As COVID-19 caught the world’s attention, Texas’ efforts to fight tuberculosis began to wane.

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Narciso Lopez spent over two decades fighting the spread of tuberculosis in South Texas. He used to think that when the flow of patients to the clinics where he worked was slow, it meant that the surrounding community was healthy. But when the COVID-19 pandemic hit in early 2020, everything changed.

“I was getting three to four a month,” recalls Lopez, TB program manager at the Cameron County Health Department.

In just a few months, the number of patients seeking care at the two county clinics has been halved. “And then I didn’t get anything at all,” he said.

As COVID-19 gained worldwide attention, Lopez began to focus on a parallel issue: whether TB was being overlooked on the Texas-Mexico border.

“I knew that there must be cases of tuberculosis; they just weren’t found,” Lopez said in a recent interview.

Until 2020, work was carried out all over the world to eradicate tuberculosis, which is transmitted from person to person by airborne droplets. Many public health experts considered this to be an achievable goal, as tools are available to detect and treat it. But the disease’s prevalence in Mexico and immigration along the border has made it a longstanding health problem in these communities.

In areas with heavy immigrant traffic, such as Cameron County, TB is a major health problem. Cameron is on the southernmost tip of Texas, and every year millions of people cross the border between Mexico and Mexico at four border crossings in the Brownsville area. Brownsville is the county seat and largest city. In 2019, prior to COVID-19, Texas’s 32 border counties had an average TB rate of 8.4 cases per 100,000 people, more than double the rate for the state as a whole and nearly three times the national rate.

However, since the start of the pandemic, some TB dispensaries in border areas have been doing fewer tests, receiving fewer referrals from local hospitals and health care providers, and treating fewer patients. Lopez and others who do this public health work on the ground every day agree that less TB is unlikely to be circulating. Instead, they say, testing and treating COVID-19 has required so much attention and energy that TB has been pushed off the radar, threatening to undo decades of progress towards its elimination.

Lopez said his county’s TB department typically sees 40 to 60 patients a year.

“And then, all of a sudden, during the COVID pandemic, we dropped to 20,” he said.

It seems the numbers are coming back. In 2022, there were 35 TB patients registered at county clinics, Lopez said. But it is still lower than before the pandemic.

According to Jeanne Salinas, program manager to combat the county health department. The county also conducted hundreds of fewer TB tests.

As of 2020, TB is “overlooked” as a diagnosis for patients reporting “prolonged or coughing up blood, weight loss,” according to Salinas. [and] with a fever.” After COVID-19 became a pressing concern for everyone, these patients, including new immigrants, as well as people who regularly traveled abroad for work or to visit family on the other side of the border, were tested for COVID-19. Salinas said that only if symptoms persist would patients be tested for TB. This delay time allowed the disease to progress in individual patients and potentially spread throughout the community.

This reflects a general Russian trend. Tuberculosis rates in the U.S. have “continuously declined” from 1993 to 2019, according to the Centers for Disease Control and Prevention. However, in 2020 there was a “dramatic” drop of nearly 20% in reported cases, which CDC materials suggest may be due to “late or missed TB diagnosis or real declines in TB incidence associated with pandemic mitigation measures and changes in immigration and travel. But because tuberculosis is more contagious than COVID-19 (its particles stay in the air longer), measures such as masking and distancing are less effective. So, Salinas claims the first.

Persuading people to test for TB was difficult even before COVID-19, Lopez said. First, some medical professionals mistakenly thought the disease was not serious. Another complication is that tuberculosis and COVID-19 have similar symptoms. When doctors and other healthcare workers saw these symptoms, their first concern was COVID-19. And for a while, that was their only concern.

Other issues are diagnosis and treatment. Samples for rapid COVID-19 tests and even more sensitive and expensive PCR tests can be collected with a simple nasal swab. Screening for TB is more invasive, either through a skin test requiring a follow-up visit to a healthcare professional, or through a blood draw that is checked in a laboratory. At the height of the pandemic, healthcare providers were so focused on getting people to and from clinics and hospitals quickly, Lopez said, wasting time screening for TB was not a priority.

Although TB ​​is a curable disease, it may require up to a year of prescribed antibiotics to treat it, which experts say increases the need for early case detection.

The Texas Department of Health reports on its website that the incidence of TB is “higher on the Texas-Mexico border” than in the rest of the state. Dr. Armando Meza, head of infectious disease at the Texas Tech University Health Sciences Center in El Paso, said this is because “nearly all TB cases in the United States come from immigrants.”

Dr. Linda Villarreal, former president of the Texas Medical Association, who is a member of the Border Health Caucus, added that many people live in Mexico but work in Texas, and vice versa, “so there may be vague health issues and impact. ”

There is one more snag. Tuberculosis, Villarreal explained, is especially difficult for people’s immune systems to suppress if they also have other health problems, and the borderline is a hotspot for diabetes and other chronic diseases such as hypertension or heart disease.

COVID-19 itself is something of a comorbidity because it can make people more susceptible to TB. Some of her patients have had both conditions, Salinas said. She suspects that some of those who died from COVID-19 may also have had or instead of tuberculosis.

Frontier areas tend to be poor, and “tuberculosis is a disease of the poor,” said Meza of the Texas Institute of Technology. “And who is poor in this country? Minorities, immigrants, mentally ill people who live in close quarters and in common places.” Not to mention people who are not insured and cannot afford medical care.

Mesa said he often drives past the border, and when he does, he sees crowds of people waiting on the Mexican side in Ciudad Juarez, hoping to cross the border. If they do, he said, he hopes they will receive proper medical attention and care.

“For me, this is what I fear more than COVID-19,” Meza said. “If there is no systematic change, then things can get more complicated.”

Disclosure: Texas Tech University, the Texas Medical Association, and the Texas Tech University Health Sciences Center have provided financial support to The Texas Tribune, a non-profit, non-partisan news organization funded in part by donations from members, foundations, and corporate sponsors. Financial sponsors play no role in Tribune journalism. Find the complete list them here.