Approximately 10 Million new cases and 1.5 Million deaths annually.
Significant burden: 18.2 Million cases and 692,000 deaths globally as of August 4th, 2020 and rising.
Transmission
Droplet transmission of M.tuberculosis bacterium.
Transmission occurring from asymptomatic individuals may be less for TB than Covid-19.
Droplet transmission of SARS-CoV-2.
May also be transmitted via surface contamination, possibly the fecal-oral route, and there may be some aerosol transmission.
Symptoms
Coughing with mucus or blood
Coughing that lasts more than 2 months
Chest pain
Loss of appetite
Weight loss
Chills, fever, or night sweats
Fatigue
Fever or chills
Cough, shortness of breath or difficulty breathing
Fatigue and headache
Muscle or body aches
New loss of taste or smell
Sore throat, congestion, or runny nose
Nausea, vomiting, or diarrhea
Tuberculosis
Covid-19
Treatment
TB has established curative treatment regimens that include the administration of first line drugs such as Rifampicin and Izoniazid and others.
Drug regiments can be completed at home with regular visits to the hospital.
Approximately 5% experience severe symptoms necessitating intensive care and invasive mechanical ventilation and ~20% are hospitalized.
Trials are currently on-going and only limited treatments are currently available, including the administration of Remdesivir and Dexamethosone in severe cases.
Limitations of Current
Treatment
Rise of resistant strains to multiple drugs (MDR) and completely resistant strains (XDR).
Significant negative side effects of medication leading to higher rates of non-compliance or early termination of the treatment plan.
Treatment durations are lengthy and can last from 6 months to 2 years.
Trials are currently on-going.
There are some compassionate use treatement options available to temporarily treat symptoms, however, no direct antiviral treatment is available.
Treatment duration is currently unknown due to the lack of available treatment plans.
Comorbidities
Increasing
Vulnerability
Cancer
Chronic Lung Diseases
Smoking
Alcohol Use Disorders
Depression
HIV
Immunocompromised State
Type 2 Diabetes Mellitus
Cancer
Chronic Kidney Disease
Chronic Lung Diseases
Obesity
Heart Conditions
Sickle Cell Disease
Immunocompromised State
Type 2 Diabetes Mellitus
Infection Control and
Containment
Patients wear masks while infectious.
Patient triage based on respiratory symptoms.
Adequate ventilation and airflow in waiting, consultation, and inpatient areas.
Use of PPE by medical staff, particularly masks.
Social and Behavioral Change Communication (SBCC) on cough etiquette.
Contact investigation.
In the US, TB cases must be reported to state authorities.
Identification of hotspots.
Risk communication and countering misinformation.
Rapid patient isolation and quarantine, and quarantine of contacts.
Social distancing and recommendation to wear masks.
In addition to infection control measures similar to TB, additional measures such as frequent disinfection of surfaces must be implemented.
PPE and maintaining physical distance are even more critical given asymptomatic spread.
Contact tracing and investigation at the onset is crucial, before community transmission is entrenched.
In the US, COVID-19 must be reported to state and local health authorities.
Lockdowns, curfews, closing businesses.
Risk communication and countering misinformation.
Tuberculosis
Covid-19
Vaccination
Bacille Calmette-Guérin (BCG) vaccine is available for newborns and infants.
Effectiveness of BCG vaccine is significantly lower for adults and elderly populations.
Trials are currently on-going.
Effectivenness of potential vaccine candidates is currently unknown.
Lack of data regarding the effectivenss of potential vaccines in elderly or immunocompromised populations.
Opportunities and
Lessons Learned
Infectious diseases, whether viral or bacterial, are a global issue, which deserves to receive increased attention and awareness. Both tuberculosis and COVID-19 are considered pandemics and there are numerous learnings from each that can help to lead to improved mitigation measures and management of current and future outbreaks. The Mueller Health Foundation (MHF) along with its partners is currently focusing on the following areas of improvement in a harmonized and strategic way to first tackle tuberculosis and then other infectious diseases in the future:
1) To ensure improved effectiveness of vaccinations, MHF is exploring precision vaccine approaches for all types of patients taking into account age, sex, geographic location, and comorbidities.
2) MHF is exploring the use of immune-boosting agents, such as adjuvants, to improve prevention and treatment options for immunocompromised populations.
3) MHF is working on finding novel treatment options through the use of an AI-driven platform called TBMeld, to find new drug compounds and combinations that shorten the duration of treatment, reduce side effects, and improve effectiveness.
4) Through the TB Connect blockchain initiative (currently being created) MHF is working to improve information sharing, reporting, and data analytics.
5) MHF is an advocate for improved contact tracing and for ensuring consistent messaging on the local, state, and federal level. MHF is working on creating educational films on the prevention and treatment options currently available.
6) MHF fosters global collaboration and public-private partnerships. In conclusion, tackling infectious diseases has to be a concerted effort and needs to be at the forefront of public policy. Learnings from one infectious diseases can be applied to the treatment, prevention, and management of other infectious diseases to solve global pandemics now and in the future.
