TB, COVID-19 Testing Facilities Are Available, Treatment Is Free – Dr Aboki

Dr. Danjuma Aboki is the State Coordinator for TB, Leprosy and Buruli Ulcer. He recently spoke on issues surrounding Tuberculosis and Covid-19. Here is how the interview went.

We will like to enlighten the general public through you to understand the similarities, the difference, whatever connects TB and COVID-19 for prevention and the rest. Are the symptoms of COVID-19 and Tuberculosis similar?

There are similarities and there are differences. I will start with TB. First and foremost, TB as we know it is a chronic airborne disease. And the organism that causes it is called a bacterium. It is chronic in the sense that it starts gradually and continues for a long time. One funny thing about it is that for TB, the treatment modalities are different and it takes some time to treat TB.

TB is characterised by fever. I will like to present some of the signs and symptoms of TB. We have fever. The fever can be intermittent or continuous; whichever one. We have weight loss where you find out that a victim continuously loses weight. We have cough which is considered number one. If at all they don’t know any sign and symptom of TB, they will know cough because the disease mostly affects the lungs. We have what we call night sweat. And sometimes we have people who don’t have the urge to eat – loss of appetite.

And it is transmitted through the air. That is the vessel that conveys it. The mode of transmission is through the air. Maybe later I will come to how it is contracted.

Then, when we are talking of COVID-19, the organism that causes it is a virus. It is not a bacterium. Also, it is inhaled. Air is also the vessel of transmission. It gets to the lungs. You can also have fever which you also find in TB and when there is cough and sneezing which is very frequently found in COVID-19. So, the fever is there and you can have body pains.

All I can say is that the mode of treatment for COVID-19 and TB are different. Prevention is almost the same because you need to prevent yourself from inhaling these organisms. So, what do you do? You can see now that we use facemasks. In fact, it is COVID that came that people started using facemasks more than with TB. But with TB, when you are in contact with someone who has TB and you know that the person has it, you just give yourself some distance and observe some precautionary measures and you are done.

So, the organism that causes COVID-19 and the one that causes TB are different. And you know, when we are talking of viruses, sometimes viruses are very difficult to deal with. Let me site an example – though out of it – when we are talking of HIV, there is no cure for that. It is a virus. But for bacteria, whichever type of bacterium you have, if you treat it well, you get cured.

Given that some of these symptoms are similar, what symptoms should one look forward to know if he or she has either TB or COVID-19?

Let me start with COVID-19. There are some striking features for COVID-19. You can have general body pains. You could have sneezing which is also common there. You find out that you are having running nose and cough. And the cough may not be productive but in TB it is common that you may have cough whereby you produce sputum.

So, if it is COVID-19, of course fever will be there. So, the best thing to do when you have these features of sneezing and continuous coughing that is unproductive which could be sudden, TB is a chronic thing. It comes gradually. But you may wake up to find out that you have started sneezing, you have headache, body pains and other features that may come. You may also have breathing difficulty. The thing one needs to do is to go for test. If you rule out TB, you can go for COVID-19 test. And the tests are available. The test will tell you whether it is COVID-19 or TB. And there are different tests.

Regarding the test you just mentioned; do you get tested at the same point or one will have to check for COVID here then go to another place to test for TB?

We have what we call integration of services and it is very, very important. What happens now is we have facilities where you can have test for TB and also there are services where you can test for COVID-19.

Like in some of our laboratories, the machine that is used to test for TB can also be used to test for COVID-19. But the difference is that the cartridge for TB is different from the one for COVID-19 test. And now we have what is called PCR. So, when you subject this to test for TB, coming to COVID-19 it has a different cartridge but it can be in the same laboratory. The same person can conduct test for TB and for COVID-19 but the modalities and how it is done is left for the experts. But they can use a common facility.

Are there similarities? And if there are, what are the similarities in how COVID-19 and TB spread?

I mentioned it earlier. It is airborne. You inhale it through the nose. You know I mentioned facemask earlier and how people wear the facemask is another topic on its own. We need to correct that because if you don’t wear it correctly, you are not free from it.

But let me mention this, 80 percent of TB cases are TB that affect the lungs. The other 20 percent are those that affect other parts of the body. So, we have pulmonary tuberculosis that affects the lungs alone and then we have the extra-pulmonary which affects the intestine, urinary tract, abdomen, the brain and any part of the body can be affected. But that one is just 20 percent.

