The authors of the letter to the editor entitled “Impact of the COVID-19 pandemic on tuberculosis in Peru: are we forgetting someone?”1 state that a series of interventions should be implemented in our country, such as TB units, "to ensure all the necessary health measures to increase confidence among the population and reduce the risk of resistant forms of TB".
They assert that Metropolitan Lima and Callao report 64% of tuberculosis (TB) cases, 79% are multi-drug resistant (MDR-TB), and 70% are extremely resistant (XDR-TB). No capital of any nation in the world has such incredibly high rates of MDR-TB and XDR-TB. What we read in document2 is that Metropolitan Lima and Callao report 64% (19,860) of TB cases, 79% (1020) of MDR-TB cases, 70% (76) of XDR-TB cases and 45% of deaths, so comments are unnecessary.
The COVID-19 pandemic led to an 18% drop worldwide in newly diagnosed TB cases from 2019 to 2020. In Peru, the drop was 26%,3 lower than the figures for Gabon (80%), the Philippines (37%), Lesotho (35%) and Indonesia (31%), and similar to the figure for India (25%).4 A state of national emergency was declared in Peru on 16 March 2020,5 which lasted throughout the year with different restrictive measures, including quarantine of the entire population for 16 weeks,6 a night curfew, only virtual classes allowed, the need for social distancing, prevention of meetings and closure of outpatient clinics. Despite that, Peru has the highest mortality7 and orphan8 rates associated with the disease in the world, meaning that the population, fearing contagion, either does not go or takes longer to go to health facilities when sick. For all these reasons, it is striking that in Peru there was a lower drop in cases than in countries where the restrictions were less severe.
Table 1 in the letter shows that for the year 2020 in Peru there was a 2.5% dropout rate among the sensitive cases and 5.7% among the resistant ones.1 These very low dropout rates, even lower than those of the previous three years (Table 1)3 in Peru, have been achieved because the directly observed therapy (DOT), which takes place in the healthcare establishment (institutional DOT), was expanded to home DOT, in which healthcare workers go to the home, and to DOT with family support network, in which the therapy is administered by a family member, in addition to telemonitoring for follow-up.9
Coverage (approximated as notifications divided by incidence) of TB treatment in 2020 worldwide was 59%, down from 72% (uncertainty interval [UI]: 65–80%) in 2019. The most immediate consequence of the large drop in the number of people newly diagnosed with TB and on treatment was an increase in the number of deaths from TB in 2020 (+5.6%), reversing the annual reduction we had seen since 2005, with the total number of deaths returning to the level of 2017.4 We have to assume that there will be a spike in our disease rates in the coming years, the duration of which will depend on when our country returns to normal.
Having exceeded the goals in TB control, in the 1990s, Peru left the TB80 group, which includes the countries that contribute 80% of the burden of the disease in the world. Our country's Tuberculosis Control Programme, now called Strategy, is rated as one of the best in the world.10 The letter sent to your journal has enabled us to make these comments and explain how we have worked during the pandemic with people affected by TB in Peru, where the numbers being diagnosed have reduced. Still, the high levels of cure achieved previously have been maintained.
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Conflicts of interestNone.
