Previous and active tuberculosis in COVID-19 patients increases risk of death and prolongs recovery

Sy, K. T. L.; Haw, N. J. L.; Uy, J.

Background: There is growing literature on the association of SARS-CoV-2 and other chronic respiratory conditions, such as COPD and asthma. However, little is known about the relationship between coinfection with tuberculosis (TB) and COVID-19 outcomes. We aimed to compare the risk and survival time of death and recovery among COVID-19 patients with and without TB. Methods: We created a 4:1 propensity score matched sample of COVID-19 patients without and with TB, using COVID-19 surveillance data in the Philippines. We conducted a longitudinal cohort analysis of matched COVID-19 patients as of May 17, 2020, following them until June 15, 2020. The primary analysis estimated the risk ratios of death and recovery comparing COVID-19 patients with and without TB. Kaplan-Meier curves described time-to-death and time-to-recovery stratified by TB status, and differences in survival were assessed using the Wilcoxon test. Results: The risk of death in COVID-19 patients among those with tuberculosis was 2.17 times greater compared to those without tuberculosis (95% CI: 1.40-3.37). The risk of recovery in COVID-19 patients among those with tuberculosis was 25% less than the risk among those without tuberculosis (RR=0.75, 0.63-0.91). Similarly, time-to-death among COVID-19 patients with TB was significantly shorter (p=0.0031) and time-to-recovery among those with TB was significantly longer than patients without TB (p=0.0046). Conclusions: Our findings show that coinfection with tuberculosis increases morbidity and mortality in COVID-19 patients. Our findings reiterate the need to prioritize routine and testing services for tuberculosis, even with increased disruptions to health systems during the SARS-CoV-2 pandemic.