COVID-19 and TB
Knowledge and Library Services Evidence Update
Part of the Barts Health Education Academy
Hello and welcome to this edition of Barts Health Knowledge and Library Services’ monthly COVID-19 and TB Evidence Update.

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Guidance and Institutional Publications
Latest Research Articles

Library COVID Update
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Our Other Recent Updates

Guidance and Institutional Publications

From The UK Health Security Agency: UKHSA launches long term action plan to reduce tuberculosis in England
"The UK Health Security Agency (UKHSA), working with NHS England (NHSE), has launched a 5-year action plan to drive down tuberculosis (TB) cases in England... While recorded incidence of TB fell again in 2020 (to 4,138), the coronavirus (COVID-19) pandemic has had an impact on diagnoses... It is expected that missed and delayed diagnoses, late presentation of symptoms and delayed treatment will have increased the pool of undetected and unreported TB in the community, potentially leading to and increase in TB cases in the short term..."
From The World Health Organisation: WHO releases new global lists of high-burden countries for TB, HIV-associated TB and drug-resistant TB
"In future, other countries may be considered for inclusion on this watchlist – for example, based on evidence about the impact of the COVID-19 pandemic on TB services and disease burden. It is crucial that countries on the watchlist as well as  mid- to low-incidence countries continue on their pathway to the 2030 targets, and then to pre-elimination and elimination... The context of the COVID-19 pandemic was considered prior to finalizing the updated global high-burden country lists. In particular, an assessment of whether the impact of the pandemic on TB incidence could plausibly affect the countries included in each list was done. Based on this analysis, it was concluded that it was unlikely that the COVID-19 pandemic would change the countries included in each list..."

