By: Ana Altchek, Follow South Jersey Intern
SOUTH JERSEY – The CDC released a statement on March 24th about the effect of COVID on tuberculosis (TB) trends in the United States. The statement was made in response to preliminary data published earlier that day, which revealed TB disease diagnoses fell 20% in 2020 and remained 13% lower in 2021 than they were prior to the pandemic.
At first glance, the reduction in reported cases may seem like a positive development. The CDC announced in their statement that the decrease can reasonably be attributed to new preventative measures in the healthcare field, such as wearing masks and social distancing. With that said, the CDC noted that the lower numbers of reported cases may also be due to delayed or missed TB diagnoses because of its similarity to COVID.
Although there were 5.8 million reported cases of TB in 2020, the World Health Organization estimated nearly double that number. Even though the United States may actually have lower numbers of the disease due to preventative measures, other countries with high endemic rates may have had limited access to proper resources and medical staff during the span of the pandemic.
Although TB cases have gone down overall on a national level, New Jersey is one of eight states that has maintained a higher TB rate than the national average. In 2018, the country average was 2.8 compared to New Jersey’s rate of 3.2. Infectious disease expert and Chief of Medicine at Jefferson Health, Dr. Todd Levin says that this discrepancy in reported cases is most likely concentrated in North Jersey because of its proximity to New York.
In regard to South Jersey, Levin says that TB is so rare that it’s difficult to see any major difference over the last couple years. The Jefferson Health Microbiology lab reported four TB cases in 2018 and five cases in 2020.
“I’ve been working here for 20 years,” Levin said. “We pretty much have a steady number of TB cases a year but it’s not more than a handful or ten at most. We certainly don’t see it very much. We do a lot of rule-out for TB when we consider it as a diagnosis but it’s pretty rare.”
In accordance with the CDC, Levin says that extra attention to hand hygiene and social distancing certainly could have contributed to the decrease in national cases. Additionally, many cases in the United States come from foreigners who live in the US and travel back and forth to their home countries. Since people weren’t traveling much in the last couple years, this risk factor was much less significant.
These factors have contributed to lower disease spread in the area overall. This past winter there was a slight spike in flu cases compared to the year prior, but still incomparable to the rates of previous years. By staying up to date on vaccinations and avoiding large venues and gatherings, all viruses are on the decline.
“Those common sense recommendations really help, they really do make sense,” Levin said.
Levin says that despite the low baseline of TB cases, it’s certainly possible that some cases could have been missed. In 2020, healthcare workers almost exclusively saw COVID cases. People were reluctant to come to the hospital and many people avoided getting checked for diseases unless they were sure it was COVID.
According to infectious disease specialists at Jefferson Health, Dr. Mark Condoluci, there are two types of TB. The first type, active TB, describes patients who have symptoms after exposure. Patients with active TB may experience an ongoing cough, weight loss, fevers, unexplained sweating, and coughing of blood. While the coughing of blood is a common indicator of TB, the other symptoms present similarities with COVID and may explain why some diagnoses were missed.
In the other type of cases referred to as latent TB, a person has been exposed but does not present ongoing symptoms. With latent TB, there is always a chance that the person could develop an active infection if their immune system is compromised by illness, organ failure, or certain medication. Condoluci says that latent TB patients are most at risk for reinfection during their first year after exposure. Then, the odds become less likely with a 1-2% chance of re-infection every year.
While TB cases have been on the decline since COVID, Condoluci mentioned that a phenomenon has been noticed during the span of the pandemic. Some people with latent TB who had severe cases of COVID experienced disease reinfection. Condoluci noted that if those people had been previously diagnosed with TB, the reactivation wouldn’t necessarily count as a new case. In addition, medication used to treat COVID inflammation, like steroids, could further increase reactivation risk.
Even though most people in the South Jersey area don’t have to worry about TB on a regular basis, certain US populations may be more at risk. Areas that have high incarceration rates and high immigration rates tend to experience higher levels of TB. Thus, as the United States transitions back to normalcy and people resume traveling and gathering in large crowds, TB spread could pick up again and spread to other areas in the country.
As for the healthcare system though, Levin predicts that COVID measures will continue to stay in place in medical settings since COVID, like the flu, will most likely continue to exist in some form.
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