In the first week of April, a 42-year-old man walked nearly seven kilometres from his house, in the town of Hapur in Uttar Pradesh, to get himself tested for drug-resistant tuberculosis at the TB centre in the district. He works as a tailor and does not own any vehicle. “I walk slowly now,” the 42-year-old tailor told me, sounding breathless over the phone. “I often struggle to breathe. But I plucked up the courage and kept walking.”
During his trek to the TB centre, the tailor said he was stopped by the police and asked where he was going. He was allowed to pass after he told them he wanted to get medicines. It took him about an hour-and-half to walk to the district’s TB centre and around the same amount of time to return. He had to make the journey again to get the results, when he discovered that he had tested positive. With another long walk, the 42-year-old returned with medication. “I felt that if I delayed taking medicines further, I could lose my life,” he said. His name, and those of other TB patients quoted in this story, have been withheld for their privacy.
After Prime Minister Narendra Modi announced the nationwide lockdown on 24 March, the public-health system has been directed primarily towards COVID-19 prevention and treatment. The shutting of outpatient departments in the country’s hospitals have severely affected those with other ailments, such as TB, even though it shows symptoms—cough, fever and difficulty in breathing—similar to those of COVID-19. The consequences have been grave, with the lockdown leading to a sharp drop in the diagnosis of tuberculosis, which in turn could increase the transmission of the disease through undiagnosed patients. Even among patients who have been diagnosed, the restrictions on movement have made it difficult to access regular treatment, which can have irreversible effects of the infection developing a resistance to life-saving drugs.
In India, the Central Tuberculosis Division, which works under the health ministry, implements the TB prevention, treatment and control programme in the country. A dashboard maintained by the CTD shows that TB diagnosis has fallen drastically during the lockdown. In the month before it began, from 25 February to 24 March, there were 1,80,966 reported cases of TB. But from 25 March to 24 April, the CTD dashboard recorded only 57,538 TB diagnoses—about one-third the number of cases. From 6,032 patients a day recorded in the month before lockdown, the dashboard recorded just 1,917 per day detected in the first month of the lockdown—a drop of nearly 70 percent.
“Though our TB outpatient services are open, the daily footfall in hospitals and other healthcare centres have reduced,” Dr Raghuram Rao, the deputy additional director general of the CTD, said. Rao added that the healthcare workers are also more preoccupied with COVID-19 services, and to some extent, the data entered by the health workers is also not as up to date. But TB has long been a grave public-health concern in India. As recently as 2018, the World Health Organization estimated that there were nearly twenty-seven lakh new TB patients in India. It also estimated that the disease has killed 4,49,700 people that year—more than 1,200 per day, and 32 patients for every 100,000 people.