By Kaiser Health News
5:01 a. m. February 16, 2023 CST
Narciso Lopez has spent more than two decades fighting the spread of tuberculosis in South Texas. I used to think that when the flow of patients to the clinics where I worked was slow, it meant that the surrounding network was healthy.
But when the COVID-19 pandemic hit in early 2020, that changed.
“I was getting 3 to 4 a month,” recalls Lopez, TB program manager for the Cameron County Health Department.
Within months, the number of patients seen at the county’s two clinics was cut in half.
“And then I didn’t get anything at all,” he said.
As COVID-19 captured the world’s attention, Lopez began to focus on a parallel concern: whether TB is overlooked along the Texas-Mexico border.
“I knew there would have to be instances of TB there; they just didn’t meet,” Lopez said in a recent interview.
By 2020, progress is being made around the world to eliminate TB, which is transmitted from one user to another over the air. Many public fitness experts have thought it’s an achievable goal, as equipment is needed to identify and treat it. However, the prevalence of the disease in Mexico and immigration along the border have made it an ongoing health challenge in those communities.
In high-traffic spaces like Cameron County, TB is a serious health problem.
Cameron is on the southern tip of Texas, and each year millions of people cross to and from Mexico at the 4 border crossings in the Brownsville area. Brownsville is the county seat and largest city. In 2019, before COVID, Texas’ 32 border counties had an average TB occurrence of 8. 4 instances consistent with 100,000 residents, more than double the state’s total and nearly triple the national rate.
However, since the beginning of the pandemic, some TB clinics in border spaces have conducted fewer tests, received fewer referrals from local hospitals and providers, and treated fewer patients. The box agrees that TB is unlikely to circulate less. Instead, they say, covid testing and treatment have attracted so much attention and power that TB has disappeared from the radar, threatening another decades of progress in its elimination.
Lopez said his county’s tuberculosis branch sees 40 to 60 patients a year.
“And then, all of a sudden, we went down to 20 the COVID pandemic,” he said. The numbers seem to be recovering. In 2022, Lopez said, county clinics treated 35 TB patients.
But this is still below pre-pandemic levels.
Hidalgo County, Cameron’s neighbor to the west, experienced a similar trend in 2020, when the number of TB cases halved from last year, from 71 cases to 36, according to Jeanne Salinas, head of the tuberculosis program for the county’s fitness department. The county also conducted far fewer TB tests.
Since 2020, Salinas said, TB has been “overlooked” as a problem for patients reporting “prolonged coughing or coughing up blood, weight loss, fever. “
After COVID became the most sensitive concern of all, those patients, who included new immigrants and others who crossed the border to work or to make a stopover in the circle of relatives on the other side, were screened for the virus. Salinas said that only if symptoms persist can only patients be screened for TB. This delay allowed the disease to progress in individual patients and potentially spread to the community.
This reflects a national trend. According to the Centers for Disease Control and Prevention, TB incidence rates in the United States “steadily declined” between 1993 and 2019. However, in 2020 there was a “sharp” drop of nearly 20% in recorded cases, according to CDC documents. it may simply be due to “delayed or missed TB diagnoses or true relief in TB onset similar to pandemic mitigation efforts and adjustments in immigration and travel. “as masking and distancing are less effective. Thus, Salinas supports the former.
Convincing others they wanted to get checked for TB was complicated even before COVID, Lopez said. For starters, some fitness staff members mistakenly thought the disease wasn’t a problem. The fact that TB and COVID have similar symptoms in percentage has another complication. When doctors and other medical professionals saw those symptoms, their first fear was covid. And for a while, that was his only fear.
Other problems are diagnosis and treatment. Samples for immediate covid checks, and even the most delicate and beloved PCR checks, can be taken with an undeniable nasal swab. A blood test that is tested in a laboratory. At the height of the pandemic, Lopez said, providers were so focused on getting other people in and out of clinics and hospitals temporarily that taking the time to get tested for TB wasn’t a priority.
Although TB is a curable disease, its remedy can require up to a year of antibiotic prescription, which, experts say, increases the urgency of detecting cases early on.
The Texas Department of State Health Services states on its website that TB rates are “higher along the Texas-Mexico border” than in the rest of the state. Armando Meza, an infectious disease leader at Texas Tech University’s Health Science Center in El Paso, said this because “almost every case of tuberculosis in the U. S. is in the U. S. and Canada. “”The U. S. comes from immigrants. “
Dr. Linda Villarreal, president of the Texas Medical Association and a member of the organization’s Border Health Caucus, added that many other people live in Mexico but work in Texas, and vice versa, “so it could lead to unclear health problems and exposure. “
There is still some other catch. TB, Villarreal explained, is especially difficult for people’s immune systems to suppress if they also have other health problems, and the border is a hot spot for diabetes and other chronic health conditions like high blood pressure or heart disease.
COVID is a type of comorbidity because it can make other people more vulnerable to TB. Some of his patients have had any of these diseases, Salinas said. She suspects that some other people who died from COVID may also have had TB, or instead.
Border spaces tend to get impoverished and “TB is a disease of the poor,” said Texas Tech’s Meza. “And who is deficient in this country? Minorities, immigrant populations, the mentally ill living in close gatherings and the percentage do not unusual spaces. Not to mention other people who don’t have insurance and can’t take care of themselves.
Meza said he drove to the border and, when he did, saw crowds waiting on the Mexican side in Juarez, hoping to cross. If they do, he said, he expects them to receive proper checkups and care.
“For me, that’s what scares me more than COVID,” Meza said. “If there’s no systematic change, that’s where things can get complicated. “
KHN (Kaiser Health News) is a national newsroom that produces detailed journalism on fitness issues. Along with surveys and policy research, KHN is one of the top 3 operating systems of KFF (Kaiser Family Foundation). Endowed for-profit organization that provides data on fitness problems to the nation.
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