Worldwide Effects of Coronavirus Disease Pandemic on Tuberculosis Services, January–April 2020

Giovanni Battista Migliori; Pei Min Thong; Onno Akkerman; Jan-Willem Alffenaar; Fernando Álvarez-Navascués; Mourtala Mohamed Assao-Neino; Pascale Valérie Bernard; Joshua Sorba Biala; François-Xavier Blanc; Elena M. Bogorodskaya; Sergey Borisov; Danilo Buonsenso; Marianne Calnan; Paola Francesca Castellotti; Rosella Centis; Jeremiah Muhwa Chakaya; Jin-Gun Cho; Luigi Ruffo Codecasa; Lia D'Ambrosio; Justin Denholm; Martin Enwerem; Maurizio Ferrarese; Tatiana Galvão; Marta García-Clemente; José-María García-García; Gina Gualano; José Antonio Gullón-Blanco; Sandra Inwentarz; Giuseppe Ippolito; Heinke Kunst; Andrei Maryandyshev, Mario Melazzini, Fernanda Carvalho de Queiroz Mello, Marcela Muñoz-Torrico; Patrick Bung Njungfiyini; Domingo Juan Palmero; Fabrizio Palmieri; Pavilio Piccioni; Alberto Piubello; Adrian Rendon; Josefina Sabriá; Matteo Saporiti; Paola Scognamiglio; Samridhi Sharma; Denise Rossato Silva; Mahamadou Bassirou Souleymane; Antonio Spanevello; Eva Tabernero; Marina Tadolini; Michel Eke Tchangou; Alice Boi Yatta Thornton; Simon Tiberi; Zarir F. Udwadia; Giovanni Sotgiu; Catherine Wei Min Ong; Delia Goletti


Emerging Infectious Diseases. 2020;26(11):2709-2712. 

In This Article


For most TB centers during their respective national lockdowns in the first 4 months of 2020, we found reductions in TB-related hospital discharges, newly diagnosed cases of active TB, total active TB outpatient visits, and new LTBI and LTBI outpatient visits. These results may be explained by a general decrease in the use of health services, including emergency services.[11] Resources for TB service provision were reassigned to other medical services. Outpatient visit numbers may have decreased because of patients' fear of exposure to severe acute respiratory syndrome coronavirus 2.[12] Access to medical services may have decreased because of interruptions in or difficulty accessing public transportation, although health-related travel was permitted in most countries. In some TB centers (e.g., Mexico City), the hospital patient intake system was modified to support COVID-19 admissions, thus severely hindering TB services. In some centers, screening for LTBI was considered a lower priority than screening for active TB or COVID-19. Because of lockdowns, reactivation of active TB in persons with LTBI who did not receive preventive therapy may be expected, such as in contacts recently exposed to TB or in those who are immunocompromised.[13,14] In England, compared with 2019, TB notifications decreased by 16.5% during April and by 37.3% during May 2020; the LTBI program was paused in response to COVID-19 on March 26.[15]

Lockdowns have favored the increased use of telemedicine. Telehealth is a new service offered by TB programs. In TB centers surveyed in Australia, Russia, India, and the United Kingdom, telehealth service use increased in the first 4 months of 2020.

Although our study cannot comprehensively describe all features of TB management, we found that the COVID-19 pandemic had a substantial impact on TB services worldwide. The main strength of our study is the global coverage from 33 TB centers from 16 countries on 5 continents. Limitations include lack of data from some countries. In 9 of the 16 countries, data were limited to reports from only 1 TB center, which may not have fully represented that nation's TB healthcare activities. In addition, some TB centers were located in countries with low TB incidence (e.g., Italy). The description of the changes in the TB burden over a few months did not allow for appropriate statistical inferences in these countries with low TB incidence. More information about the medium- and long-term effects of the COVID-19 pandemic on TB services after a specified time from the diagnosis of the first COVID-19 patient in each country is needed.

The COVID-19 pandemic seems to have affected TB services in all 16 countries that provided data. At select TB centers, increased use of telehealth services during the pandemic was recorded. Resources urgently need to be channeled to ensure that TB care continues efficiently despite the ongoing COVID-19 pandemic.