Joining forces to end TB and COVID-19

Message from Dr Tereza Kasaeva,
Director, WHO Global TB Programme

WHO / Elena Longarini

Dear colleagues, partners and friends,

The current COVID-19 crisis has been a test for countries, health systems, key stakeholders, and those delivering health services at the front line. In the presence of new health threats like COVID-19,
it has become even more critical to protect those most vulnerable and ensure continuity of care for those grappling with ongoing epidemics like tuberculosis (TB). This is a time for resilience, rapid learning and urgent action to save lives. At the
forefront of these efforts are the health heroes: nurses, doctors and other health workers. Today on International Nurses Day I would like to salute their tireless dedication to alleviate suffering and save lives, at the risk of their own.

As we look forward to the easing of lockdown measures across many countries over this week and the coming weeks, we need to take the opportunity to build on lessons learned and put in place measures to mitigate future crises and disruption
of health services for those in need.

Since January 2020, when Dr Tedros Adhanom Ghebreyesus, WHO Director-General declared the novel coronavirus outbreak (2019-nCoV) a Public Health Emergency of International Concern, the WHO Global TB
Programme with Regional and Country Offices, in close collaboration with partners and civil society has been monitoring the impact of the COVID-19 pandemic and providing guidance and technical support to countries. We are also collating data and experiences
of COVID-19 patients with concurrent or previous history of TB to document the natural history of disease and outcomes in these patients. Here are a few highlights:

• January onwards (still ongoing): Regular coordination with WHO Regional and Country Offices, partners and civil society to monitor impact of COVID-19 on TB services. Technical assistance, guidance and support is being provided to
  countries on service delivery, infection control, and drug and diagnostics supply management.

• March: On 20 March, WHO issued an information note on considerations for TB services during the COVID-19 crisis. The note was developed with inputs from WHO regional and country offices, key partners and civil society including, USAID,
  Stop TB Partnership, Global Fund and the WHO Civil Society Taskforce on TB. On 24 March, WHO organized an Online Talk Show on World TB Day, with a keynote speech delivered by Dr Tedros Adhanom Ghebreyesus, WHO Director-General. Dr Tedros highlighted
  the importance to continue efforts to tackle longstanding health problems, including TB during global outbreaks such as COVID-19. He said, “COVID-19 is highlighting just how vulnerable people with lung diseases and weakened immune systems
  can be. The world committed to end TB by 2030; improving prevention is key to making this happen. Millions of people need to be able to take TB preventive treatment to stop the onset of disease, avert suffering and save lives”. Following the Talk
  Show a joint virtual townhall was organized with Stop TB Partnership on TB and COVID.

• April: Scientific Brief on BCG vaccination and COVID-19 was released on 12 April. Two webinars were organized at the end of April jointly by WHO and the Stop TB Partnership on TB and COVID.
• May: WHO modelling and analysis on impact of COVID-19 on TB mortality was published on 4 May. Modelling is being used to inform planning and budgeting for TB prevention and care and to provide a basis for funding requirements. An
  analysis was also undertaken across 6 WHO Regions on the impact of COVID-19 on the implementation of National TB Programmes.

In parallel with these efforts to tackle TB and COVID-19, continue our core functions for the global TB response. This includes the development and roll out of new guidelines, in March we released new guidelines on TB preventive treatment. Countries continue
to be supported to, build their capacity, implement new guidelines, ensure continuity of care and strengthen accountability. We are also working on the finalization of the Global TB Strategy for TB Research and Innovation and the UN Secretary General
2020 Progress Report on TB.

The coming months will be critical for all of us, especially for those affected by both TB and COVID-19. We need to focus on the following key actions:

• Ensure effective infection prevention and control measures, to protect the health and safety of health workers, staff, and patients. Personal protective equipment should be provided for all health staff involved in care delivery for
  both TB and COVID-19.

• Stand against stigma and discrimination and promote the human rights of the most vulnerable. Stigma and fear around communicable diseases like TB and COVID-19 hamper the public health response. Governments, citizens, media and communities
  have an important role to play in preventing and stopping stigma.

• Scale up simultaneous testing for TB and COVID-19, taking into consideration similarity of symptoms (cough, fever and difficulty breathing), and based on exposure or presence of risk factors. As countries prepare
  to share existing molecular platforms for COVID-19 testing, it will be essential to maintain current molecular diagnostic services for TB patients.

• Promote access to people-centered prevention and care services. Home-based and community-based prevention and care should be strongly preferred over hospital treatment for TB patients (unless serious conditions require
  hospitalization) to reduce opportunities for transmission. This includes WHO recommended, all-oral TB treatments for multidrug-resistant TB and extensively drug-resistant TB. Digital adherence technologies can help bridge the gap in communication.
  TB preventive treatment should be ensured for household contacts, especially given increased risk of exposure.

• Build and strengthen community, youth and civil society engagement to close gaps in care. Community health workers, youth volunteers and civil society can be engaged in reaching those at risk or those affected by
  TB and/or COVID-19 with care. We need to harness the potential of these groups while ensuring effective infection control and protective measures for them. Please do read the touching story from China below about Xu Xinghua- a TB survivor who
  is now working as a volunteer and peer consultant for TB patients through an online peer-to-peer support group in China. With the outbreak of COVID-19 in the beginning of 2020, Xu has had to go beyond the line of duty to ensure that people with
  TB get uninterrupted treatment.

Dear colleagues, partners and friends; the COVID-19 pandemic has highlighted the need for more preparedness and solidarity to ensure access to health care in times of crisis. We must learn from this experience and emerge victorious. The commitments made,
and targets set by Heads of State and other leaders to accelerate action to end TB must be kept even in crisis, backed by adequate investments. We need to do this to protect the lives of millions of people struggling with TB each day, and to sustain
the gains we have made in the fight against TB.

The time is now for solidarity and action. Let us join forces and step up the fight to end TB and COVID-19 – only united will we succeed.

Dr Tereza Kasaeva
Director
Global TB Programme
World Health Organization

---

#ThanksHealthHeroes
The caretaker buddy: Peer-to-peer support for TB patients
Xu Xing-hua (Yunnan, China)

---

WHO Information Note and Q&A on TB and COVID-19

New WHO recommendations to prevent tuberculosis aim to save millions of lives

The WHO Global TB Programme, along with WHO regional and country offices, has developed an Information Note, in collaboration with stakeholders. This note is intended to assist national TB programmes and health personnel to urgently maintain continuity
of essential services for people affected with TB during the COVID-19 pandemic, driven by innovative people-centred approaches, as well as maximizing joint support to tackle both diseases.

Read the Information Note.

 

Access the new Q&A
on TB & COVID-19

 

---

WHO Modelling analysis: Predicted impact of the COVID-19 pandemic on global deaths in 2020

WHO has released results of modelling work undertaken on the predicted short-term impact of the COVID-19 pandemic on TB deaths in 2020. Results indicate that TB mortality will significantly increase in 2020 and will primarily affect the most vulnerable TB patients. If global TB case detection decreases by an average 25% over a period of 3 months (as compared to the level of detection before the pandemic), an additional 190 000 TB deaths are predicted (a 13% increase), bringing the total to 1.66 million TB deaths in 2020. This number is near the global level of TB mortality of the year 2015, a serious setback in the progress towards the targets of the UN High-Level Meeting on TB and WHO End TB Strategy.  Read the analysis

---

Community-based health care, including outreach and campaigns,in the context of the COVID-19 pandemic

Community-based health care is an essential part of primary care at all times; in the context of the COVID-19 pandemic, the distinct capacity of trusted community members for social engagement and delivering care where it is needed is ever more critical. This joint WHO, UNICEF and IFRC guidance addresses the role of community-based health care in the pandemic context. It includes practical recommendations for decision makers to help keep communities and health workers safe, to sustain essential services at the community level, and to ensure an effective response to COVID-19. Using this comprehensive and coordinated approach will help countries strengthen the resilience of community-based health services throughout the pandemic, into early recovery and beyond. Read more

---

COVID-19 and National TB Programmes:
Summary of Findings across the Six WHO Regions

 

A preliminary analysis has revealed several challenges. These include a slow-down of routine and facility-based case finding and diagnosis across all WHO regions; human resources for TB increasingly engaged in COVID-19 response efforts; drop in TB
case notifications in several high burden countries; lack of real-time TB surveillance data that hampers countries’ ability to assess the situation in terms of decrease in case notifications and access; various levels of disruption in all
6 WHO regions concerning procurement and supply of medicines and diagnostics. Stock-out situations and stock shortages are noted in in several regions and a decline in routine, facility-based TB treatment services is observed in all regions. Countries
have been advised by WHO to shift to the provision of outpatient, community-based TB treatment and care services.

However, in parallel, positive steps have been taken by countries, with some implementing innovative, people-centered case finding strategies.  Different approaches are being used in countries to dispense medications to patients at home, including
through greater engagement of community and civil society actors in service delivery.

---

Joint WHO and Stop TB Partnership Webinars:
Coping with TB during the COVID-19 crisis

Access the webinar and presentations here.

---

Scientific Brief: 
Bacille Calmette-Guérin (BCG) vaccination and COVID-19

 

There is no evidence that the Bacille Calmette-Guérin vaccine (BCG) protects people against infection with COVID-19 virus. Two clinical trials addressing this question are underway, and WHO will evaluate the evidence
when it is available. In the absence of evidence, WHO does not recommend BCG vaccination for the prevention of COVID-19. WHO continues to recommend neonatal BCG vaccination in countries or settings with a high incidence of tuberculosis.

 

Read more