MANILA, Philippines – One morning in September, housewife Fely Loren Barracas started coughing. She thought it was just an ordinary cold, but a week’s course of antibiotics failed to help. She worried about getting the coronavirus, which as a cancer patient she was particularly vulnerable to.
“I got scared,” the 57-year-old patient told VICE World News during her visit to a community health center. “My doctor feared it was COVID-19, so I got another swab test even though I have been tested at least five times this year for my chemotherapy.”
The virus has claimed the lives of more than 20,000 people in the Philippines, one of the hardest-hit countries in Southeast Asia. The country was also ranked the worst place in the world to have COVID by Bloomberg. Her swab test yielded a negative result, providing a sense of momentary relief. But the cough persisted.
After undergoing a chest X-ray and more, she was shocked to learn she had tuberculosis, an infectious disease that has faded from the news during the pandemic but remains one of the leading causes of deaths around the world, especially in developing countries. According to the World Health Organization (WHO), in 2019, 1.4 million people died of TB while an estimated 10 million were infected. Tuberculosis has been referred to as the forgotten pandemic.
Affecting adults and children, TB can be cured and treated using widely-available drugs taken in a course of as short as six months. But the world’s focus on COVID-19 is increasing the TB burden and deaths, experts say.
In the Philippines alone, over 100,000 Filipinos may die of TB in the next five years if health services continue to be weighed down for the next 16 months, according to statistical modeling used by the Department of Health.
Tuberculosis has long been a problem in the country, where almost 600
persons have TB for every 100,000 population, one of the highest in Asia. Thanks to grants, experienced health workers, and grassroots efforts, responses to TB in the Philippines have received praise from global health alliances.
But the pandemic has forced a dramatic redirecting of resources, with healthcare workers and medical equipment used to detect TB.
Before the pandemic, a sprawling network of centers in almost every barangay or village in the Philippines provided screening, testing and medication for TB.
After the pandemic set in, however, extended lockdowns and stay at home orders cut into visits. In August 2020, there was a 50 percent reduction in TB patients visiting these centers from the annual estimate of 400,000.
“The lockdowns made TB services challenging,” Dr. Anna Marie Celina Garfin, national TB program manager, told VICE World News. “We cannot gather people in the community for the screening activities.”
“There’s also a lot of fear not only among the patients but also among health workers, especially those who conduct the testing themselves,” she added.
Caused by a bacterium called Mycobacterium tuberculosis which usually targets the lungs, TB is an airborne disease spread person-to-person through the air. A person with active TB can infect five to 15 more people through close contact each year.
With the coronavirus pandemic dragging on, the Philippines is now recalibrating its strategy from finding new ways to do active case finding of TB in communities to modifying the administration of drugs.
Garfin said that the free medication in public health facilities administered orally each day is now given to patients in bulk every month. Several mobile apps where patients report their course of treatment help health staff monitor if patients are following their treatment plans.
Non-profit organizations and local governments are also conducting simultaneous TB screening at coronavirus vaccine sites. Mobile X-Ray machines are also parked at some vaccination sites for people who complain of lung problems.
A healthcare worker takes a chest X-ray of a patient during a tuberculosis screening on September 24, 2021 in Manila, Philippines. Photo: Red Santos, courtesy of USAID TB Innovations
But Dr. Ma. Cecilia Aquino, chief of the Karuhatan Health Center, said diagnosing TB during the pandemic can be tricky. That’s because COVID-19 and TB share the same symptoms: cough and fever.
“People come to us with coughs for more than five days, fever and other symptoms. We need to establish first if it’s COVID or not,” Aquino told VICE World News.
“They are hesitant to be treated if you say you will test them for COVID. It seems that they are more comfortable with the fact that they might have TB, but we emphasize that we need to check them for COVID first.”
But being diagnosed with TB also requires continuous treatment for patients to tackle the infection.
Luisa Francisco, who has been serving as a local volunteer health worker for 16 years, said she can’t actively monitor her partner-patients now. Ideally, she would go to their homes to watch them take their TB medication. Now it’s done over a video call on Facebook, which isn’t the same as patients might cheat.
“I need to see that they have swallowed the pills even though they call,” she said.
Video calls, along with other teleconsultation platforms, have been a last resort to ensure that services are not disrupted.
“We really need to open ourselves to options. We need to innovate to fight TB,” Aquino said.
When VICE World News visited a health center in Valenzuela, a city north of the capital Manila, new TB patient Barracas received her first month of medication. She now starts a six-month journey, though the center is confident she’ll beat the disease as long as she adheres to the treatment plan.
“It helps that the medicines are free so all people have to do is to take their medicines, no more excuses,” she said, alluding to the devastating economic impact the pandemic has had in the Philippines.
“When they have money, people prioritize food over medicines,” she added.
Shooting range attendant Alex Manigat knows this all too well. He previously had TB in 2017, but he did not dutifully take his pills. During a company check-up this year, he was diagnosed with TB again and infected his wife.
Having learned from his previous mistake, he’s grateful to have had another chance to free himself of the infection. He and his wife just completed their six-month treatment and are now TB-free.
“It is better to get checked up as early as possible before it gets worse,” he said.
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This reporting was supported by a grant from the United States Agency for International Development (USAID).