Namibia: Managing TB Care During COVID-19

(file photo).

LAST week Joseph Leonard was called in by a nurse at a clinic in Windhoek for a regular check-up.

The 31-year-old tuberculosis (TB) survivor, who was diagnosed with the disease in April last year, had been on treatment for the pulmonary disease for seven months.

He describes it as the most difficult time of his life.

"I used to feel dizzy at times and I had cold spells. I always woke up feeling hot and wet (sweating), and when I went to the TB centre they diagonised me with the disease last year," he says.

He, however, has not shown any symptoms of TB since his recovery in November last year. Despite this good news, health professionals raised another concern - nurses had explained to him that a new infectious disease, the novel coronavirus (Covid-19), was especially dangerous to someone with pre-existing health issues such as TB.

"They are checking up on us to make sure we are taking care," he says.

Apart from having to deal with longstanding health conditions like TB, Covid-19 has presented the healthcare system with more challenges.

However, optimistic Leonard believes he will be brave to face Covid-19, should he ever get the infection. He is taking care of himself well, seeing that he is someone with an already vulnerable respiratory system.

"I am aware that it is really a dangerous virus, Covid-19 can be more dangerous than TB," he acknowledged.

"I am not suspecting any symptoms of TB," he says, "But I am not scared of the coronavirus because they [doctors] gave me courage to take care of myself, so even if I get infected, I have to rely on the same courage I had during the treatment of my TB," he added.

One week before he was diagnosed with tuberculosis, Leonard experienced aggressive and heavy coughing.

He says his experience with TB was traumatising and he barely believes he was the same person he was months ago.

COVID-19 EFFECT ON TB CARE

According to the World Health Organisation (WHO) The symptoms of TB and Covid-19 are, however, similar.

TB is caused by bacteria (mycobacterium tuberculosis) that most often affect the lungs. Tuberculosis is curable and preventable. Unlike Covid-19, TB spreads from person to person through the air.

Between 2020 and 2025 an additional 1,4 million TB deaths could be registered as direct consequence of the Covid-19 pandemic.

Modelling work by the WHO suggests that if the Covid-19 pandemic led to a global reduction of 25% in expected TB detection for about three months - a realistic possibility given the levels of disruption in TB services being observed in multiple countries - could lead to a 13% increase in TB deaths. In Namibia, TB cases are expected to rise to 8 000 or 9 000 by the end of 2020, according to the head of the national TB programme at the ministry, Albertina Thomas.

Namibia recorded 1 992 TB cases from January to March this year. Thomas said the country is likely to report about 2 000 TB cases by the end of June.

She noted that TB patients are prone to contracting Covid-19, which has spurred the ministry to set up strategies to mitigate the spread of Covid-19 to this risk group.

STIGMA

It is said that stigma and fear around communicable diseases such as TB hinder the public health response.

In addition, the World Health Organisation says Covid-19 has provoked social stigma and discriminatory behaviour against people of certain ethnic backgrounds as well as anyone perceived to have been in contact with the virus.

CAN TB AND COVID-19 BE TESTED ON THE SAME TYPE OF SPECIMEN?

The World Health Organisation says diagnostic methods for TB and Covid-19 are distinct and individuals being evaluated for both conditions need specimens which are commonly different.

Sputum, and other biological specimens, can be used to diagnose TB using culture or molecular techniques. The most common form of tests for Covid-19 are by nasopharyngeal or oropharyngeal swab or wash in ambulatory patients. However, WHO says sputum or endotracheal aspirate or bronchoalveolar lavage may be used in patients with severe respiratory disease such as TB.

WHO ADVICE FOR HEALTH AUTHORITIES FOR TB CARE

Some guidelines from the health organisation to ensure sustained continued TB care throughout the pandemic include the following:

- All measures should be taken to ensure continuity of services for people who need preventive and curative treatment for TB.

- Preventive measures must be put in place to limit transmission of TB and Covid-19.

- Accurate diagnostic tests are needed for both TB and Covid-19.

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