Dr. Bolot Maikanaev, director of the National TB Center (NTC), tells in this interview how the NTC worked during the Covid-19 pandemic peak and about the current situation with tuberculosis.
Could you tell us how the NTC worked during the peak of the Covid-19 pandemic?
During the peak of the pandemic, at the NTC, we provided first medical aid for the treatment of Covid-19. All of our employees and medical workers were trained (doctors, nurses and junior staff alike). Subsequently, 38 beds were made available at the NCP for Covid-19 patients, in compliance with all infection control measures. We purchased personal protective equipment (PPE) with public funds, and received some from partners and donors. Of course, at the beginning it was very difficult to get PPE due to the general shortage, but nevertheless we managed.
Was it hard for your staff to work in the red zone?
Of course it was very difficult, especially in the first days. They were faced with obstacles and the fear of getting infected with Covid-19. What was difficult was the global lack of knowledge on this disease and how to deal with it. Naturally, at first it wasn’t easy to sort patients (triage) and there were very few available hospital beds, especially in July, during the very peak of the disease. Nonetheless, we did our best to assist the population of the Kyrgyz Republic. There were cases when our employees got sick themselves. We treated them too and organized observation and rehabilitation for all staff at the Issyk Kul Lake. The observation period for the first brigade coming from the red zone was made possible thanks to the help of the AIDS Foundation East-West (AFEW), later the UNDP / Global Fund project organized a 14-day observation for all brigades in comfortable conditions in hotels, as well as at Issyk-Kul Lake, and we are very grateful to them for that.
How did the laboratory work at that time?
Our national reference laboratory (NRL) once again proved its quality and provided great assistance in the fight against COVID-19. Laboratory doctors and assistants worked around the clock, in shifts, and remained in the red zone 24/7. They did a tremendous job with COVID-19 PCR testing. And at the beginning of the summer we received rapid tests to be used on GeneXpert machines, purchased by the UNDP. These new tests help diagnose patients for Covid-19 even faster.
How did tuberculosis patients receive treatment during the pandemic?
Treatment of tuberculosis patients was not interrupted. The NCP issued an order enabling to distribute anti-tuberculosis drugs for 10-14 days at a time to all patients on ambulatory treatment. When possible, patients were transferred to video-observed treatment, and work with case managers and community supporters was also increased to ensure constant treatment monitoring The only thing that had to be limited was the flow of patients from regions: due to the lockdown, patients could not come to Bishkek, so received treatment at their place of residence. Outpatient treatment is now encouraged. But patients requiring hospitalization received appropriate treatment in hospitals. We discharged only those patients who could receive at-home treatment from the hospitals.
What is the situation with TB diagnosis: has it decreased?
Yes, TB diagnosis has decreased these past months. We already see an increase in the number of people with TB symptoms, and, unfortunately, patients with advanced forms of TB. Of course, this is the impact of COVID-19. I think that we must, together with primary health care, strengthen our work on early detection and diagnosis of TB among the population.
How do you think the Covid-19 pandemic is affecting the TB epidemic?
COVID-19 has had a significant impact on the tuberculosis epidemic. All the health care system’s efforts and funds were deployed to fight this disease. Medical workers did not have enough time to provide quality assistance to patients with other diseases. Some patients with poor adherence to treatment interrupted it completely. Fewer people are seeking medical help and diagnosis, so we expect that in a while the situation with tuberculosis will worsen.
What would you like to tell health care workers and the society to avoid a worsening of the situation?
We encountered a little-known disease and had to deal with it face to face. And now we know a lot about this virus and its effect on other comorbidities. In this regard, I want to say that nowadays we need to be able to distinguish COVID-19 from other diseases. It may look like the flu or tuberculosis but we need to know exactly how to identify it. It is important not to forget about other diseases, especially about tuberculosis.
What would you like to tell TB patients?
I want to tell them not to interrupt their treatment, to continue getting monitored regularly, to follow all doctors' recommendations, and to seek help on time if they have any health problems.
Relatives, friends and family members of our patients: you can help us in ensuring treatment adherence and a favorable outcome. Support your loved ones in such difficult times. Treat them with understanding. Only if we are all together we can overcome the burden of tuberculosis!
Despite the COVID-19 pandemic in the country, TB services and the primary health care network continue to operate.