A 25 per cent fall in India’s counts of new tuberculosis patients during the first half of 2021 compared with the corresponding period in 2019 indicates trouble with the country’s efforts to juggle its resources for Covid-19 and TB, health experts have said.

The national TB control programme had registered 995,639 patients from the government and private sector between January 1 and July 12 this year, about 25 per cent of the 1.33 million notified in the same period in 2019, or the pre-Covid-19 era.

The fall in notifications has stirred concerns among public health experts that many TB patients could remain undiagnosed and untreated, which could cause their illness to worsen while posing the threat of infection to the people around them.

The impact of the Covid-19 pandemic had reduced India’s TB notifications last year, too. But doctors and public health experts had hoped that special efforts and guidelines to manage both Covid-19 and TB circulated in August last year would have increased notifications this year.

The guidelines from the Union health ministry had recommended “bi-directional screening” — testing for TB in all Covid-19 patients who also have symptoms of tuberculosis (cough or fever for two weeks or longer, weight loss and night sweats) and testing all TB patients for Covid-19.

“Bi-directional screening could turn a challenge into an opportunity — if done well, it would help increase TB detection and notifications. But the data so far and ground reports suggest that implementation has been frightfully low,” said a health expert who requested anonymity.

The number of new TB cases notified so far this year is slightly lower than the 1,000,580 cases notified between January 1 and July 12 in 2020. After sharp falls in registrations during the early months of the pandemic last year, the numbers had increased.

India had detected around 174,000 new TB cases in December 2020, close to around 179,000 patients registered in December 2019. But as Covid-19 counts began to rise after mid-February this year, doctors say, diagnostic services for TB patients weakened again.

“Many private clinics closed down, and people would also have had difficulty with finding transport to reach diagnostic centres,” Nita Jha, a Patna-based public health expert with the non-government World Health Partners, who is tracking access to TB care in Bihar, told The Telegraph.

Jha and other experts said the diversion of staff and diagnostic equipment for Covid-19 has also likely contributed to the fall in notifications. During April and May this year, the country registered around 206,000 TB patients, a 53 per cent decline from over 443,000 patients in April-May 2019.

The Covid-19 crisis and its consequences may “derail” India’s target to eliminate TB by 2025, Digambar Behera, a pulmonary medicine specialist had cautioned in a commentary earlier this year in the Indian Journal of Medical Research.

The TB elimination target seeks to reduce India’s incidence of the disease from 217 per 100,000 population in 2015 to below 77 per 100,000 by 2025 and reduce deaths from tuberculosis from 32 per 100,000 in 2015 to less than 3 per 100,000 by 2025.