Tuberculosis rising after COVID-19 pandemic redirected services, say Canadian health officials

Canada's longstanding efforts to reduce and eliminate tuberculosis suffered a setback as a result of the COVID-19 pandemic, according to Canadian health officials.

The ability to offer crucial services such as contact tracing, prevention, early diagnosis, treatment and care for tuberculosis were reduced as resources were redirected to fight the COVID-19 pandemic, said Dr. Tom Wong, chief medical officer of public health for Indigenous Services Canada.

"All of those have contributed to, in some areas, stalling of the progress made or in some cases reversing the downward trend of TB," Wong said.

Tuberculosis is a treatable and curable disease caused by bacteria that frequently affects the lungs, but can also live in other parts of the body. In Canada, it kills about five per cent of those infected. In 2020, 10 percent of active TB cases were resistant to TB drugs.

Across the country, several areas have seen recent increases in cases, especially in Inuit and First Nations communities, losing ground after years of progress.

Saskatchewan, for instance, has seen its annual number of TB cases rise from 67 in 2019, to 144 in 2022. Of those cases, 44 per cent were among children in northern First Nations communities.

"In our region we have the highest rates in our province," said Tina Campbell, a registered nurse and tuberculosis advisor with the Northern Inter-Tribal Health Authority in Prince Albert, Sask.

The health authority is responsible for 33 First Nations communities where there are currently three declared tuberculosis outbreaks.

In 2020, Campbell said, there were 16 TB cases across all of the communities. In 2022, that number rose to 72.

"Before COVID, TB programs in Canada and globally were starting to see a decline because of the efforts of health care practitioners responding to outbreaks and to cases everywhere," said Campbell.

But limitations from the pandemic – including lockdowns and staffing issues – hampered those efforts. In northern Saskatchewan it meant most cases were diagnosed only when people presented to health centres or hospitals, resulting in lower case counts, Campbell said.

Now that more intensive contact investigations have picked up again, case counts are rising.

"The numbers did increase. We did identify more active TB because we were physically in the community doing the investigation," Campbell said.

Campbell said those investigations are a major undertaking that take a lot of coordination between the health authority and the communities.