Ending the stealthy killer

by Admin-Phmp

Text by Henrylito D. Tacio

Photo: medicinet.com

What was touted to be a disease of the past, tuberculosis (TB), has remained still taking a toll among Filipinos.

In the Davao region, for instance, TB is still “a health concern,” despite the availability of medicines that can treat the disease. About 12,890 TB cases had been recorded by the regional office of the Department of Health (DOH) as of February 2017.

In South Cotabato, health personnel “have detected nearly 200 new TB cases in the past several months as it continued to expand its surveillance in the province’s 10 towns and lone city,” Philippine Daily Inquirer reported last May 31.

In 2020, the global TB report of the UN World Health Organization (WHO) said the Philippines has “the highest TB incidence rate in Asia, with 554 cases for every 100,000 Filipinos.”

Last year, the DOH predicted that over 100,000 Filipinos may die of TB “in the next five years” – 20,000 TB deaths annually – “if TB services continue to be disrupted by mobility restrictions brought about by COVID-19.”

A modeling study done by the Imperial College of London projected between 65,100 to 146,300 TB deaths may happen if local TB services remain limited in another year. Thank God that COVID-19 cases went down early this year, and we will soon be back to normal.

Pandemic or no pandemic, the Philippines needs to bring down TB cases. If other countries were able to do it, why can’t our country accomplish it? What are some of the obstacles to attain the goal?

A study, which was published in The Lancet, noted: “In the Philippines, where nearly 10 million people reside in urban slums, social determinants are major drivers of tuberculosis in endemicity.”

The study cited the local 2019 TB Program Review showing “how vulnerable populations – the urban poor, people living with HIV (human immunodeficiency virus), and people deprived of liberty – are more susceptible to infection and worse treatment outcomes.”

Worldwide, TB is the 13th leading cause of death and the second leading infectious killer after COVID-19, according to the UN health agency. The Philippines is among the 30 high TB burden countries.

In 2020, an estimated 10 million people (5.6 million men, 3.3 million women, and 1.1 million children) fell ill with TB worldwide, the WHO reports. No country is spared from it, and age doesn’t matter either.

TB was once romanticized as the “artist’s disease,” having affected such famous people as Antoine Watteau, Amadeo Modigliani, Carl Maria von Weber, Frederic Chopin, Anton Chekhov, Henry David Thoreau, and William Somerset Maugham.

Two famous leaders who died from it were Mahatma Gandhi and our very own Manuel L. Quezon. TB was also featured in countless 19th-century poems, paintings, and novels.

TB has existed since at least 2000 BC, as shown by TB tubercles found in mummified bodies. References to TB can be found in the writings of ancient Babylonia, Egypt, and China. The term “tuberculosis” was first used in 1839, and it is derived from the Latin word tubercula, meaning small lump, referring to the small scars seen in tissues of infected individuals.

There is nothing a person can do to not get TB. You can change your behavior to lower the risk of being infected with HIV, but you cannot stop breathing.

Carried in sputum droplets, the TB bacteria – like the coronavirus – are transmitted through the air. Even getting into a taxi that was occupied by a TB patient three hours before can lead to infection. 

“TB is spread from person to person through the air,” the WHO says. “When people with TB cough, sneeze, or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected.”

Yes, that’s how infectious TB is. About one-quarter of the world’s population has a TB infection, which means they have been infected by TB bacteria but are not (yet) ill. Fortunately, these people cannot transmit the disease.

“People infected with TB bacteria have a 5-10% lifetime risk of falling ill with TB,” the WHO says. “Those with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a higher risk of falling ill.”

Common symptoms of active lung TB are cough with sputum and blood at times, chest pains, weakness, weight loss, fever, and night sweats.

“When a person develops active TB disease, the symptoms may be mild for many months,” the WHO says. “This can lead to delays in seeking care, and results in transmission of the bacteria to others.”

People with active TB can infect 5-15 other people through close contact over the course of a year. Without proper treatment, 45% of these people with TB will die. Nearly all HIV-positive people with TB will succumb to the disease.

Fortunately, TB is curable and preventable. An estimated 66 million lives were saved through TB diagnosis and treatment between 2000 and 2020, the WHO reports. Ending the TB epidemic by 2030 is among the health targets of the UN Sustainable Goals.

“Active, drug-susceptible TB disease is treated with a standard 6-month course of 4 antimicrobial drugs that are provided with information and support to the patient by a health worker or trained volunteer,” the WHO says. “Without such support, treatment adherence is more difficult.”

Health Secretary Francisco T. Duque III urged Filipinos to help fight the disease. “Let us end the stigma associated with tuberculosis,” he said. “TB is a treatable disease, and we can prevent deaths and possible outbreaks if TB is detected and treated early.” 

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