Tuberculosis is associated with a 2.1-fold increased risk of severe COVID-19 disease, the health ministry said on Wednesday, recommending that all newly-diagnosed tuberculosis patients or those currently on treatment should be tested for COVID-19 and vice versa.

The prevalence of tuberculosis among COVID-19 patients has been found to be 0.37 to 4.47 percent in different studies, the ministry said and highlighted that there has been an overall decline in tuberculosis notification by 26 percent during January to June, as compared to the previous year, due to the coronavirus pandemic.

In its “Guidance note on Bi-directional TB-COVID screening and screening of TB among ILI/SARI cases” issued on Wednesday, the ministry said studies have shown that a history of active as well as latent tuberculosis is an important risk factor for the SARS-CoV-2 infection.

“This not only results in increased susceptibility but also rapid and severe symptom development and disease progression with poor outcomes. Tuberculosis is associated with a 2.1-fold increased risk of severe COVID-19 disease,” the document said.

In addition, tuberculosis patients also tend to have comorbidities or living conditions (malnutrition, diabetes, smoking habit, HIV etc.) that increase their vulnerability. In order to address this dual morbidity of tuberculosis and COVID-19, activities such as Bi-directional TB-COVID screening, TB screening for influenza-like illness (ILI) cases and TB screening for severe acute respiratory illness (SARI) cases should be carried out, the ministry said.

Under Bi-directional TB-COVID screening, COVID screening for all diagnosed TB patients and TB screening for all COVID-positive patients should be conducted.

Tuberculosis and COVID-19 are infectious diseases, which primarily attack the lungs. They present with similar symptoms of cough, fever and difficulty in breathing, although tuberculosis has a longer incubation period and a slower onset of disease, the document said.