Pandemic Has Seen Big Rise in TB Cases in Ealing
Borough has London's second highest rate of infection
Ahmed Yassin, third from right, and colleagues work to help TB patients. Picture: Ealing TB Nursing Service
April 15, 2021
Coronavirus has been the public health priority over the last year, but less is known about another infectious disease with similar symptoms and an infection rate that has also been multiplying.
Tuberculosis (TB) is sometimes mistakenly believed to be a “disease of the past”, but Ealing borough records the second highest rate of the illness in London, after Newham, and followed by Brent in the latest available 2018 data.
Medics say around a third of the world’s population has ‘latent TB’, which is likened to “sleeping in the body”, and there is a 10 per cent chance of the infectious disease becoming ‘active TB’ where symptoms such as a cough, fever, weight loss and night sweats begin to appear.
Famous figures such as politician Nelson Mandela, Beatles member Ringo Starr and Bollywood star Amitabh Bachchan have had TB. Despite this, battling the stigma of its association with poverty and its previous “death sentence” status is a huge part of work being done internationally, and locally to fight the disease.
Ahmed Yassin is a community support worker based at Ealing Hospital and a clinic in Southall Broadway who works with vulnerable TB patients to help them go through their treatment. He also educates the public on the disease to challenge misinformation and stigma.
“It’s curable, it can affect anyone including famous people, it does not choose just certain people, it’s not just associated with poverty,” he said.
“We’re trying to make sure everybody knows the signs and symptoms, they will be able to identify it, and will be able to tell that person to seek help.”
He told the Local Democracy Reporting Service how the Covid pandemic has worsened conditions for TB infection, such as through the wide-reaching impact of job losses, lower incomes, where some people have become homeless and are unable to eat well affecting their immune system.
“Your immune system goes low, you become homeless, you are going through a lot,” he explained.
“There’s a good chance your latent TB infection at that time will become active TB, we had so many cases in that situation for the last year.”
And referring to groups such as undocumented migrants and people recently made homeless, he said that cases previously of two or three a year have now “tripled or quadrupled” since the pandemic.
In 2018, cases of TB were recorded with a rate of 37.7 per 100,000 in Ealing, the equivalent of 129 cases.
A key target area for spreading awareness and tackling the stigma is in Southall, which has the highest rates of TB in Ealing borough, Ahmed says due to its ethnically diverse population.
In Ealing, a joint strategic needs assessment report by the council and NHS from December 2019 shows the preventable and curable disease disproportionately affects “vulnerable and disadvantaged” populations, such as migrants, ethnic minorities and people experiencing homelessness or a history of imprisonment.
According to the analysis, 82 per cent of people with TB in Ealing were born outside of the UK, but had been in the UK a long time before it became active or was diagnosed. More than 70 per cent of cases were diagnosed within five years of living in the UK.
The most common countries of birth were India, at 37 per cent, followed by the UK at 12 per cent, Somalia recorded 11 per cent and Pakistan at 5 per cent. India has the highest prevalence of TB in the world.
Through Ahmed’s outreach work at schools’ parents evenings, mosques, gurdwaras and hosting street stalls, he said there are a lot of misconceptions about the disease, which, like Covid, can be passed on simply through breathing.
He said: “A lot of people look at you and say ‘I’ve got nothing to do with TB’ and you say ‘Do you know Ealing has [one of] the highest rates of TB?’ They’ll come back to you…
“A lot of people think TB has been eradicated a long time ago and it is not around anymore… I tell them facts trying to attack the misconceptions people have, almost all the people have misconceptions.”
TB is most common in the lungs but can impact any part of the body such as the brain, bones and spine.
Left untreated it can spread to different parts of the body and could cause disability even after treatment, something Ealing Hospital’s infectious diseases consultant Dr Padmasayee Papineni fears may be a knock-on effect from Covid.
She said: “The thing is though TB remains very much because it disproportionately affects vulnerable people, and there’s so much stigma associated with it, it can often remain hidden.
“I think one of the real tragedies is it is preventable and it is treatable so it’s something that if people are diagnosed early or if they are diagnosed at that stage of having latent infection they can be treated.”
Dr Papineni added that the delays in patients seeking help and getting referred has meant more patients are showing disseminated disease, where it affects multiple areas of the body.
“The majority of TB is pulmonary TB, so affecting the lungs, and common symptoms are cough, fever, weight loss and night sweats so when people are having a cough during the pandemic, they’re calling NHS 111 and told their symptoms are Covid related rather than TB,” Dr Papineni explained.
“The other thing is what we found…is that because of lockdown we found the duration of symptoms prior to review by TB services increased.
“The reasons were about things like patients concerned about getting Covid if they come to a healthcare facility, some people had become unemployed or lost their housing so they had other priorities than their health.”
Ealing Hospital is also among those contributing data to the World Health Organisation’s TB centre, where research is being done to see if there could be a relationship between Covid and TB.
“One thing we do know about Covid, what we’re seeing even one year later people are having long-term effects…on their lung function in terms of having ongoing cough, breathlessness,” Dr Papineni said.
“Even though TB is curable there may well be for some people some loss of lung function and so whether or not there’s going to be an overlap with if you had both conditions you’re more at risk of that, at the moment we just don’t know.”
Positively however, health professionals are seeing a declining trend in TB over the last few years.
Ahmed believes going out into the community and supporting patients has had an impact, helped as well by education and contact tracing making a difference in tackling the disease.
For Dr Papineni, she believes while treatments haven’t changed it could be more to do with societal effects or migration trends that have contributed to the decline.
But the ongoing work to challenge the stigma is still vital.
She added: “I think knowing so many famous people, politicians, film actors, have had TB, it can affect any one of us and so there’s no shame in just breathing.
“What we want is for people who have got active TB for us to diagnose and treat them so they can get on with their life without suffering the long term consequences of disease that has come disseminated.”
Anyone concerned over TB symptoms should contact their GP. For further information or advice people are also welcome to contact Ahmed Yassin on ahmed.yassin@nhs.net.
Anahita Hossein-Pour - Local Democracy Reporter