Latest Research Articles

COVID-19 pandemic: SARS-CoV-2 specific vaccines and challenges, protection via BCG trained immunity, and clinical trials
"This study reviews the concept and mechanisms of trained immunity induced by the Bacille Calmette Guérin (BCG) vaccine and identifies questions that should be answered before the BCG vaccine could be used to combat COVID-19 pandemic. Moreover, we present for the first time the details of current BCG vaccine clinical trials, which are underway in various countries, to assess its effectiveness in combating the COVID-19 pandemic. Finally, we discuss the challenges of COVID-19 vaccines and opportunities for the BCG vaccine..."
Effects of Coronavirus Disease Pandemic on Tuberculosis Notifications, Malawi
"Malawi did not have an official COVID-19 lockdown but closed schools and borders on March 23, 2020. In an interrupted time series analysis, we noted an immediate 35.9% reduction in TB notifications in April 2020; notifications recovered to near prepandemic numbers by December 2020. However, 333 fewer cumulative TB notifications were received than anticipated. Women and girls were affected more (30.7% fewer cases) than men and boys (20.9% fewer cases). Fear of COVID-19 infection, temporary facility closures, inadequate personal protective equipment, and COVID-19 stigma because of similar symptoms to TB were mentioned as reasons for fewer people being diagnosed with TB. Public health measures could benefit control of both TB and COVID-19, but only if TB diagnostic services remain accessible and are considered safe to attend..."
[Commentary] Where are the RNA vaccines for TB?
"A simple mRNA vaccine was shown to protect mice against tuberculosis more than 15 years ago. Like COVID-19, tuberculosis is a respiratory infection killing over a million people per year. It too presents a global emergency. Can the stunning success of RNA vaccination against COVID-19 be replicated for TB?..."
Variances in BCG protection against COVID-19 mortality: A global assessment
"The BCG vaccine is known to impart nonspecific immunological benefits alongside conferring protection to tuberculosis in endemic regions. It is also known to protect against bladder cancer and other respiratory tract infections. During the coronavirus disease 2019 (COVID-19) pandemic, the BCG vaccine has gained attention due to its role in conferring protective immunity. We demonstrate the potential immunological protective mechanisms that play a role against COVID-19. We conduct a global assessment of the countries that have the highest and lowest mortality rates determined by an a priori methodology. Lastly, we discuss the potential limitations of incorporating BCG vaccines as potential strategies against COVID-19 and provide recommendations regarding their use in ongoing and future epidemics..."
Facility-based directly observed therapy (DOT) for tuberculosis during COVID-19: A community perspective
"we present quantitative and qualitative findings from a global community-based survey on the challenges of administering facility-based DOT during a pandemic as well as potential alternatives. Our results found that decreased access to transportation, the fear of COVID-19, stigmatization due to overlapping symptoms, and punitive measures against quarantine violations have made it difficult for persons with TB to receive treatment at facilities, particularly in low-resource settings. Potential replacements included greater focus on community-based DOT, home delivery of treatment, multi-month dispensing, and video DOT strategies..."
Tackling TB and COVID-19: US leadership is needed on global health, now more than ever
"Despite progress towards ending the COVID-19 in the United States, and recognition of the role of the new US administration in supporting the global response to the pandemic, World TB Day offers a moment to highlight the opportunity to better align the US’s pandemic response with investments in global TB programs. Investing in TB and COVID-19 does not need to be an either-or scenario. With sound science, effective collaboration, smart investments and efficient synergies, COVID-19 efforts can enhance the global TB response, not undermine it..."
[Letter] A fatal case of triple coinfection: COVID-19, HIV and Tuberculosis
"Multiple factors could contribute to the death of our patient, including non-adherence to antiretroviral treatment, low CD4 count, high viral load, hypoalbuminemia, lymphopenia, increased acute phase reactants and a late diagnosis of tuberculosis, and these could be factors associated with the worsening of HIV/MTB/SARS-CoV-2 coinfection. According to our findings, triple infection can occur, even though it is uncommon. As a result, the existence of other infectious diseases should be carefully evaluated and ruled out in patients with COVID-19, especially in HIV and immunocompromised patients. More extensive studies are needed to fully comprehend the physiopathology of M. tuberculosis, HIV, and SARS-CoV-2 coinfection..."
Tri-infection: Tuberculosis, HIV, COVID-19 and the already strained South African health system
"The world has made progress during these unprecedented times; however, we cannot deny the impact that the COVID-19 pandemic has had on the subjective well-being of the TB/HIV co-infected. Adding more pressure on a populace that is likely to be poverty-stricken and battling felt stigma. While healthcare providers fight to reduce the spread of COVID-19, they should promote initiatives that promote mental health and social cohesion..."
Adapting active case-finding for TB during the COVID-19 pandemic in Yogyakarta, Indonesia
"Active case-finding (ACF) for TB using community-based approaches is a potential strategy to offset reductions in TB detection by obviating the need for patients to seek care at a health facility. A number of approaches can be used to conduct TB ACF safely and screen designated target populations while managing the risks of SARS-CoV-2 transmission for staff, individuals and the community. We present a framework of options for and experience of adapting TB ACF services in response to the challenges of COVID-19 in our programme in Yogyakarta, Indonesia. Key changes have included revised prioritisation of target populations focusing on household contacts, reducing case-finding throughput, implementation of additional infection control measures and precautions, and integration of COVID-19 screening among those being screened for TB. Our approach could inform other programmes seeking to adapt TB ACF services to mitigate the negative impact of COVID-19 on TB case detection..."
[Commentary] 100 years of Bacillus Calmette–Guérin immunotherapy: from cattle to COVID-19
"A growing body of evidence indicates that BCG offers protection against various non-mycobacterial and viral infections. The non-specific effects of BCG occur via the induction of trained immunity and form the basis for the hypothesis that BCG vaccination could be used to protect against the severity of coronavirus disease 2019 (COVID-19). This Perspective article highlights key milestones in the 100-year history of BCG and projects its potential role in the COVID-19 pandemic..."
SARS-CoV-2 and Mycobacterium tuberculosis coinfection: A case of unusual bronchoesophageal fistula
"We here report a case of COVID19 and pulmonary tuberculosis coinfection. COVID19 pneumonia was the mode of discovery of the tuberculosis. In the present case, the tuberculosis appeared as parenchymal and endobronchial pseudotumoral lesion, which has been complicated by a bronchoesophageal fistula. The evolution of the parenchymal, endobronchial lesion and bronchoesophageal fistula was favorable after two months of anti-tuberculosis treatment..."
Tuberculosis-Associated Hospitalizations and Deaths after COVID-19 Shelter-In-Place, San Francisco, California, USA
"A mandated shelter-in-place and other restrictions associated with the coronavirus disease pandemic precipitated a decline in tuberculosis diagnoses in San Francisco, California, USA. Several months into the pandemic, cases involving severe illness resulting in hospitalization or death increased compared with prepandemic levels, warranting heightened vigilance for tuberculosis in at-risk populations..."
"In this double-blind, randomized trial, elderly Greek patients were randomized (1:1) to receive either BCG revaccination or placebo at hospital discharge, followed by 6 months observation for incidence of COVID19 infection. BCG revaccination resulted in 68% risk reduction for total COVID19 clinical and microbiological diagnoses (OR 0.32, 95% CI 0.13-0.79). Five patients in the placebo group and one in the BCG-vaccinated group had severe COVID19 that necessitated hospitalization. 3 months after BCG vaccination 1.3% of placebo and 4.7% of BCG-vaccinated volunteers had anti-SARS-CoV-2 antibodies. These data argue that BCG revaccination is safe and protects the elderly against COVID19. BCG revaccination may represent a viable preventive measure against COVID19..."
Coronavirus Activates an Altruistic Stem Cell–Mediated Defense Mechanism that Reactivates Dormant Tuberculosis: Implications in Coronavirus Disease 2019 Pandemic
"We report mesenchymal stem cell (MSC)–based altruistic defense against a mouse model of coronavirus, murine hepatitis virus-1 (MHV-1) infection of lung. MHV-1 infection led to reprogramming of CD271+ MSCs in the lung to an enhanced stemness phenotype that exhibits altruistic behavior, as per previous work in human embryonic stem cells..."

