A decade ago, in 2010, The Telegraph reported that London had become the ‘TB capital of Europe’. Sharing a series of statistics which indicated that Britain was the only nation in Western Europe to have logged rising levels of tuberculosis, it revealed that more than 9,000 cases were being diagnosed each year.
The epicentre of the disease was, unsurprisingly, the capital, where 40 percent of the UK’s cases occurred. This was an increase of around 50 percent in the space of 10 years, with the figure for London having jumped from 2,309 per annum to 3,450.
Interestingly, this article, and another published in The Guardian, considered some probable causes behind this phenomenon, as suggested by an eminent professor who worked at University College London. In the words of this medic, the rise was most likely attributable to the ‘Victorian’ conditions that pervaded in the capital, where poor housing, insufficient ventilation, and overcrowding were common, especially in deprived areas.
While the report and its figures are historic, they nonetheless lead to a rather pertinent question: are we seeing the same factors at play now that Covid-19 has taken hold and could the real danger be having underlying TB while becoming infected by COVID19, explaining the difference in the severity of the symptoms?
What is tuberculosis and how is it comparable to coronavirus?
For those who have not come across the disease before, TB is caused by a bacterium known as mycobacterium tuberculosis. Predominantly affecting the lungs – as in more severe cases of coronavirus – it can have a highly damaging impact on our respiratory health.
However, this is not the only way it can affect us. In addition to causing breathing difficulties, the infection can also spread to other organs via our bloodstreams, and this is when it becomes particularly dangerous.
As in the case of coronavirus, tuberculosis is a primarily airborne disease, which is passed on when we cough and sneeze. Where it differs – and is arguably less contagious – is that it is usually spread through prolonged contact with infected individuals, (possibly because less of us have the predisposition to contract TB) as opposed to being transmitted through more short-term contact, in the way of colds, the flu, and Covid-19.
Where it is again similar, however, is in some of the ways in which it can manifest: through a persistent cough, fever and sweating, and more common symptoms of illness such as fatigue. What is also interesting is that it can be asymptomatic for a prolonged period of time, only fully manifesting when the sufferer’s immune system weakens, as in the case where people have been exposed to COVID19.
This is, of course, very much like Covid-19, which can also start out with very few obvious symptoms before progressing to a more extreme state. Herein lies the danger with both diseases, as this gives them a period of time in which they can spread before those afflicted become aware of their illness.
Who is most likely to be affected by tuberculosis?
As we mentioned above, eminent professionals talking on the subject, albeit a decade ago, suggested that the rise in tuberculosis in London was likely a result of the sort of living conditions seen in the capital.
Indeed, we know for a fact that TB is most likely to occur in deprived urban communities, where poor living conditions and nutrition are more prevalent than elsewhere. Those with a weaker immune system or less-than-perfect health are also at a higher risk, with HIV sufferers, alcoholics, and those who are malnourished seeming particularly susceptible.
What is especially interesting with regards to the tuberculosis outbreak reported 10 years ago is that it predominantly affected those who had been born outside of the UK – much like coronavirus. While this might lead to the supposition that these individuals were infected elsewhere, almost all had in fact contracted the disease while living and working in Britain.
This self-same pattern has been reported with regards to Covid-19, where ethnic minorities have been disproportionately affected. Rather than being down to any innate susceptibility, however, research has identified a number of external factors that may explain this phenomenon.
Firstly, those belonging to ethnic minorities are very much overrepresented among keyworker professions - in particular, among the healthcare sector and public transport staff. In addition, studies have shown that these same groups are more likely to live in overcrowded, intergenerational housing, which may explain why the disease spreads more quickly among such demographics.
What this arguably suggests is that the same factors which make individuals more susceptible to TB may also make us more likely to contract and struggle more severely with Covid-19.
How might this inform our approach moving forward?
If we thus imagine, for a moment, that TB and Covid-19 are comparable with regards to who is most at risk of contracting them and how severely they’re likely to be affected, this suggests that what we have learned from the former could perhaps be put to use in shaping how best to handle the latter.
There is growing research, resulting in the advice that we should all start administering optimal levels of vitamin D3 that has previously been shown to be useful in treating TB, due to its anti-inflammatory properties. With this and the many similarities between the two diseases in mind, a team of Spanish scientists from the University of Granada are currently conducting a 10-week trial to see whether a similar treatment plan could be useful in treating coronavirus symptoms and de-escalating the severity of the illness. We await the results with great interest.
What would we recommend:
We would recommend that all vulnerable people and frontline workers should have TB and Vitamin D Tests made freely available to them and where vitamin D deficiency or TB is identified they should be taking increased levels of immune supporting nutrients like Vitamin D, Vitamin C, Zinc & Quercetin and ideally staying away from infected areas.
