CARTA AL EDITORREVISTA DE LA FACULTAD DE MEDICINA HUMANA 2022 - Universidad Ricardo Palma
1 Research Professor, Instituto de Investigación de Ciencias Biomédicas, Facultad de Medicina
Humana. Universidad Ricardo Palma, Lima, Peru.
2 Student at Faculty of Human Medicine, Universidad Ricardo Palma, Lima, Peru.
3 Pulmonologist, Hospital Nacional Dos de Mayo, Lima, Peru.
The COVID-19 pandemic has negatively affected other disease prevention and control programs that could cause more deaths than the coronavirus itself (1), and also having substantial consequences for other domains, such as social impact: slowing economic growth and increasing rates of unemployment, poverty, and food insecurity.
The pandemic context generated a particular concern for the regular provision of health services since
human and infrastructure resources for medical care were transferred to services related to COVID-19,
for this reason, patients with health problems health not related to COVID-19 were abandoned by not
having access to health care services (2). Consequently, control measures and
epidemiological surveillance of tuberculosis (TB) were affected, which would produce an increase in the
number of cases (3).
Peru is one of the countries with the highest incidence of tuberculosis, both sensitive and resistant, in the world. Although the public health measures adopted in the country have improved the care, diagnosis and management of People Affected by TB (PAT), there are still limitations in the control of the disease, especially in multidrug-resistant TB (MDR), People Deprived of Freedom (PDF) and People Living with HIV (PLWHIV), as referred to by Guin et al. (4).
According to data from the World Bank, between 40 and 60 million people will have fallen into extreme poverty in 2020 as a result of COVID-19, knowing the close relationship between poverty and TB, an increase in prevalence and incidence is expected to medium and long term (1).
Both COVID-19 and TB affect the respiratory system, primarily the lungs, and have similar symptoms such as cough, fever, and shortness of breath, although the severity and duration of symptoms vary (1). But, COVID-19 has overtaken TB as the infectious disease with the highest death rate per day (5). Comorbidities such as chronic kidney disease, diabetes, lung cancer, and chronic obstructive pulmonary disease (COPD), especially secondary to smoking, have a higher risk of hospitalization and death when related to COVID-19 and/or TB (6). A preventive measure to prevent the spread of SARS-CoV-2 was mandatory social isolation at home, however, this measure could facilitate the transmission of TB, due to prolonged contact at home (7).
During the COVID-19 pandemic (2020-2021), in the Specialized Tuberculosis Unit of the Pulmonology Service at Hospital Nacional Dos de Mayo, a more than double increase in the prevalence of hospitalized patients with Type 2 Diabetes Mellitus (DM2) and TB (Figure 1) ompared to the periods prior to the pandemic (2015-2019); which could be explained as a secondary effect of poor control of the disease, late diagnosis and inadequate follow-up of chronic diseases, due to the insufficient functioning of the first level of care (8).
The average uptake of respiratory symptoms decreased by 46.8% during the pandemic period, compared to the pre-pandemic period (Figure 2); however, no change was found in the percentage of positive smear microscopy when we compared the period prior to the pandemic (3.7%) with the period of the pandemic (3.8%). In addition, we evidenced that there was no change in the average number of hospitalizations of patients with MDR-TB 9.
Author Contribution: XBD, ACA, KNH, MCN, RVV and FLT have also participated in the preparation and final approval of the letter to the editor.
Declaration of conflicts of interest: Renzo Villanueva-Villegas is supported by the Fogarty Research Training Grant in Chronic Noncommunicable Respiratory Diseases in Peru (PulmPeru), funded by D43 (D43TW011502). The rest of the authors declare no conflict of interest.
Corresponding author: Karina Narváez-Hidalgo
Adress Cipriano Rivas 524 San Juan de Miraflores, Lima - Peru