The potential impact of COVID-19-related disruption on tuberculosis burden.

Before the COVID-19 pandemic, over 4000 people were dying from tuberculosis (TB) every day [1]. As with past emergencies [2], the impact of COVID-19 on TB outcomes is a serious cause for concern [3] but is currently unknown. Health systems overload, due to high numbers of COVID-19 cases, as well as interventions necessary to limit the transmission of SARS-CoV-2, could result in severe reductions in health service availability and access for the detection and treatment of TB cases [4]. However, physical distancing interventions could also limit Mycobacterium tuberculosis transmission outside of households, where most transmission occurs [5]. This has not been adequately explored in existing work [6–8], and it is currently unclear whether social distancing could compensate for disruptions in TB services, and what the impact of these combined COVID-19 disruption effects on TB burden is likely to be. CFM was funded by the Bill and Melinda Gates Foundation (TB MAC OPP1135288). RGW and NM were funded by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement that is also part of the EDCTP2 programme supported by the European Union (MR/P002404/1) and and ESRC (ES/P008011/1). RGW was additionally funded by the Bill and Melinda Gates Foundation (TB Modelling and Analysis Consortium: OPP1084276/OPP1135288, CORTIS: OPP1137034/OPP1151915, Vaccines: OPP1160830), UNITAID (4214-LSHTM-Sept15; PO 8477-0-600). RMGJH was funded by an European Research Council Starting Grant (action number 757699). The funding sources had no role in the study or decision to submit the paper for publication. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.