To the Editor — In the midst of the COVID-19 pandemic, the world must remain vigilant to the potential for eruptions of tuberculosis (TB) and its drug-resistant (DR-TB) strains. Many countries with a high TB burden remain reliant on in-person and community-based directly observed therapy for TB treatment. With the current COVID-19 conditions that affect mobility and access to care1,2,3,4, both seem impractical.

Global TB is exacerbated by the COVID-19 pandemic. Regular treatment facilities are being closed because of a lack of resources, and TB could be misdiagnosed in settings in which COVID-19 testing is not available. Local governments must identify feasible options to retain patients with TB and DR-TB in care while fighting the COVID-19 pandemic. On 20 March 2020, the World Health Organization released an Information Note on TB and COVID-19 urging national TB programs to maintain continuity of essential services for people affected with TB during the COVID-19 pandemic5. It recommends providing adequate stocks of TB medicines for all patients in order to ensure treatment completion without the patients’ having to visit treatment centers unnecessarily to collect medications; this essentially forces the global TB program to shift from directly observed therapy to self-administered therapy. Digital-health technologies such as electronic medication monitors and video-supported therapy were also recommended to help patients adhere to their treatment. However, for optimal implementation of this strategy, trials evaluating the effectiveness of remote treatment for TB in low- and middle-income countries are desperately needed. Healthcare workers urgently need to disseminate information on how to address patients with TB and DR-TB in the current COVID-19 outbreak. The most common medications used to treat TB and DR-TB need to be adequately stocked, primarily in countries with a high burden, to sustain clinical services in case of further restrictions due to COVID-19. For countries in sub-Saharan Africa where the healthcare system is fragile in withstanding the COVID-19 outbreak6,7,8,9, responding to these two diseases at the same time needs due diligence.

There have been several efforts contributing to the global TB momentum, including the End-TB Strategy, and tremendous efforts have been made to halt the TB epidemic. Undoing those gains would undoubtedly increase global health-security tension and result in deadly economic, social, political and health consequences. Both COVID-19 and TB have no borders, and both require a major commitment from all key stakeholders.