What is the impact of COVID-19 era on annual tuberculosis notifications in India? A comparative study (2017-2022)
Authors: Kumar Piyush , Anupama Advocate , Singh Harshika 
Published: February 2023

Abstract
Globally Tuberculosis (TB) is 13th leading cause of mortality and the 2nd leading infectious killer after COVID-19, 1.6 million people died in 2021 from TB (including 187 000 people with HIV). The emergence of COVID-19 pandemic situations on the already overburdened health care system of India may have affected new TB cases notification as well as treatment, setting back the previous achievements made to eliminate TB by 2025. Lockdown-induced under-reporting (80% reduction in TB notification rates) of active TB will affect TB epidemiology as well as NTEP (National Tuberculosis Elimination Program) elimination goal by 2025. There are significant studies which found that COVID-19 is promoting the growth of active tuberculosis in a patient with dormant/latent tuberculosis infection. In the COVID-19 epidemic, diagnosis and treatment of tuberculosis, or tuberculosis and the co-infection with COVID-19, may be compromised as TB and COVID-19 both present with respiratory symptoms that are similar to each other. According to the 2019 India TB Report, 2, 24,000 incident cases per year of paediatric TB are estimated accounting for 22% of global burden. In spite of many similarities and differences, there is still a lack of clarity about the exact epidemiological relationship between COVID-19 and TB. This was a cross-sectional, retrospective, quantitative; research study aimed to know the impact of COVID-19 era on TB (tuberculosis) notifications in India (includes all 36 states and UTs of India). All the 36 participants’ states and UTs newly detected tuberculosis cases notifications were followed from 1st January 2017 to 31st December 2022. The total number of newly detected tuberculosis cases notifications from 1st January 2017 to 31st December 2022 was 12290180 (n) including all 36 participants. The (period prevalence) total number of newly detected tuberculosis cases notifications during pre-COVID-19 era (2017-2019) was 5914621 and during the COVID-19 era (2020-2022) were 637559. The total annual newly detected tuberculosis cases notifications (including public and private healthcare facilities) in India including all 36 participants from beginning of year 1st January till 31st December during a year were 1525045, 1997873, 2391703, 1810834, 2145678, 2419047, for years 2017, 2018, 2019, 2020, 2021, and 2022 respectively. The mean of newly detected tuberculosis cases notifications from all public and private healthcare facilities during Pre-COVID-19 era (2017-2019) was 164295 (Std. Err. - 37404.92; [95% Conf. Interval] - 88359.01- 240231; Std. Dev. - 224429.5). The mean of newly detected tuberculosis cases notifications from all public and private healthcare facilities during COVID-19 era (2020-2022) was 177098.9 (Std. Err. - 43081.17; [95% Conf. Interval] - 89639.43 -264558.3; Std. Dev. - 258487). The incidence rate of newly detected tuberculosis cases notifications per lakh population was 112.62; 145.94; 172.92; 129.68; 152.44; and 169.63 respectively for years 2017, 2018, 2019, 2020, 2021, 2022. This research study revealed that the incidence rate of newly detected tuberculosis cases notifications per lakh population kept on increasing during the pre-COVID-19 era and it decreased abruptly during the first COVID-19 year 2020 by 25.00 percent (%) compared to previous year of pre-COVID-19 era 2019.