So, the transmission is airborne just as is the case of COVID-19. All of them are transmitted over the air not by touch. That is why you are advised to wear your facemask and when you are with someone that has the disease, you should be careful the way you relate with them.

We try as much as we can to avoid clients or patients being stigmatized. That is another dangerous trend. So, what we do is to make sure that if you are handling TB, we know you are handling TB. If you are handling COVID, we know you are handling COVID.

But also know that someone who has TB can also have COVID. And also, somebody can have TB, COVID and HIV. And we have in one of the States, a child of eight (8) years old who had these three.

You said one can have TB and also have COVID. If one is on TB treatment, is there any guidance or recommendation for such a person if he/she gets infected COVID-19?

If you get infected with COVID-19 and you have TB, we have experts who have been trained on how to handle such cases. You know, it is double barrel to have COVID and to have TB and God help you if you have HIV also. So that means three areas coming together. You need experts coming together.

Such patients can be treated actually with antiretroviral drugs for HIV and also drugs for COVID and also drugs for TB. I am bringing the three though you asked for two to tell you that even if the diseases are three or more, if we call specialists from different fields, they will know how to handle that problem.

How deadly is COVID-19 compared to TB?

I will not like to comment much about data and statistics. I will like to mention that for TB, the death rate for TB patients is not as bad as it was but for those that have TB and HIV, the death rate is more. I don’t want to give a figure.

If we are talking about the death rate for TB in this State, we can talk of 12 percent. But most of our patients that die have TB and HIV.

For COVID-19, we have a focal person who can give an insight into that. I don’t want to go into that because I just mentioned my own area that I know very well. But there is supposed to be collaboration between TB and COVID-19. But for the State, those that have COVID-19 and TB, I believe are not much. We have a few.

Is one who has recovered from TB at greater risk of getting infected with COVID-19?

Not quite because if you are treated for TB and you get cured, you can still get the infection. It is not as if when you are treated and you get cured you cannot get it. If you don’t observe the precautionary measures that are supposed to be taken, you can have it. It is possible that you get cured for a disease and still contract it, especially diseases that are airborne. I can give you an example with malaria. If you are treated for malaria and you get cured, it doesn’t mean you cannot still get it.

For COVID, if you get treated and you are cured, it doesn’t rule out that you will not even have it again. If you don’t obey the modalities on prevention, you can still have the infection. It is not as if it gives an immunity that will stop you completely from getting the infection though I know there is vaccination now and it helps a lot so that those that don’t have it will not have it. But you never say never when it comes to medicine because those who had it can still have it even after they are cured. So, it is not a 100 percent assurance that if you get cured you will not have it or you that was treated for TB and were cured will not have COVID-19. You can have it.

Talking about treatment, we keep reading and hearing about new methods of treatment and novel ways to protect oneself from COVID-19. How do we know if they are true? Even though you said your area of specialty is TB.

You know COVID-19 is a recent development and researches are going on. As I speak, there are drugs that are used to treat COVID-19 and patients get cured. Yes, there are new developments and probably the drugs we started with will not be the drugs we will be using in the next five years.

For example, for TB, when we started treating it, the modalities for treatment of TB are different from what we have today. And what we have today is more effective. There are more effective drugs that we use that are more patient friendly, that are less costly and they put less stress on the patient. That is the essence of science, to make life better and more bearable for the patient.

For COVID treatment, yes, we have treatments and people get cured actually. But if researches are going on to improve the modalities of treatment, it is a good thing. But I can’t deny the fact that researches are going on and I believe that in times to come, the modalities for treatment will be different from what is being done now for more effectiveness and so that patients can get cured within the shortest period and probably give long lasting immunity.

Is it necessary for a TB contact to still take TB preventive therapy?

For TB, for now we don’t have vaccination for TB. What I will say here is that the BCG that is given to children, we advise that parents do that. Why am I saying that? It gives them an immunity that will stop them from getting very sick when they have TB infection. You know, we have what is called TB infection and TB disease. So, for children that have taken the BCG, even if they get the TB, it will not be as bad as if they had not taken it.

But for adults, we don’t have anything. If you had BCG when you were a child, it is a plus to you. But as you grow as an adult, we do not have any specific vaccination for TB. The only prevention is for you to take care of yourself, windows should be opened, overcrowding should be discouraged and other things that you need to do so you don’t get the disease. But we don’t have vaccination for TB.

