Amid Covid: TB, Malaria & HIV Cases Skyrocketing

By The NAMD Staff

It is a longstanding disease that, TB along with HIV and malaria, has creeped back into global consciousness with the onset of the coronavirus pandemic.  

One and a half million people will die from it worldwide this year.

First, there is fever and fatigue, then a persistent, hacking cough and shortness of breath.  It is aerobic, and spreads easily in crowds or close contact with a symptomatic or asymptomatic person.  

Contact tracing, sheltering in place, and closing businesses are efforts to mitigate spread of the disease.  The sick are sequestered and treated for weeks that can turn into months.

It is tuberculosis, and it has stealthily crept back to the forefront of infections that ravage its victims.  

Data from 2018 reports that positive cases of TB, HIV and malaria were at the lowest in decades. However, with all efforts concentrated on eradicating Covid-19, these three diseases have proliferated the world’s populations again. 

Dr. Pedro L. Alonso, director of WHO’s global malaria program, notes that the all-consuming scientific focus on containing, treating and eliminating coronavirus has distracted medical professionals and limited resources for TB, HIV and malaria patients.

Limited land, air and sea travel due to Covid-19 has hindered patients in Africa, Asia and Latin America from getting essential check-ups, diagnoses, medications and treatment.  

Closed clinics and patients’ fear of coronavirus infection contributes to the extremely challenging issue of adequate treatment for them. These challenges in obtaining adequate health care affect 80% of TB, HIV and malaria programs and the interruptions in treatment can lead to drug resistance, which has been a major concern in many affected countries. 

India’s TB cases, which are 30% of the world’s diagnoses, experienced a serious drop in positive cases because testing has decreased to just 25% of previous test numbers.  

According to a study by Johns Hopkins University and partners, countries sheltering in place for three months or more and rolling out a ten-month return to normal could incur 6.3 million new cases of TB and 1.4 million deaths from it.

Russia’s HIV clinics have been changed to coronavirus test sites.  

Just a six-month disruption in the distribution of antiretroviral medication to patients could result in 500,000 more deaths, annually.  

And although it is malaria season, travel restrictions prohibit West Africa from distributing mosquito nets and pesticide sprays for prevention of the disease which plague the country with 90% of the world’s cases.

The WHO posits a future possibility of malaria deaths doubling to 770,000. 

Public health experts portend the current trends could reverse decades of advances made in the fight against TB, HIV and malaria.

The Global Fund asserts that preventing this impending disaster could cost $28.5 billion. 
Delayed Diagnosis

Historically, a pandemic’s effect on the socioeconomically underserved is the most prolonged and deadly.  

Even today, a drug-resistant strain of TB that surfaced in the 1990’s Eastern Europe is still prevalent there.

 Lack of prompt diagnosis impacts effective treatment, and can impede recovery, resulting in rapid decline and death.

Malaria can become fatal in less than 36 hours from its first symptom, fever.

The WHO is considering the distribution of antimalarial drugs to the entire population in West Africa.  

This strategy was implemented during the Ebola crisis in 2016. 

Pregnant women in sub-Saharan Africa are not going to clinics to check on their HIV status.  

Lack of diagnosis and a three to six-month interruption in treatment can result in HIV-positive women transferring the infection to their babies.  Children born with HIV could increase 150%, according to U.N. AIDS.

Without proper diagnosis, TB, easily spread aerobically, from close contact and can rapidly infiltrate densely populated areas such as Rio de Janeiro or South African townships. One person can infect more than 15 people in one year. Consequently, untreated cases will increase exponentially. 

Stop TB Partnership’s Dr. Lucica Ditiu considers it a reckless and unsafe health policy to turn clinics’ focus to coronavirus in lieu of continued diagnosis of TB and HIV. The same equipment, GeneXpert, can effectively detect genetic codes for TB and HIV and magnify RNA for coronavirus. 

The WHO cites the rise of coronavirus case and plummeting TB diagnoses in 121 countries: 70 percent drop in Indonesia, 50 percent in Mozambique and South Africa, and 20 percent in China. Mexico also experienced a drop in TB cases as Covid-19 cases soared.  

Restricted from travel, Medical Impact’s Executive Director, Dr. Giorgio Franyuti treated coronavirus patients in Mexico City, far away from his usual work in TB diagnosis and treatment of the Lacandon population in Mexico’s remote jungles.  

But while in the Covid-19 makeshift hospital, the doctor saw nine patients with characteristic TB symptoms of phlegmy coughs and fever. Misdiagnosed as coronavirus, the patients became quite ill without the treatment for TB, contracted coronavirus and four of the nine patients died.

Dr. Franyuti notes that TB is not being tested, though 10 million cases have been diagnosed every year. Considering TB to be a “monster,” the doctor states that Covid-19 has not compared to those numbers. 

A similar scenario emerged in India.  On March 24, hospitals focused exclusively on Covid-19, with many out-patient services for other illnesses closed. New TB cases were 60,486 compared to 179,792 cases a year prior, in 2019.

