By Franco Spinetta. Diary Z
Tuberculosis (TB) is reputed to be a disease of the past. However, “el Muñiz”, the huge Hospital for Infectious Diseases in the Parque Patricios neighborhood, was forced to open an extra room due to the strong growth in hospitalizations for tuberculosis.
Consultations for symptoms compatible with TB grew by around 40 percent compared to those arriving at the hospital before the pandemic. Confirms it to Diary Z Domingo Palmero, head of the Muñiz Pneumotysiology Division, professor at the UBA and the Universidad del Salvador, and consultant for the World Health Organization.
We are admitting very serious cases. I have been treating tuberculosis for 40 years and when I was studying, the professor would show us one of these cases as an exception.
Domingo Palmero, head of the Vaccarezza Institute
Palmero directs the Instituto de Tisioneumonología Vaccarezza, a reference center that operates in Muñiz. “We are admitting very serious cases, with multiple locations of the disease. I have been treating tuberculosis for 40 years and when I was studying, the professor would show us one of these cases as an exception. Today nothing surprises us anymore ”, he assures.
What is the situation today?
When we talk about tuberculosis, we have to differentiate between pre-pandemic and post-pandemic, assuming that we are now at that stage. From 2012 onwards, tuberculosis cases have been on the rise. Half are concentrated between the City and the suburbs, where people come and go. There are also many cases in Salta and Jujuy. Until the pandemic, the incidence of cases had been increasing progressively, with about 12 thousand cases per year. With mortality, the same thing happened, in recent years it rose slightly. Until the pandemic.
And what happened in the pandemic?
The isolation began, people stayed at home, the health system was doomed to Covid and the rest of the pathologies took a back seat: oncological, cardiovascular and, among them, tuberculosis. People were afraid to go to hospitals for fear of catching it. This resulted in lack of consultations, abandonment of treatments and even diagnostic errors. There were cases of people who had a cough, they approached the health center, they swabbed them and they tested negative. The symptoms continued, and later we began to see severe cases. When the isolation was finished, the patients began to return.
What was the impact on the Muñiz?
We had a tuberculosis ward for men and one for women. The hospitalization center for this pathology is called the Koch Pavilion, but during the pandemic it was remodeled for covid. There are 150 beds. Now the covid has fallen notably, but today it is populated with tuberculosis. We had to open two men’s tuberculosis wards, which have become full.
The patient usually does not have food or shelter, or many live in a single environment. They are sectors for which a cough in the family is the last of the problems.
Domingo Palmero, Vaccarezza Institute
Are they serious cases?
The most striking thing, in addition to the number of cases, is that they are serious, very serious cases, disseminated forms of the disease that advanced during a whole year of pandemic. The consequences are dire. The WHO denounced that last year there was a global increase in deaths from tuberculosis, around 100,000 more. Now, surely this year and next year will see the real increase in tuberculosis cases. In March of this year, an organization called Stop Tuberculosis, which depends on the UN, synthesized in one sentence what is happening: In 12 months of pandemic, tuberculosis control in the world was delayed 12 years. It is a global problem, not just Argentine.
Beyond the complications in the pandemic, why have tuberculosis cases increased for 10 years?
The problem is that many think it is a disease of the past. But tuberculosis is associated with social vulnerability, and vulnerability has been increasing progressively since the 2001 crisis, with ups and downs.
Tuberculosis exists, it is not from the past. Cough, cold and phlegm for 15 days must motivate the consultation to the doctor, who in turn has to understand that tuberculosis exists.
Domingo Palmero, Vaccarezza Institute
What is the patient’s profile?
The patient usually does not have to eat, does not have a home or has a precarious home where many live in a single environment. They are sectors for which a cough in the family is the last of the problems. They keep going because their problems are different. In the middle sectors, a chronic cough or fever quickly leads to a consultation. The profile of the patient that we hospitalize is people living on the streets, people who have no family or who are neglected due to various problems, there is a lot of drug addiction as well. This is a factor that complicates the treatment because the only priority of the addict is to consume, unfortunately they relapse and stop being treated. So we have poverty, addictions, vulnerability in general. It is the population that we mainly serve.
Doesn’t the growth in cases have to do with a lack of vaccination?
Tuberculosis has a problem. The only vaccine that exists is from 1921, BCG turned 100 years old. It is a vaccine that protects against tuberculous meningitis and disseminated forms, but not so much on pulmonary forms. Protection is 60 percent. A population vaccinated with BCG will have fewer cases, but it does not mean eradication of the disease.
What is the survival in severe cases?
It is very variable. It depends on how advanced the disease is and the immune response. An advanced form in an HIV positive patient has a high mortality. In an immunocompetent person, it has an expectation of one or two years. In the pre-antibiotic era, 25 percent of the patients cured themselves, 25 died in a matter of months, another 25 died after a year, and the last 25 percent remained chronic, eliminating bacilli and infecting them. That happened between 1930 and 1940. A person who is not treated today is as if he were at that time. We are seeing that people with tuberculosis infected their nucleus a lot, we have a focus control that we do from the hospital. The problem is that this disease is often not symptomatic, but it is contagious. It is very difficult to eradicate.
Is it possible then that there will be a greater report of tuberculosis in the coming years?
Yes, definitely. I’m not saying it, the WHO says it. An institute of Tisioneumonology, the Vaccarezza, operates on the Muñiz estate. There the care of tuberculosis patients in the first year of the pandemic fell by half. And now it’s going up. They come to do the consultation and many have to be admitted. We are admitting very serious cases. It amazes us. I have been treating tuberculosis for 40 years. When I was studying, the professor would show us a case of these as an exception. They are very serious cases, with multiple locations of the disease, with months of evolution. The issue is serious.
Argentina has an excellent tuberculosis control system, the first in Latin America. The problem is that with the pandemic an iceberg was formed that is now emerging.
Domingo Palmero, Vaccarezza Institute
Compared with the pre-pandemic, how much did the proportion of hospitalized patients go up?
What we see in the Muñiz and in the Vaccarezza is 40 percent more patients, at least. Those who are admitted are serious cases. Tuberculosis, in general, does not require hospitalization and its treatment is outpatient. It is the reality that we are living in and we will probably have to put up with this for a couple more years. Argentina has an excellent tuberculosis control system, the first in Latin America, and drugs are available. The problem is that with the pandemic an iceberg was formed that is now emerging.
What message do you give to the population to promote prevention?
The message is: tuberculosis exists, it is not a disease of the past. Cough, catarrh and phlegm that lasts more than 15 days must motivate the consultation of the doctor, who in turn also has to understand that tuberculosis exists. In the medical community, especially in the private area, they have the idea that tuberculosis is a rare disease. The metropolitan area, the City and the suburbs, is the most worrying area.