Tuberculosis Surpasses COVID-19 as Most Deadly Infectious Disease

In 2022, an estimated 1.2 million people died around the world from COVID-19, while 1.3 million people died from tuberculosis (TB), according to the World Health Organization (WHO).

As cases of the COVID-19 virus and related deaths dwindle, tuberculosis, caused by the bacterium Mycobacterium tuberculosis, has reclaimed its spot as the deadliest infectious disease.

TB “is curable, provided we diagnose early, intervene, and the drug regime is followed religiously,” Seyed Hasnain, National Science Chair at the Indian Institute of Technology and distinguished professor of life sciences at Sharda University in India, wrote to The Epoch Times via email. So why is it still so deadly?

A Disease of Poverty

Poverty is the breeding ground for tuberculosis.

TB is particularly endemic to eight countries, namely Bangladesh, China, the Democratic Republic of the Congo, India, Indonesia, Nigeria, Pakistan, and the Philippines. Over two-thirds of the world’s TB sufferers are from these countries.

Commonalities among these eight countries are overcrowding, poverty, and malnutrition, Dr. Vinod Kumar, director of Institute of Thoracic Medicine at Madras Medical College, wrote to The Epoch Times.
China poses a slight exception. A significant proportion of the country is rich and above the poverty line, yet many are below the poverty line or are living in extreme poverty. While official reports state that the country has prospered and made significant improvements to eliminate poverty, this is challenged by experts.

Tuberculosis is transmitted through the air by someone with an active TB infection in their lungs or throat. This can occur when the person coughs, speaks, or sneezes.

Overcrowded conditions are often damp, dirty, dark, and poorly ventilated. These places promote TB persistence since TB bacteria can be killed by sunlight, and exposure to sunlight also increases immunity.

Malnutrition is a surrogate of poverty and is also comorbid for tuberculosis. It puts a person at a greater risk of infection as the body cannot defend against these bacteria. Around 40 percent of TB cases are associated with malnutrition.

A Long Path to Diagnosis

Almost a third of newly ill patients with TB globally remain undetected or undiagnosed,” Dr. Keertan Dheda, professor of TB research at the London School of Hygiene and Tropical Medicine, wrote to The Epoch Times. This can be due to poor diagnostic techniques and difficulty accessing care.

Traditionally, tuberculosis diagnosis involves a series of steps. The first steps are a review of medical history, a physical examination, and an X-ray of the lungs.

However, patients need a laboratory test to confirm a TB diagnosis and exclude other lung diseases.

Sputum smear is the most common test done in countries with a high TB burden. The person is asked to cough up saliva and mucus from the respiratory tract to be examined under the microscope for TB bacteria. This test is not the most sensitive and may miss 20 percent to 70 percent of TB patients, especially those with latent TB infections where the bacteria is absent in the lungs.

In the United States, where infections are less common, TB is often first tested by doing a skin or blood test. These tests detect latent tuberculosis bacteria. However, a positive result only indicates a prior infection; subsequent tests are needed to check if the infection is active.

In recent years, a new TB diagnostic technique that analyzes the bacteria’s DNA has emerged. This technology is more accurate and sensitive at detecting TB, and patients can generally expect a result in two hours.

“DNA-based technologies have flooded the market, but unfortunately, in resource-poor countries, the high cost of such diagnosis becomes an impediment,” Mr. Hasnain wrote, adding that diagnosis made through the microscope may be necessary due to its affordability.

The fear of TB can also make people resistant to seeking a diagnosis and informing their friends and family that they have it. This can lead to the infection’s unknowing spread.

Treatment for Tuberculosis

Treatment for nonresistant TB involves a six-month regimen of antibiotics.

The most common treatment for infectious TB is isoniazid INH in combination with three other drugs: rifampin, pyrazinamide, and ethambutol. However, this combination can have side effects of fatigue, jaundice, nausea, and weakness. It is common for patients to abandon the treatment due to these side effects or once they start feeling better.

The infection may then return with drug-resistant TB bacteria. In such a case, more prolonged treatment with another combination of antibiotics—namely, fluoroquinolones, bedaquiline, and linezolid—would be required for nine months to two years.

In some countries, counterfeit drugs or poorly made drugs lead to ineffective treatment. Malnutrition and metabolic diseases can reduce drug absorption and prevent proper treatment.

The Way Forward?

Since the COVID pandemic, the number of reported TB cases has fallen, along with the number of patients enrolling themselves in TB treatment. However, experts are concerned that the decline is due to the pandemic impeding individuals from seeking diagnosis rather than a slight victory over the disease.

As COVID-19 progresses to the endemic stage, TB cases are expected to continue to rise.

Mr. Hasnain proposed that health care should conduct timely screening for TB and include better drugs, vaccines, and diagnostics. He added that multinational corporations are not interested in these responses due to estimated poor investment returns.

It is unlikely that TB will be given the same attention as COVID-19, according to Dr. Dheda. In contrast to COVID-19, the disease has a long incubation period of up to six months and is a slow-progressing disease, often taking months to years for serious symptoms to manifest.

“It is not as socially and politically alarming as COVID‑19, where symptoms develop over a few days and large numbers of patients present to hospital with acute illness,” he wrote.

Dr. Kumar proposed that work be done to improve a person’s own immunity. “This can be done only if the social aspects of TB causation, like poverty, overcrowding, [and] malnutrition, are addressed,” he wrote.

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