For a layman, while you were talking, you spoke about bacteria and virus. We would like you to say a little more about the differences and how an ordinary person can protect himself and not get infected by either of these two.

It is just to say that prevention against TB and any viral disease. I said TB is a bacterial infection. Structurally, those that have studied biology know that the structure of a bacterium is different from that of a virus. For a bacterium, based on the structure, the cell membrane and the internal structures, drugs that are taken for this organism can easily penetrate. And these bacteria, when they affect a cell, they don’t go and penetrate into the cell. Even if they do, they lie at the periphery. That is for bacteria. That is why drugs can easily get to them.

But for a virus, it is very stubborn. The virus goes into the cell right into what we call the nucleus that even drugs cannot go into. And it has certain chemicals that make it to multiply. Within few minutes, a virus can multiply into millions and it is difficult to eradicate. And the drugs are difficult to get.

These are some of the differences and that is why I told you that to eradicate a virus is difficult. And I cited the example of HIV and some of the viral infections that we have. But for TB, once you take anti-TB drugs holistically and in accordance with the laid down regulation, you will get cured completely. And when I say cure, that means the organism will be eradicated. But for viruses it is difficult because of some of the reasons that I gave.

In size, bacteria are bigger than viruses. For viruses you need very strong microscope devices to even see them. But for bacterium you can use an ordinary microscope to view and see it. You either use a very strong device to view a virus or some chemical reactions that will tell you the virus is there. So, it is much easier for you to see the bacterium compared to the virus. 

Is there anything you want to add or anything you will want to say that we didn’t ask?

There are a lot of things but if we are to go deeply into this, it will take a very long period. But my advice is that these two diseases, we can do something to keep ourselves away from them. Like for TB, my advice is for people to avail themselves. When you cough or you have features suggestive of TB, based on awareness we have created, you should make yourself available in the laboratories that we have and get yourself tested.

If you are tested and it is confirmed that you have TB, the drugs are there free. You will not pay a dime. When I say free, I don’t mean that the drugs are manufactured at no cost. I always say this that somebody somewhere is buying these drugs for us. Some partners somewhere are giving these drugs. And you know when you say treatment is free, people take it as if it is nothing. But when you tell somebody to buy something for fifty thousand, that is when the person will believe. If you were to spend money to treat TB, many people would have died. And in the State, we have 64 microscopic centres all over the Local Government Areas of the State.

And also, the latest test that is being carried out now is the Keen Expert Test. That machine, we have it at 15 sites in the State. What that device does is that it tests for sputum and other body fluids for TB. It will tell you two things which are very important. If the organism is there, it will tell you that the organism is there. Not only are they there but it will tell you whether the bacterium is resistant or not. I can’t go into that because it is another chapter. But it will tell you this because the treatment that we give to people that don’t have resistant TB which we call susceptible TB is different from those who have resistant TB. And the duration of treatment is not the same.

I tell people that the first line of anti-TB is the best ever to have. Once you scale through that one that is fine and good. But if you fail that one you are going to another level which is dangerous. Because the drugs that will now be used for resistant TB are more toxic, they are not as effective as the first line anti-TB drugs. That is what we always tell people when you are on TB treatment it is better for you to start and continue. If you know that you will not continue, don’t even start. You can wait till such a time that you will have the drugs to take.

Time may not permit us. I would have mentioned some of the sites we have.

For COVID, we also have some sites. In this State we have facilities that test for COVID and the experts are handling it. When the test is done, it doesn’t take much time. You will get your result.

What I am trying to say is that people should avail themselves so they will have these services which are free of charge. I once went to a village and when the villagers saw the vehicle we came in, they started running. When we asked them why they were running, they said they thought we were coming to give them injection for COVID. But we were there for TB. You the media have a very important role to clarify, to educate people and to create more opportunities such as this so we tell people to avail themselves. There is nothing to fear about it. If you come out, it will be better for you. Not only for you but for your family members and other people in the society. So, I call on people to make themselves available. Services are free. Nobody is charged. Why should we not take such services?

In a nutshell, mine is a plea for people to come out to benefit from our services and also for precautionary measures especially for COVID. Wear your facemasks and wear it correctly. You see some people wearing facemask and leaving their nose open. What is the essence? So, put it on correctly especially in overcrowded environments especially worship centres and events. You can remove it when you are alone but once people start coming, you should put it on. That is my plea.