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November 2021, Volume 71, Issue 11

Letter to the Editor

The positive impact of COVID-19 on Tuberculosis endemic areas

Farhan Ali  ( Department of Internal Medicine, Dr Ruth K.M Pfau Civil Hospital, Dow University of Health Sciences, Karachi, Pakistan. )
Kashif Ali  ( Department of Internal Medicine, Dr Ruth K.M Pfau Civil Hospital, Dow University of Health Sciences, Karachi, Pakistan. )

Madam, Tuberculosis (TB) is a primary disease of lungs, and it can affect any part of the body. It is caused by the bacterium called Mycobacterium tuberculosis (MT) and has an aerosol spread from person to person as when someone coughs, sneezes, speaks or sings.1 According to data from the World Health Organization (WHO), nearly 1.8 billion people are infected with MT, and it is estimated that 1.5 million people died last year.2 TB has a huge financial burden on the developing world, especially those that are still in financial crises. It is stated in literature that there are some twenty-two countries which are considered to be "High Burden" Countries (HBCs) for TB. Pakistan is also in the list of HBCs, and a global survey for TB statistics was done in 2018, in which Pakistan contributes around 6% of TB cases in the world. It is estimated that approximately 562,000 people were infected with TB in Pakistan in 2018, and nearly 42000 people died of it.3

Pakistan has a population of 212.2 million, and that makes it the fifth populous country in the world.4 Owing to the high population, there is a huge load on the hospitals of Pakistan, especially those cities that are overpopulated.

We are working in Ruth KM Pfau, Civil Hospital, a tertiary care hospital in Karachi, Pakistan, where 7000-8000 people come to the outpatient department (OPD), with almost 1000 patients attending the accident and emergency department (ER) each day. As known, TB spreads through infected droplets, and high inflow of patients in OPD and ER could increase the risk of spread of TB whenever an infected patient coughs, or sneezes in the waiting area, or facing the health care workers.

Before the COVID-19 pandemic, there was no social distancing practiced between patient to patient and patient to health care workers or wearing of any protective gears like masks, gloves by health care workers. This caused them to be exposed.

During the pandemic, we practiced social distancing and wearing of protective gear: mask and gloves, which helped us not only to prevent coronavirus but also TB.

Coronavirus also spreads similarly as TB, and the world has successfully curbed on COVID-19 through the implementation of strict and effective standard operating procedures (SOPs). This gives a promising result to the world as to how an infectious disease which spreads through air droplets, can be restrained.

TB endemic countries can also apply this method to eliminate TB that was applied for the coronavirus. Social distancing and wearing masks must be mandatory for all people who are coming to OPD or ER because the hospital is the main source of the spread of TB to others.

There should be triage areas in OPD and ER to segregate those with symptoms of TB: Fever, Cough, weight loss. If these measures are taken, there will be a significant drop in the number of TB cases.


Disclaimer: None.

Conflict of interest: None.

Funding disclosure: None.





1. 2021. How TB Spreads. [Online] [Cited  2021 July 12]. Available  from: URL: howtbspreads.htm.

2.      TB Alliance. A Global Threat. [Online] [Cited 2021 May 20]. Available from: URL:

3. [Online] [Cited 2021 January 25].Available from: URL:

4. Pakistan Population (2021) - World meter. [Online] [Cited 2021 April 22]. Available from: URL:


Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: