Make India TB-free by 2025: Deployment of doctors and health workers engaged in tuberculosis treatment and surveillance in COVID-19 duties makes the goal more challenging in Assam

Joya Kosa (22), a resident of Koyamari Basti in Assam’s Lakhimpur district was suffering from fever and throat pain for nearly two months after the world’s largest nation-wide lockdown began in India on March 24. Her husband, Biran Kosa, became helpless as he was unable to take Joya to the doctor due to lockdown that was enforced to prevent spread of COVID-19 pandemic.

After the lockdown was relaxed, Biran took her to hospital with the help of Sundar Sai who has been engaged in tuberculosis prevention activities in tea garden areas of the district. The doctor confirmed that Joya was suffering from tuberculosis. Biran had returned home from Arunachal Pradesh after he became jobless due to lockdown. He used to earn as a driver there. Biran’s loss of livelihood and illness of his wife have pushed the family into uncertainty.

Binod Kurmi, who works in a tea garden in Jorhat district too has a similar story to share. Due to lockdown he could not go the hospital to bring medicines for his six-year old daughter Malati, a TB patient. Later, REACH (Resource Group for Education and Advocacy for Community Health) TB Champion Minati Nayak Puran helped him to arrange medicines through the nearest Primary Health Centre for administering the required medicine doses for Malati at home.

Likewise, Biren Ekka, a resident of village in Lakhimpur district and a TB patient could not go to a doctor even after his illness aggravated during lockdown. He could see a doctor only after the lockdown was relaxed.

Photo- Bhabesh Medhi

There are many TB patients like Joya, Malati, Biren who, either could not visit a doctor or procure medicines in time during the lockdown in the state. The lockdown also delayed detection of TB in some patients. Thus COVID-19 pandemic came in the way of treatment of TB during the lockdown period. Official data also show that lockdown adversely affected examination, treatment, and surveillance of TB patients in the state. Both Minati Nayak Puran and Sundar Sai say that apart from disruption of communication, most of the doctors and health workers engaged in TB treatment have been deployed in COVID-19 duties. This has posed huge challenge to treatment of TB in the state, they say.

Data available with the State TB Cell of the Health and Family Welfare Department show that detection of TB patients has sharply declined following lockdown in the state. According to official statistics, detection of TB patients has declined by 40 to 50 per cent during the three months of lockdown in March, April, and May. As against detection of 3583 TB patients in January, 3964 in February, altogether 2836 TB patients were detected in the month of March 1652 in April, and 2349 in May. Data uploaded in the website of Central TB Division ( Nikshay) of the Ministry of Health and Family Welfare show that as against detection of 196,124 TB patients in January and 211,053 patients in February, the detection of TB patients in the country declined to 162,146 in March, 75,998 in April and 97,752 in May.

Joint Director, Health (TB) Dr Nayanjyoti Das who heads the State TB Cell says that 41 per cent of doctors and health workers engaged in TB treatment have been entrusted COVID-19 duties. Besides, declaration of Gauhati Medical College and Hospital, Assam Medical College and Hospital in Dibrugarh, Jorhat Medical College and Hospital, Tezpur Medical College and Hospital, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam Hills Medical College and Research Institute, Diphu, Mahendra Mohan Choudhury hospital and Lokpriya Gopinath Bordoloi TB Hospital at Kalapahar in Guwahati as COVID hospitals have also disrupted examination and treatment of TB in the state.

Photo courtesy : Official Twitter account of Kamrup Metropolitan District Administration

There are 30 CB-NAAT (cartridge based nucleic acid amplification test) machines in Assam for testing of TB samples for early diagnosis of the disease. No TB sample was tested in the state during the lockdown. Of the 30 CB-NAAT machines in the state, three have been used in detection of COVID-19- two in Fakhruddin Ali Ahmed Medical College and Hospital in Barpeta and one in Jorhat Medical College and Hospital. The two CB-NAAT machines currently used to detect COVID-19 in Fakhruddin Ali Ahmed Medical College and Hospital in Barpeta are meant for TB patients in Barpeta and Chirang districts. Tuberculosis samples from Chirang district are now being tested in neighbouring Kokrajhar and Bongaingaon districts, says Dr Das.

The CB-NAAT machine of Majuli island district has been shifted out to Jorhat Medical College and Hospital for COVID-19 detection. This has hampered TB testing in the river island.

Assam government has designated the newly constructed 125-bedded Lokapriya Gopinath Bardoloi TB Hospital at Kalapahar in Guwahati as COVID-19 hospital. The TB patients currently undergoing treatment in the old hospital building were to be shifted to the hospital building built at a cost of Rs 26 crore in April but it has been deferred due to designation of the hospital as COVID-19 hospital. Admission of COVID-19 patients in the new building triggered apprehension of being infected by corona virus among family members of some of the TB patients. Therefore, a section of TB patients has been taken home by their family members. District TB officer, Kamrup (Metropolitan) district Dr Mridul Bharati Nath says: “We could not conduct any TB tests during initial days of admission of COVID-19 patients in the TB hospital. However, our efforts are on to continue the tests amidst all difficulties.”

Treatment of TB has still remained a challenge for the state and the entire country. Number of people affected by TB and the death toll due to the disease have been on the rise in the state. According to World TB Report, three out every ten TB patients in the world are from India. In India, an average 1200 people die due to TB every day. About 27 lakh people are infected by TB every year in India. Data available with the State TB Cell show that an average 3699 persons were infected every year and average 308 persons were infected every month in the state over the past three years. On an average 112 persons died every month and 1334 persons died every year in the state during the last three years.

Photo courtesy : Official Twitter account of Kamrup Metropolitan District Administration

Dr Das says that disruption in the communication system during lockdown and normal TB examination and treatment processes due to COVID-19 pandemic have been identified to be factors behind detection of TB patients has significantly in the state declined post lockdown. He, however, says that wearing of facemasks and maintenance of physical distancing norms to prevent spread of COVID-19 also cannot be ruled out as factors behind decline in detection of TB patients in the state. For, TB is a contagious disease and its spread can be significantly reduced if the patients wear masks and maintain physical distance. He says that nothing could be conclusively said at this moment and a definite conclusion could be arrived at only after full-fledged TB examination and treatment are restored. Keeping the prevailing situation in mind, he hopes that full-fledged TB examination and treatment may be restored in the state only in November.

The country has been witnessing surge in TB infection even as it has set the target of making India TB free by 2025. The COVID-19 pandemic has added to the huge challenge of achieving the target in the state as well as in the entire country.

Bhabesh Medhi

( Bhabesh Medhi is a journalist based in Guwahati. He is a recipient of Reach Media Fellowship, 2018 under which he has been reporting on health issues. He can be reached at [email protected])