A non-systematic literature review article, involving researchers from the Instituto de Saúde Pública da Universidade do Porto (ISPUP), highlights that the social determinants of tuberculosis and COVID-19 highlight the need for a universal health service and a system that ensures social protection for the most vulnerable populations affected by both diseases. The authors point to a set of good practices described in the literature that are intended to help governments and health professionals deal with emerging infectious diseases in a post-COVID-19 world.
Entitled Different disease, same challenges: Social determinants of tuberculosis and COVID-19, the review published in the scientific journal Pulmonology aimed to describe “the social determinants behind tuberculosis and COVID-19, analyse the similarities between the two diseases, and understand from the available evidence what could be learned so far from the best practices already published for both pathologies”, says Ana Sofia Aguiar, researcher of the infectious diseases group of the Epidemiology Research Unit (EPIUnit) of ISPUP, and first author of the article, together with Raquel Duarte, pneumologist and also member of EPIUnit.
What are the social determinants of health?
The social determinants of health are factors of social, environmental and economic context which affect the health of the population and can lead to inequalities in health status. They include poverty, food security, housing conditions, education, income, access to healthcare services, social isolation, the existence of comorbidities (such as HIV, diabetes, mental illness, etc.), excessive alcohol consumption, among several other non-biological factors that can condition health outcomes.
Many of the social determinants described above influence the treatment success of tuberculosis patients, and the same can be said for COVID-19.
In the review article, the researchers show that both conditions have similarities and share several risk factors.
Let’s look at some examples. Both tuberculosis and COVID-19 mostly affect the most vulnerable and weaker groups in society – those with lower incomes, more precarious jobs, lower education and worse housing conditions.
Similarly, both diseases particularly affect people who already have comorbidities, such as cancer, lung disease, smoking, depression, diabetes and HIV. Moreover, they have a significant impact on the economic system and on health and social services.
The management of these two infectious diseases, particularly COVID-19, requires an effective and coordinated response, which does not sacrifice other essential medical services, and which does not exclude the most vulnerable groups in society.
As Ana Aguiar explains, “protection from loss of income is an important factor in following public health advice, such as staying at home when ill or in quarantine after exposure. People living in an insecure employment context, with poor social security, have increased risk of infection and the social impact of the disease”.
The authors of the article list a number of good practices described in the literature for the management of tuberculosis – a disease that has been studied for much longer – and for the control of COVID-19, in order to assist health professionals working with patients affected by these diseases, and to inform decision-makers about actions that should be implemented and strengthened in the management of future infectious diseases.
Good practices for infectious disease management
Good examples include the rapid responsiveness of health systems to manage COVID-19 through, for example, the construction of new hospitals, the increase in the number of beds in intensive care units, and the recruitment of retired health professionals and medical and nursing students.
Another positive aspect was the implementation of effective epidemiological surveillance systems to ensure timely contact tracing, which had already been done by tuberculosis health workers and was improved with COVID-19.
Mass testing of the population is another example to be followed and maintained in the long term, as well as compliance with preventive measures – use of personal protective equipment, personal hygiene, namely hand washing and respiratory etiquette, distance between people and self-monitoring of symptoms, with abstention from work.
Also noteworthy was the improvement in community care provided at home, with public health doctors making frequent calls to assess the health status of patients; something that was also already happening in the treatment of tuberculosis but was intensified with COVID-19.
“All the good practices we have listed can and should also be applied in the management of future epidemics and pandemics, because they have proven to be effective in controlling the spread of infection and the managing of infectious diseases”, points out Ana Aguiar.
The need for a global health response
Researchers maintain that COVID-19, like tuberculosis, has reminded us of the importance of, firstly, prioritising health and allocating financial and human resources to this area. Secondly, it reinforced the relevance of Public Health as a discipline, knowledge and specialty.
Both diseases highlight the need for universal health services and social security systems that protect the most vulnerable groups in society, who are the most exposed to these diseases and also those who feel their negative consequences most acutely, such as unemployment.
“The response to the pandemic of COVID-19 has demonstrated that, with political will, it is possible for the international community to mobilize resources, accelerate discoveries in the scientific field, and employ new public health tools to combat a pandemic. The same strategies should now be used to manage tuberculosis and other infectious diseases, which affect the most vulnerable groups in society,” stresses the ISPUP researcher.
Ana Aguiar stresses the need to prepare for a post- COVID-19 world, “where the creation of people-centered health systems, with community-oriented interventions, will become vital instruments to achieve better health, economic, and moral results”.
Also participating in the article are researchers Marta Pinto, from the Faculdade de Psicologia e Ciências da Educação da U.Porto and ARS Norte, Isabel Furtado, from the Infectiology Service of the Porto Hospital Centre, Simon Tiberi, from the Royal London Hospital – Barts Health NHS Trust, Knut Lönnroth, from the Global Public Health Department of the Karolinska Institute, and Giovanni Battista Migliori, coordinator of the study and Director of the World Health Organization Collaborating Centre for Tuberculosis and Lung Disease in Tradate (Italy).