The Biggest Monster is Spreading. And It's Not The Coronavirus

 Tuberculosis kills 1.5 million people each year. Lockdowns and supply chain distribution threaten progress against the disease as well as H.I.V. and malaria.

It begins with a mild fever and malaise, followed by a painful cough and shortness of breath. The infection prospers in crowds , spreading to people in close reach. Containing an outbreak requires contact tracing, as well as isolation and treatment of the sick for weeks or months.

The  insidious disease has touched every part of the globe. It is tuberculosis, the biggest infectious disease killer worldwide , claiming 1.5 million lives each year.

Until this year , TB and its deadly allies, H.I.V and malaria , were on the run. The toll from each disease over the previous decade was at its nadir in 2018 , the last year for which data are available.

Yet now, as the coronavirus pandemic spreads around the world , consuming global health resources , these perennially neglected adversaries are making a comeback.

Covid 19 risks derailing all our efforts and taking us back to where we were 20 years ago.

It's not just the coronavirus has diverted scientific attention from TB, H.I.V and malaria. The lockdowns particularly across parts of Africa, Asia and Latin America, have raised insurmountable barriers to patients who must travel to obtain diagnoses or drugs, according to interviews with more than two dozen public health officials, doctors and patients worldwide.

Fear of the coronavirus and the shuttering of clinics have kept away many patients struggling with H.I.V , TB and malaria, while restrictions on air and sea travel have severely limited delivery of medications to the hardest hit regions.

About 80 percent of tuberculosis,H.I.V and malaria programs worldwide have reported disruptions in services and one in four people living with H.I.V have reported problems with gaining access to medications , according to U.N. AIDS .

Interruptions or delays in treatment may lead to drug resistance , already a formidable problem in many countries.

According to one estimate, a three month lockdown across different parts of the world and a gradual return to normal over 10 months could result in an additional 6.3 million cases of tuberculosis and 1.4 million deaths from it.

A six month disruption of antiretroviral therapy may lead to more than 500,000 additional deaths from illness related to H.I.V., according to the W.H.O. predicted that in the worst case scenario , deaths from malaria could double to 770,000 per year.

The Global Fund, a public private partnership to fight these diseases , estimates that mitigating this damage will require at least $28.5 billion, a sum that is unlikely to materialize.

If history is any guide, the coronavirus impact on the poor will be felt long after the pandemic is over. The socioeconomic crisis in Eastern Europe in the early 1980's for example, led to the highest rates in the world of a kind of TB that was resistant to multiple drugs, a dubious distinction the region holds even today.

The starting point in this ruinous chain of events is a failure to diagnose. The longer a person goes undiagnosed , and the later treatment begins , the more likely an infectious disease is to spread, sicken and kill.

Across sub-saharan Africa , fewer women are coming to clinics for H.I.V diagnosis. A six month disruption in access to drugs that prevent H.I.V - positive pregnant women from passing the infection to their babies in utero could increase H.I.V infections in children by as much as 139 percent in Uganda and 162 percent in Malawi , according to U.N. AIDS.

Diminished diagnostic capacity may have the greatest effect in TB , leading to dire consequences for households because, like the coronavirus, the bacterium spreads most efficiently in indoor air and among people in close contact.

Each person with TB can spread the disease to another 15 individuals over a year, sharply raising the possibility of people infected while indoors spreading it among their communities once lockdowns end.

The prospect is especially worrisome in densely populated places with high rates of TB.

The more you leave undiagnosed and untreated, the more you will have next year and year after .

TB is the biggest monster of them all. If we are talking about deaths and pandemics, 10 million cases a year, Covid doesn't compare yet to that toll.

The pandemic has hindered the availability of drugs for H.I.V , TB and malaria worldwide by interrupting supply chains, diverting manufacturing capacity and imposing physical barriers for patients who must travel to distant clinics to pick up the medications. And these shortages are forcing some patients to ration their medications, endangering their health.

People with H.I.V and TB who skip medication are likely to get sicker in the short term. In the longterm there's an even more worrisome consequences, a rise in drug resistant forms of these diseases. Already drug resistant TB is such a threat that patients are closely monitored during treatment, apractice that has mostly been suspended during pandemic.