INDONESIA SET TO FORGE FORWARD IN TB HANDLING AMID COVID-19 PANDEMIC by Fardah

Jakarta, 25/3/2021 (ANTARA) - Several nations observed Tuberculosis (TB) Day on March 24 in a somber, concerned manner, as the fight against TB, one of the world's deadliest infectious killers, has been hindered by the COVID-19 pandemic.

World TB Day 2021 themed The Clock is Ticking" aims to send across the message that the world is running out of time to act on commitments made by global leaders to end TB.

The World Health Organization (WHO) reported that daily, nearly four thousand people die of TB and close to 28 thousand people fall ill with this preventable and curable disease.

Global efforts to combat TB have saved an estimated 63 million lives since the year 2000. However, since 2020, when the COVID-19 pandemic began spreading in over 200 countries, TB handling has experienced a regress, according to the WHO.

The effects of COVID-19 go far beyond the death and disease caused by the virus itself. The disruption to essential services for people with TB is just one tragic example of the ways the pandemic is disproportionately affecting some of the worlds poorest people, who were already at the higher risk for TB, Dr Tedros Adhanom Ghebreyesus, the WHO director-general, stated.

The pandemic has greatly exacerbated the situation. An estimated 1.4 million fewer people received care for TB in 2020 as compared to the previous year, or a reduction of 21 percent from 2019, according to preliminary data compiled by the UN health agency from over 80 countries.

Among countries with the biggest relative gaps were Indonesia, at 42 percent; followed by South Africa, 41 percent; the Philippines, 37 percent; and India, 25 percent.

The Indonesian Health Ministry's Director of Prevention and Control of Direct Communicable Diseases (P2PML) Siti Nadia Tarmizi recently quoted a study analyzing TB patients that only 24 percent of the people, who recognized the TB symptoms they experienced, had visited health facilities for a medical check-up.

The same study also cited that 74 percent of the people sought treatment at private health facilities, both formal and informal health providers, which have very limited diagnostic capacity.

Hence, the government was facing difficulties in tracking TB cases in Indonesia. According to the Health Ministrys data, TB cases in Indonesia in 2020 were estimated to reach some 845 thousand, but only 350 thousand cases were reported, as compared to 560 thousand cases in 2019.

Such a situation has compelled the Ministry of Health to conduct active tracing in the community by applying health protocol measures owing to the pandemic.

"From the results of the global TB 2020 report, Indonesia is among the three countries, with the largest TB burden in the world. Indonesia needs comprehensive handling to eliminate TB as targeted by 2030," she noted.

Meanwhile, Vice President Ma'ruf Amin, in his remarks during the World TB Day commemoration in Jakarta, emphasized that the TB eradication program in Indonesia must move forward despite the COVID-19 pandemic.

"Commemoration of World TB Day amid the COVID-19 pandemic is a key reminder for us that TB eradication must not regress despite the pandemic," Amin affirmed.

The VP admitted that the COVID-19 pandemic had made it tougher to eradicate TB, as the nations resources were being channeled into handling the COVID-19 pandemic, and this had reduced sharply the capacity to handle TB.

Citing a report of the WHO, Amin noted that the TB case report in Indonesia had declined 25-30 percent during the January-June 2020 period.

"According to the WHO, the declining report can cause a dramatic increase in deaths due to TB," he stated.

However, he is optimistic of better coordination among all stakeholders, medical workers, and the public to thwart the spread of the disease during the COVID-19 pandemic.

TB must be handled seriously because it lowers the productivity levels in Indonesia, as productive age groups have mostly been affected by this communicable bacterial disease, he remarked.

Meanwhile, Prof. Tjandra Yoga Aditama, pulmonology and respiratory medicine professor of the Faculty of Medicine of the University of Indonesia (FKUI), cited a modeling by the Stop TB Partnership and Imperial College, Avenir Health, Johns Hopkins University, and USAID, which estimates that disruption caused by the COVID-19 pandemic could make indicators of progress in the world's tuberculosis program regress to the situation in 2013-2016.

"Hence, the delay is five to eight years," Aditama noted.

Another publication states that global tuberculosis detection decreases by an average of 25 percent in three months, so the number of deaths from tuberculosis will increase by 190 thousand. It translates to an additional 100 thousand deaths in the Southeast Asian region.

"If in 2018, there were 1.49 million deaths due to tuberculosis in the world, then due to the COVID-19 pandemic in 2020, there could be 1.85 million deaths in the world," he pointed out.

In fact, tuberculosis control in Southeast Asia, including in Indonesia, initially went quite well. One of the indicators is shown by the number of tuberculosis case notifications, which rose, from 2.6 million in 2015 to 3.36 million in 2018, or an increase of around 20 percent. The success of treatment for drug-sensitive tuberculosis also increased, from 79 percent in the 2014 cohort to 83 percent in the 2017 cohort. Moreover, on the basis of the number of deaths, data indicates a decrease, from 758 thousand in 2015 to 658 thousand in 2018.

Such a progress was expected to continue into 2020. However, the COVID-19 pandemic in 2020 has limited the progress.

He highlighted the two crucial steps of passive case finding at health facilities and active identification by health workers.

Such steps are in line with the seven activities that can be pursued along with the COVID-19 control efforts that comprise testing, contact tracing, infection prevention control, surveillance, strengthening health services, risk communication, and community involvement.

It is not too late to apply the strategy to prioritize case detection and handling efforts, so that the death rate from tuberculosis does not increase, he added.

TB and COVID-19 are both infectious diseases that attack primarily the lungs and have similar symptoms, such as cough and fever.