At a 1982 tuberculosis conference in Pretoria, one of the presenting doctors stressed that, “while one entertains a high index of suspicion for tuberculosis, one must not forget that there are other conditions which may present in a similar fashion”. Forty years later, that omen looks to have been cruelly turned on its head.
The likely and devastating result, according to some leading tuberculosis experts, is that we have missed swathes of new infections, and possibly even deaths. Bavesh Kana, a director at the Centre of Excellence for Biomedical TB Research, said that the last two years have “seriously compromised the gains we had made with tuberculosis”. South Africa’s long fight against the disease, he said, has been set back “five to seven years”.
Missed diagnoses means missed opportunities to get patients into treatment, contain new infections and interrupt further transmission. This will likely lead to an increase in excess death. Kana, who thinks that a “massive amount” of tuberculosis deaths are already likely wrapped up in the excess deaths usually ascribed to Covid-19, said “we have missed many people we could have saved”.
Those gains may now be under threat. As lockdowns are eased, the number of patients being admitted to Sizwe is already starting to increase. There are many readmissions amongst these patients, which suggests that there have been interruptions to their treatment. With the resultant complications, the hospital’s death rates have also started to climb. There was a time when Louw and her staff were confident they would never again see a 20% death rate. That number recently reached 25%.
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