The Ministry of Health and Family Welfare has issued a Guidance Note on Bi-directional TB-COVID screening and screening of TB among ILI/SARI cases. This Guidance Note was issued on 26th Agust 2020.
The Guidance Note points out that both Tuberculosis (TB) and COVID-19 are infectious diseases that primarily attack the lungs of the patients. They have similar symptoms such as cough, fever and difficulty in breathing. The Note also reveals that studies have disclosed that the prevalence of TB among COVID-19 patients has been found to be 0.37 – 4.47%.
The Guidance Note also reports that the history of active as well as latent TB is an important risk factor for SARS-CoV-2 infection. It has been shown to result in increased susceptibility, rapid and severe symptom development and disease progression with poor outcomes.
Furthermore, TB is associated with a 2.1-fold increased risk of severe COVID19 disease. TB patients also tend to have co-morbid conditions such as malnutrition, diabetes, smoking, HIV, etc. In order to address this dual morbidity of TuB and COVID-19, the Guidance Note prescribes for the following activities:
- Bi-directional TB-COVID screening
This contemplates COVID screening for diagnosed TB patient and TB screening for COVID positive patients. Additionally, the Note requires the establishment of linkages of TB service facilities with COVID Isolation facilities for the purpose of intensive management of TB-COVID co-morbid patients. Depending on the necessity and severity of the symptoms of the patients all COVID positive TB patients, will be admitted to a Dedicated COVID Care Centre/ Dedicated COVID Health Centre/ Dedicated COVID Hospital.
The information on COVID-19 screening among TB patients must be captured in the Nikshay portal and the note provides an updated CIF form of COVID-19 patients in its Annexure.
- TB screening for Influenza-Like Illness (ILI) or Severe Acute Respiratory Illness (SARI) cases
The following cases of ILI/ SARI will be screened for TB:
- Case with 4-symptom complex (Cough for more than 2 weeks, persistent fever for more than 2 weeks, significant weight loss, night sweats),
- history of contact with TB case,
- history of TB,
- ILI/ SARI symptoms persisting >10 days
The Guidance Note also provides a Diagnostic Algorithm for TB screening in all these cases.