Library COVID Update

All staff are now required to sign-in, and wash their hands with the gel provided, when entering our libraries.

St Bart’s Hospital Library has moved back to its original space in the department of diagnostic imaging, on the ground floor of the KGV Building. It will be staffed from 10am-4pm, Monday to Friday, and available to staff 24/7. The phone no. there is 020 3465 5467.

At Whipps Cross and Newham Hospitals we offer comfortable seats and computer access, with tea and coffee, from 10am-4pm. Please check local notices for details. Staff can continue to access our 24/7 knowledge hubs (computer rooms) on each site.

Our Library Hub at the Royal London continues to be available to staff 24/7.

Please see our new website and our Digital Library WeShare page for more information.

Visit Our Website

Browse the resource collections within our COVID-19 pages; plus further services, resources, and NHS discounts have been added to our Wellbeing pages.

Our  Leadership and Management subject guide collects all our services and resources on the topic, and signposts to external help.

You can now search the entirety of our collection from the website homepage below via the Discovery search bar too...

Visit Green at Barts Health's new website, hosted and maintained by Knowledge and Library Services:


Our Other Recent Updates

Read our latest COVID-19 Update (published 29/6/21) here.
Read our latest Inclusion and Diversity Update (published 30/6/21) here.
Read our latest Health Services Management Update (published 24/6/21) here.
Read our round-up of research published by Barts Health authors in the month of June 2021 (published 2/7/21) here.
Read our latest monthly Leadership Update (published 1/7/21) here.
Read our latest Staff Wellbeing Update (published 10/6/21) here.
Read our latest monthly Delirium in ICU Evidence Alert (published 17/5/21) here.
Read our previous COVID-19 and TB Update (published 5/5/21) here.
Read our latest Safer Surgery Update (published 18/5/21) here.

Catch up with all our archived updates on our Digital Library Weshare page.

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