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Now published in The Lancet

The Potential Impact of the COVID-19 Pandemic on the Tuberculosis Epidemic: A Modelling Analysis

24 Pages Posted: 14 Jul 2020

See all articles by Lucia Cilloni

Lucia Cilloni

Imperial College London - MRC Centre for Global Infectious Disease Analysis

Han Fu

Imperial College London - MRC Centre for Global Infectious Disease Analysis

Juan F. Vesga

Imperial College London - MRC Centre for Global Infectious Disease Analysis

David Dowdy

Johns Hopkins University - Department of Epidemiology

Carel Pretorius

Avenir Health

Sevim Ahmedov

United States Agency for International Development (USAID) - Bureau for Global Health

Sreenivas A. Nair

Stop TB Partnership

Andrei Mosneaga

Stop TB Partnership

Enos Masini

Stop TB Partnership

Suvanand Sahu

Stop-TB Partnership

Nimalan Arinaminpathy

Imperial College London - School of Public Health

More...

Abstract

Background: Routine services for tuberculosis (TB) are being disrupted by stringent lockdowns against the novel SARS-CoV-2 virus. We sought to estimate the potential long-term epidemiological impact of such disruptions on TB burden in high-burden countries, and how this negative impact could be mitigated.  

Methods: We adapted mathematical models of TB transmission in three high-burden countries (India, Kenya and Ukraine) to incorporate lockdown-associated disruptions in the TB care cascade. The anticipated level of disruption reflected consensus from a rapid expert consultation. We modelled the impact of these disruptions on TB incidence and mortality over the next five years, and also considered potential interventions to curtail this impact.  

Results: Even temporary disruptions can cause long-term increases in TB incidence and mortality. We estimated that a 3-month lockdown, followed by 10 months to restore normal TB services, would cause, over the next 5 years, an additional 1.65 million TB cases (Crl 1.49– 1.85) and 438,000 TB deaths (CrI 403 – 483 thousand) in India, 41,400 (28,900–62,200) TB cases and 14,800 deaths (10.5 – 19.2 thousand) in Kenya, and 7,960 (6,250 – 9,880) cases and 2,050 deaths (1,610 - 2,360) in Ukraine. However, any such negative impacts could be averted through supplementary “catch-up” TB case detection and treatment, once restrictions are eased.  

Interpretation: Lockdown-related disruptions can cause long-lasting increases in TB burden, but these negative effects can be mitigated with targeted interventions implemented rapidly once lockdowns are lifted.

Funding Statement: USAID and Stop TB Partnership.

Declaration of Interests: The authors declare no conflict of interest.

Keywords: tuberculosis; mathematical modelling; infectious diseases; Covid-19

Suggested Citation

Cilloni, Lucia and Fu, Han and Vesga, Juan F. and Dowdy, David and Pretorius, Carel and Ahmedov, Sevim and Nair, Sreenivas A. and Mosneaga, Andrei and Masini, Enos and Sahu, Suvanand and Arinaminpathy, Nimalan, The Potential Impact of the COVID-19 Pandemic on the Tuberculosis Epidemic: A Modelling Analysis (5/22/2020). , EClinicalMedicine, Volume 28, 100603, November 01, 2020, https://doi.org/10.1016/j.eclinm.2020.100603, Available at SSRN: https://ssrn.com/abstract=3612125 or http://dx.doi.org/10.2139/ssrn.3612125

Lucia Cilloni

Imperial College London - MRC Centre for Global Infectious Disease Analysis ( email )

London, W2 1PG
United Kingdom

Han Fu

Imperial College London - MRC Centre for Global Infectious Disease Analysis

London
United Kingdom

Juan F. Vesga

Imperial College London - MRC Centre for Global Infectious Disease Analysis ( email )

London
United Kingdom

David Dowdy

Johns Hopkins University - Department of Epidemiology

MD
United States

Carel Pretorius

Avenir Health

Glastonbury, CT
United States

Sevim Ahmedov

United States Agency for International Development (USAID) - Bureau for Global Health

1300 Pennsylvania Avenue NW
Washington, DC 20577
United States

Sreenivas A. Nair

Stop TB Partnership

Geneva
Switzerland

Andrei Mosneaga

Stop TB Partnership

Geneva
Switzerland

Enos Masini

Stop TB Partnership

Geneva
Switzerland

Suvanand Sahu

Stop-TB Partnership

Geneva
Switzerland

Nimalan Arinaminpathy (Contact Author)

Imperial College London - School of Public Health ( email )

London
United Kingdom

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