New BTS survey highlights the impact of COVID-19 on TB services

14 July 2022

The British Thoracic Society (BTS) has today published its Impact of COVID-19 on Tuberculosis Services in the UK Survey Report.

Unlike other respiratory or infectious conditions, NHS England and NHS Improvement (NHSE&I) advised that TB services should be maintained during the COVID-19 pandemic. TB remains a public health priority, with an increased risk of transmission and disease if TB services are interrupted. Furthermore, TB services are run by infectious disease and respiratory specialists who were often a key part of the local response to COVID-19.

To understand how the pandemic affected the TB services that continued to operate, The British Thoracic Society (BTS) carried out a survey during summer 2021. 72 sites responded to the survey, representing both high and low TB incidence areas across England and the devolved nations. Of these, 94% received advice from the NHS to continue TB services during the pandemic.

The survey found almost all aspects of TB service delivery faced significant disruption:

83% of the respondent’s services were adversely affected by the COVID-19 pandemic.
85% said face-to-face activities and latent TB screening of non-contacts were impacted the most.
32% of services felt the pandemic had had a detrimental effect on their TB service, such as loss of face-to-face appointments, loss of clinic space, loss of clinical capacity to see patients, and loss of staff.
By August 2021 only 48% of TB services had returned to pre-pandemic levels of working and 16% of services felt that although they had partially restored services, they were unlikely to return to pre-COVID-19 levels of activity.

The survey concluded that during the pandemic:

TB services provide a crucial public health role but were not always considered in local system resilience planning.
Communications from national health bodies to local TB services across the UK were inconsistent and should be better co-ordinated.
The development of remote consultations and monitoring of treatment were a positive outcome but are not implemented consistently and may not be sustainable in the longer term.
There were disparities across the UK in the availability of TB drugs which need to be addressed.

Although the majority of changes associated with COVID-19 appeared detrimental, some positives were identified. Most respondents reported that their employing organisation provided the support needed to continue services. This included changes to enable remote staff working, greater use of remote patient consultations and treatment monitoring and enhancement of pharmacy services to maintain patient access to care.

Professor Marc Lipman, Lead author and Chair of the BTS Tuberculosis Advisory Group said:

“Our report demonstrates the incredible flexibility and resourcefulness of TB services that enabled them to provide care during COVID and lockdown. It has also highlighted the variable local support they received, such that despite their crucial public health role, TB services were often overlooked in local healthcare resilience plans. This is disappointing given that we were in the middle of a public health emergency. We call on TB services across the UK to be offered appropriate and timely local and central support that enables their patients to continue to receive high quality care.”

Professor Onn Min Kon, Chair of the Joint Tuberculosis Committee said:

“This report highlights the dedication, adaptability and resilience of staff working within UK TB services, who despite the personal and structural challenges posed by COVID-19 showed their commitment to delivering clinical care. It is heartening to see that despite the numerous challenges, essential TB treatment remained prioritised.