagions. In poor settings, quarantine has heavy economic implications and people are losing their daily income. For most families, this generates difficulties in paying transport fees to reach health centres. In Sierra Leone, the government allowed health facilities to provide patients with enough TB medication for weeks, aiming to reduce movement and flatten the COVID-19 curve. This may lead to low treatment adherence with potential consequences for TB cure rates, development of drug resistant TB and spread in the community.

Importantly, many sub-Saharan peripheral health centres are experiencing a reduction in clinical visits (3).

Matilda Yamba, a community health worker from Bureh Town, Sierra Leone, declared that "people do not seek medical care for two reasons: they are either scared of getting SARS-CoV-2 infection in the health facilities, or are scared of being diagnosed with it". Africa knows well the social stigma associated with infectious diseases, HIV and TB being historical models, and it is not unexpected to be scared of being recognized as COVID-19 patients and blamed for spreading the virus in the community (4).

To understand the impact of COVID-19 on TB care, we evaluated the gross numbers of patients assessed for presumptive TB in the Community Health Post of Tombo, a village of Western Rural Area in Sierra Leone, with a government recognized TB outpatient unit, referral for an area of about 5,000 people. Presumptive In this context, the International Community is called on to provide massive support to poor countries. Before COVID-19, African health systems were struggling to provide appropriate care, although improvements have been made since the last Ebola outbreak. Now, Africa is not only having to face the historical enemies, but has to deal with both the direct costs of COVID-19 and the indirect consequences of COVID-19. While rich countries are now gaining more experience about the direct effects of COVID-19 on human health, the consequences on the major killers in poor countries are far from being understood. Here, endemic diseases that can present with symptoms similar to COVID-19 (TB, measles, pneumococcal disease and others), must not be forgotten (5). Importantly, in these settings where advanced forms of TB frequently occur and are 

COVID-19 pandemic in west Africa

Delia Goletti is a Professor at Saint Camillus International University of Health and Medical Sciences in Rome.We are grateful to all our colleagues that supported the development of local health services and training of The study was partially supported by the Italian Ministry of Health, Ricerca Corrente Linea 1 and 3.