What about other chronic illnesses?

Death stalks India — and not just from Covid-19. With the entire world’s focus on the new virus that has been wreaking havoc across countries, there are worries over how India will control diseases such as tuberculosis (TB) that claim several thousand lives every year.

An Asian Development Bank study in March suggests that the Covid-19 pandemic will lead to a loss of $16-43 billion across developing countries of Asia. This huge loss, many believe, may halt Asia’s progress in healthcare.

The situation is particularly worrying for India, which has the world’s highest TB burden, points out Madhukar Pai, director of the McGill International TB Centre, Montreal, Canada. “The Covid-19 pandemic is causing serious disruptions in routine healthcare services, including TB, HIV and neglected tropical diseases [such as filariasis],” he says.

India, which hopes to eliminate TB in the next five years, has 27 per cent of the 10.4 million new TB cases reported globally in a year, and accounts for 29 per cent of the world’s 1.8 million annual TB deaths, an editorial in BMJ Global Health , a reputed medical journal, said in March 2017. About 16 per cent of the estimated 480,000 new global cases of multidrug-resistant TB (patients who do not respond to the two anti-TB drugs isoniazid and rifampin) are from India, the editorial stated.

India is also home to 2.1 million people with HIV. TB and HIV co-infection — where an HIV patient also has TB — is common in India. The government plans to eliminate HIV/AIDS and malaria by 2030, measles by 2020, and lymphatic filariasis by 2021.

Over the years, India has put in place several countrywide programmes and initiatives to tackle communicable diseases. But with the lockdown after the spread of the new coronavirus (SARS-CoV-2 or Covid-19), there is worry that the other health programmes may have been put on the backburner.

“A break in the chain of execution of such programmes is likely to increase the population case load, as treatment defaulter numbers [those not following up with treatment] are likely to increase,” says public health expert Diptendra Sarkar, a professor of surgery at the Institute of Post Graduate Medical Education and Research and SSKM Hospital, Kolkata.

Restrictions during the lockdown may deter people from reaching out to medical facilities for chronic diseases, adds Sushmita Roy Chowdhury, consultant pulmonologist at the Apollo Gleneagles Hospital, Kolkata. “The mortality from TB is high in India, and if these programmes do not function well, new cases, morbidity and mortality will certainly rise, especially in areas with high-density populations,” she says.

Pai is also concerned about TB drug supply, given the ban on flights and the limited supply from China of the active pharmaceutical ingredients used in many drugs. “The incidence of multidrug-resistant TB is likely to escalate in India,” he says.

Sarkar also fears that malaria treatment will be adversely impacted since people are storing or dosing themselves with the malaria drug hydroxychloroquine as a possible treatment for Covid-19, even though this has not yet been clinically proven. Further, the ban on its export has been revoked, ostensibly under pressure from the US and demand from other countries such as Brazil. This may lead to drug resistance in malaria patients, Sarkar warns.

Not everybody is as worried. Thekkekara Jacob John, an emeritus professor and former head of the department of clinical virology at Christian Medical College, Vellore, believes there will not be an increase in HIV/AIDS cases during the pandemic, owing to reduced sexual activity due to social distancing and the absence of commercial sex-work.

Social distancing may also lead to a dip in the birth rate, he holds.

For TB patients, however, he sees this as a difficult period. “TB, unfortunately, has not come under control for decades; for TB-affected individuals, under the best of times they were in trouble; in the worst of times they will suffer,” he adds.

Jishnu Das, an economist affiliated to the Centre for Policy Research, New Delhi, and the World Bank (Washington DC), notes that in the Covid-19 pandemic, two dynamics work simultaneously in India. Those who are already sick (for example, patients with multidrug-resistant TB) may face significant disruptions in their continuity of care, as resources are shifted to other priorities brought about by the pandemic.

On the other hand, he points out, with reduced people-to-people contact during the pandemic, the spread of infectious diseases will also slow down in India, leading to a decrease in the number of new patients.

To ensure India does not face other health crises, Sarkar calls for “prioritisation” of funding. “Global political will and funding will also be a factor in curbing these less-advertised silent killers.”

According to Pai, district and state TB programmes in India should track — and resolve — service disruptions. “The national TB programme can do emergency procurements. If public labs cannot run TB tests, they can be outsourced.”

The keyword should be “preparedness”, Sarkar stresses.

Sanjeet Bagcchi is a physician and an independent writer based in Kolkata