Tuberculosis and COVID-19, the new cursed duet: what differs between Brazil and Europe?

Silva, Denise Rossato; Mello, Fernanda Carvalho de Queiroz; D’Ambrosio, Lia; Centis, Rosella; Dalcolmo, Margareth Pretti; Migliori, Giovanni Battista

doi:10.36416/1806-3756/e20210044

Denise Rossato Silva

. Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil.

https://orcid.org/0000-0003-0230-2734

Fernanda Carvalho de Queiroz Mello

. Instituto de Doenças do Tórax, Faculdade de Medicina, Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro (RJ) Brasil.

https://orcid.org/0000-0003-3250-6738

Lia D’Ambrosio

. Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italia.

https://orcid.org/0000-0002-8551-3598

Rosella Centis

. Blizard Institute, Queen Mary University of London, London, United Kingdom.

https://orcid.org/0000-0002-7000-5777

Margareth Pretti Dalcolmo

. Centro de Referência Hélio Fraga, Fundação Oswaldo Cruz - Fiocruz - Rio de Janeiro, Brasil.

https://orcid.org/0000-0002-6820-1082

Giovanni Battista Migliori

. Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italia.

. Blizard Institute, Queen Mary University of London, London, United Kingdom.

https://orcid.org/0000-0002-2597-574X

Correspondence to: Denise Rossato Silva. Rua Ramiro Barcelos, 2350, sala 2050, Santa Cecília, CEP 90035-903, Porto Alegre, RS, Brasil. Tel.: 55 51 9647-0343. Email: denise.rossato@terra.com.br

AUTHOR CONTRIBUTIONS

DRS and GBM: conception and planning of the study; drafting and revision of preliminary and final versions; and approval of the final version. FCQM, LD, RC, and MPD: drafting and revision of preliminary and final versions; and approval of the final version.

Field of study	Research question
Human exposure and immunology	When and where did COVID-19 first appear? What are the main immunological consequences of exposure to Mycobacterium tuberculosis and SARS-CoV-2?
Epidemiology	What is the real impact of COVID-19 on the epidemiology of tuberculosis and vice-versa? To what extent can SARS-CoV-2 trigger latent tuberculosis to evolve into active tuberculosis?
Transmission	What is the relevance of COVID-19 transmission via surface contamination, fecal-oral route, and aerosols versus droplet transmission? What is the relevance of transmission occurring from asymptomatic individuals? What are the implications for the prevention of transmission?
Signs and symptoms	What are the signs and symptoms possibly supporting the initial differential diagnosis between the two diseases?
Comorbidities	What is the role of different comorbidities on the incidence and mortality of the two diseases separately and when they are combined?
Vaccine	What is the real effectiveness and epidemiological impact of the COVID-19 vaccination program that has recently begun? What about vaccination of specific groups, such as the elderly and immunocompromised individuals? Is the BCG vaccine protective against COVID-19?
Other preventive measures	What are the most effective prevention measures (hand washing, use of personal protection equipment, physical distancing, other mitigation measures such as curfews and lockdowns, etc.) in different COVID-19 epidemiological scenarios?
Rapid diagnostics	What are the feasibility, importance, and potential impact of combined rapid diagnostics?
Treatment	What treatment is effective against COVID-19? Are corticosteroids necessary? Is there a relevant drug-to-drug interaction to monitor specifically? What is the importance of providing oxygen supplementation or invasive/noninvasive ventilation, and when should they be initiated? Are treatment outcomes different in patients with the tuberculosis/COVID-19 combination? What is the need for pulmonary rehabilitation following tuberculosis or COVID-19? Is pulmonary rehabilitation effective?
Case definition	What is the final case definition and associated criteria for classification of COVID-19, which are still subject to updates?
Stigma	What types of stigma are associated with the two diseases, and what can be done to prevent that?
Policy development	What have we learned in terms of policy development, risk communication, rapid implementation of travel policies, and quarantine restrictions, etc., one year after the beginning of the COVID-19 pandemic?
Resource mobilization	Can the rapid but sometimes chaotic resource mobilization experienced during the COVID-19 pandemic be used in order to prepare rational, comprehensive epidemic prevention/control plans for the future? Can this resource mobilization include benefits for tuberculosis prevention as well?
Economic impact	What is the overall cost of the COVID-19 pandemic to the global economy? To what extent will the COVID-19 epidemic create an additional economic burden that will impact the tuberculosis epidemic in the future?
Stress on health care systems	What is the real stress imposed by the two diseases on health care systems presently and in the coming future?
Data availability	How can we improve surveillance data to make evidence-based decisions?

[1] Correspondence to: Denise Rossato Silva. Rua Ramiro Barcelos, 2350, sala 2050, Santa Cecília, CEP 90035-903, Porto Alegre, RS, Brasil. Tel.: 55 51 9647-0343. Email: denise.rossato@terra.com.br

Brasil

Brasil

Tuberculosis and COVID-19, the new cursed duet: what differs between Brazil and Europe?

ABSTRACT