Coronavirus is an expensive disease and companies like Cephid of California, turn away from manufacturing TB or malaria tests in favor of making the more expensive tests for coronavirus detection.

Covid-19 tests are $10, compared to a rapid malaria tests at 18 cents. 

Treatment Disruption 

Disrupted supply, redirected manufacturing and travel restrictions have contributed to limited supplies of TB, HIV and malaria drugs for patients. These patients will ration their medications and put the chance for successful treatment in jeopardy.   

With shortages in medication, patient health is endangered. In Indonesia, Jakarta is the only city with supplies of antiretroviral drugs, which can be difficult to obtain for many HIV patients.  

So, a month’s supply gets stretched to two months.

In the immediate future, HIV and TB patients who ration or skip their medications will get sicker, but in the distant future is the concern of an upswing in drug-resistant strains of the diseases.  

Similar to Indonesia, Brazil’s HIV and TB drugs are a challenge to dispense to patients as the coronavirus pandemic rages and health care workers strive to treat the pandemic’s victims.Globally, supplies may run out as international transit is restricted, impeding the availability of chemical ingredients, raw materials and packing supplies.  

And the controversy over chloroquine’s efficacy as a potential coronavirus treatment has prompted countries like Myanmar to stockpile the drug and deplete its global stocks.

The WHO has expressed interest in diversifying manufacturers to more local venues where stock would be closer to where it is needed.  

Currently, 8 Indian companies supply 80 percent of the global stock of antiretroviral drugs.  

U.N. AIDS concludes the cost of the medications could rise by $225 million each year because of short supplies, limited work force, restricted transport and currency fluctuations.  

The inaccessibility to proper medical care makes defeating coronavirus and other deadly infectious diseases nearly impossible in remote areas of the world. In Brazil, airplanes are used to transfer coronavirus patients from Tabatinga to the nearest hospital ICU in Manaus, 1,000 miles away.

The Ministry of Health has recommended hydrochloriquine, a malaria medicine, for treatment of Covid-19 patients, despite evidence that strongly suggests it does not help and may worsen existing conditions. 

Medical experts speculate that the coronavirus pandemic could have ancillary outcomes that are positive.  

Chloroquine may be dispensed throughout remote areas of Brazil to prevent malaria.  Countries will continue to stockpile drugs and provide three to six-months supply to TB and HIV patients.

Telehealth platforms assist medical providers in treating patients by video and telephone, when distance travelling for treatment is prohibitive. 

Brazil’s Dr. del Rio acknowledges that affecting change is challenging, but believes this crisis will highlight and promote necessary changes to the system. 

REFERENCES

The Global Fund. Global Fund Survey: Majority of HIV, TB and Malaria Programs Face Disruptions as a Result of COVID-19, June 17, 2020.

The World Health Organization. Q&A on Malaria and COVID-19, June, 2020. 

The World Health Organization. Key Facts on Tuberculosis, March 24, 2020.

The Global Fund.  Global Fund COVID-19 Report: Deaths from TB, HIV and Malaria Could Almost Double in 12 Months Unless Urgent Action is Taken, June 24, 2020.

UN AIDS. Ensuring That People Living with HIV In The Philippines Have Access To Treatment During COVID-19, April 8, 2020.

UN AIDS. COVID-19 Could Affect the Availability and Cost of Antiviral Medications, but the Risks Could be Mitigated, June 22, 2020.

Chandna, Himani. India Could Soon Ban Export of Anti-TB Drugs as Lockdown Hits Production, The Print, April 21, 2020.

National Institute for Communicable Diseases. Impact of COVID-19 Intervention on TB Testing in South Africa, May 10, 2020

Nickshay Report. State-Wise Total of TB Tests, April 8, 2020.

UN AIDS. Russian Regional AIDS Centres Leading the Fight Against COVID-19, May 14, 2020.
Stop TB Partnership, The Potential Impact of the COVID-19 Response on Tuberculosis in High-Burden Countries, A Modelling Analysis.

The World Health Organization. The Cost of Inaction: COVID-19-Related Service Interruptions Could Cause Hundreds of Thousands of Extra Deaths from HIV, May 11, 2020.

The Global Fund. Global Fund COVID-19 Report: Deaths from HIV, TB and Malaria Could Almost Double Unless Urgent Action is Taken, June 24, 2020

Reliefweb.  Estimation of the Potential Impact of COVID-19 Responses on the HIV Epidemic:
Analysis Using the Goals Model, May 19, 2020.

Gubierno De Mexico. Bolein Epidemiological Sistema Nacional de Vigilancia Epidemiola Systema Unico de Informatcon, August 3, 2020.

Bhaila, Nita.  No Medicine, No Food: Coronavirus Restrictions Amplify Health Risks to LGBT + People with HIV, Reuters, May 20, 2020.

The World Health Organization. WHO Urges Countries to Enable Access to Fully-Oral Drug Resistant TB Treatment Regimens, June 19, 2020.

Lang, Veneranda, Sally Mugabe Hospital Operating at a 45% Capacity, February 5, 2020.

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