Impact of COVID-19 pandemic on clinical aspects of tuberculosis inpatients

Tuberculosis (TB) has a significant burden on society and healthcare. However the impact of COVID-19 on the management of TB cases is yet to be known. To compare/characterize TB inpatients in our health unit before, during and after COVID-19. Adults diagnosed with TB were retrospectively reviewed, comparing hospital admissions in 3 periods: Pre-pandemic (P1) (Apr/18-Mar/20), Pandemic (P2) (Apr/20-Dec/21) and Post-pandemic (P3) (Jan/22-Dec/23). Data was collected on demographic/individual/disease characteristics. 164 patients were diagnosed with TB across the three study periods (64, 41 and 59, respectively). Percentages of inpatients among diagnosed cases were 64.1%(n=41) in P1, 63.4%(n=26) in P2 and 47.5%(n=28) in P3, significantly lower in P3 compared to P1(p=0.017). An inpatient subgroup analysis during these periods was performed. When the three groups were compared, no significant differences in demographic and social factors were identified. However, a significant higher duration of hospital stay in P3 (median:13.0[7.0;17.0], 14.0[7.2;52.0], 41.0 [14.8;83.0],p=0.005) and higher symptom duration in P2 (median:37.0[14.0;90.0], 67.5[30.0;225.0]; 38.0[21.0;90.0],p<0.05) was reported. Disseminated disease tended to be more common in P3(n=7;25.0%) compared to P1(n=3;7.3%)(p=0.086). The inpatient mortality rate was 19.5% in P1, 19.2% in P2 and 7.1% in P3(p=0.327). In our hospital, COVID-19 pandemic led to fewer TB admissions but longer ones. Moreover, patients seem to have sustained longer symptoms during the pandemic and a trend to a more disseminated disease in the post-pandemic period. This may be a consequence of the reluctance in seeking medical help during the pandemic, as reported in other diseases.