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Hanna Kaur , lead nurse for TB services in Birmingham and Solihull and TB representative for the Royal College of Nursing public health forum , explains how difficult it was to keep TB services going at the beginning of the pandemic . She and her colleagues worked around the restrictions but it was difficult to know what to do , she says .
It was not always obvious which guidelines applied to those working with TB , Ms Kaur explains . ‘ All the guidelines were for hospital PPE . We were already working with a very infectious disease and wanted to protect against Covid-19 as well . It was challenging but most services kept running .’
It is vital to have regular contact with patients while they are undergoing therapy for TB , to monitor treatment , check for adverse reactions and complete regimes . Ms Kaur told Nursing in Practice : ‘ Some patients we saw on alternate weeks , or with a teleconsultation to check their symptoms . We also had a couple of patients who needed hospitalisation and were reluctant to go , but did so in the end .’
Health teams are looking to keep TB management and control – like other services – going during the second and any subsequent waves of Covid . Ms Kaur explains face-toface contact is important when a diagnosis is made but says nurses can adapt and use new ways of working for follow-up consultations , such as via teleconsultation or video consultation . But , she stresses , it is important to keep services going . ‘ Treatment interruptions and no concordance will lead to drug-resistant disease ,’ she says .
Six crucial TB symptoms to note
Coughing for more than three weeks and coughing up blood
Weight loss , slow at first and then accelerating Loss of appetite High temperature or fever Night sweats Extreme tiredness or lack of energy
SCIENCE PHOTO LIBRARY decrease compared with the same quarter in 2019 .
In other years , this decrease might well be encouraging . This year , though , it may point to something else . Mike Mandelbaum , chief executive of the charity TB Alert , explains it is likely this lower figure is being ‘ driven primarily by less diagnosis ’. ‘ Either people are not going to the doctor , or they are confusing their symptoms with those of Covid , particularly given that only about half of this is pulmonary TB .’
Mr Mandelbaum adds : ‘ It ’ s very easy to get that wrong .’ He says there is a possibility that social distancing might mean there is ‘ less chance for community transmission ’ of TB . But TB is more usually transmitted in a domestic setting . ‘ Our assumption is that there is probably , as with so many other conditions , a lack of diagnosis . The problem is that it is infectious , so there is a greater risk of infecting others .’
PHE had a five-year strategy for TB until April this year . Mr Mandelbaum has said another strategy is needed , but one that recognises TB needs to be tackled alongside coronavirus . ‘[ The strategy ] needs to be updated ,’ he tells Nursing in Practice . ‘ The impact of Covid-19 on it has to be reviewed ; but , like the previous five-year national strategy it takes a broad holistic view of the pathway and the populations at risk . And that informs the way in which services are designed and delivered .’
2018 showed
13 % of people with TB have a ‘ social risk factor ’, such as a homelessness , a history of substance misuse or time spent in prison
Pre-pandemic For years – before the pandemic – TB has been a priority disease to tackle . While rates are relatively low in the UK , significantly , the proportion of people with additional risk factors has increased . TB is mostly a disease of older people in the UK , and we have an ageing population . But it is also a disease of health inequality and is more common among people who are homeless and people in prison . Social risk is a significant factor in determining who is more likely to get the disease . The rate of TB among the most deprived 10 % of the population is six times higher than among the least deprived , according to official data from 2018 .
‘ The number of cases fell just over 40 % between 2012 and 2018 , before showing a small rise in 2019 ,’ says Mr Mandelbaum . ‘ Within this figure the number of people with social risk factors such as homelessness remained steady , so they were therefore an increasing proportion of overall cases , which suggests the health inequalities in TB have increased .’
Ms Kaur agrees . ‘ Over the years , we ’ ve seen that a wide range of comorbidities mean that complexity of cases has been rising even as numbers were falling .’
Older people with TB in the UK are often people who were exposed many years ago and have only now developed active TB – or they are in families who have moved to the UK from places where the disease is prevalent , such as sub-Saharan Africa , South-East Asia , Eastern Europe and Central America . Around half of the TB is pulmonary and half extrapulmonary . Younger patients tend to be most at risk for severe cases , but ( unlike Covid-19 ) that does not mean that their peers are likely to be infected . TB is not a disease of the playground , it is a disease of the family .
When a child is diagnosed , the first thing clinicians do is look at the adults in the household , because that is where the infection has probably come from . TB is spread by tiny drops of saliva from coughs or sneezes and most people will fight off the infection straight away , but for some it will attack the lungs ( pulmonary TB ) and possibly also other organs ( extrapulmonary TB ). This is known as active TB . Pulmonary TB is infectious , whereas extrapulmonary is not . Other people will develop a form known as latent TB , where the bacteria remain in the body ,
Winter 2021 nursinginpractice . com