In the six weeks before South Africa responded its first diagnoses of COVID-19 with the start of physical distancing measures, more than 47,000 people on average there were tested for tuberculosis with the rapid and reliable Xpert diagnostic tool each week. An average of more than 3,700 of those tests identified active tuberculosis in people who could then access treatment. In the weeks that followed, as the government closed schools and restricted international travel as well as mass gatherings, before launching what Reuters news service called “one of the world’s toughest lockdowns,” restricting all but essential movement from home, and bringing public transportation to a virtual standstill, the numbers of people accessing the rapid test for tuberculosis dropped by nearly half, with an average of a little more than 24,000 tests a week. The accompanying decline in the resulting number of tuberculosis diagnoses was “less dramatic,” than the testing drop, an analysis from South Africa’s National Institute for Communicable Diseases notes, likely because people feeling sick with advanced disease were more motivated to overcome the restrictions on movement to seek care. Still tuberculosis diagnoses dropped by 33%.

Suppose you have a large group of people, confined together, considered likely to pose a threat to people outside their walls, but without the ready means to determine if they pose a threat to each other? If the space wasn’t built to contain the spread of an airborne infectious diseases, a public health disaster could be among the unintended consequences of that arrangement.

In sub-Saharan Africa where the odds of dying within a year of starting treatment for HIV can still hover close to one-in-10, diagnosing and treating TB — a curable disease that remains the leading cause of death for people with the virus — at the point of HIV testing offers a life-saving opportunity to improve patients’ chances. That makes accurate, point of care testing all the more urgently needed in places like in rural Malawi, where an X-ray to identify TB, and treatment  for the disease based on symptoms, can be out of reach during the wait for laboratory test results.

A project that shifted treatment for drug-resistant tuberculosis from overburdened Bangladesh hospitals to patients’ homes saw time between diagnosis and treatment initiation drop from more than three months to less than a week, reducing risks of the continued spread of the disease, a study reported in Global Health Science and Practice found. In the process, researchers found rates of treatment success climbed from 70 percent in 2011 to 76 percent in 2015, while death rates among patients treated for drug-resistant tuberculosis dropped from 14 percent to 9 percent.

A note from the field in this week’s Morbidity and Mortality Weekly Report describes the case of a dangerously ill man in the United States. Weak, coughing, and losing weight, with pain in his chest, he was tested for tuberculosis, which it turned out he had, and put on the first-line of treatment for the disease.

Study randomized clinics to use Xpert or fluorescence microscopy for patients newly diagnosed with HIV showing TB symptom.

In the South Kivu province of the Democratic Republic of the Congo, where the impacts of military conflict fuel the spread of disease while challenging health service access, obstacles to finding undiagnosed people sick with — and at risk of transmitting — tuberculosis are matched only by the urgency to do so.

In a hospital serving an urban population, more than a third of patients with a confirmed TB diagnosis also had HIV. Of those, nearly three quarters had been diagnosed with the virus that greatly increased their risks of becoming sick from the world’s oldest airborne infection, with a median of six years between a test showing they had HIV, and a test showing they had become sick with tuberculosis. Among those 73 patients already diagnosed with HIV, only 10 were accessing the antiretroviral treatment that protected their immune systems and offered them a defense against TB. Even at the end of their treatment, when 74 patients had accessed antiretroviral medicine, the treatment had been effective enough to suppress the virus in only a little more than half the patients. Three years after they completed the treatment, fewer than a third had maintained continuous treatment for HIV, or suppressed viruses. The high rates HIV/TB co-infection, and low rates of treatment, as well as of viral suppression, compare unfavorably to those of some African countries confronting the highest burden of both diseases.

It’s a measure of the time technology takes that now, finally, an app exists to address the wasting that gave tuberculosis its original name — consumption. Leading to malnutrition, serious side effects from drugs or failure to absorb medicines, the serious weight loss that can characterize the disease raises risks of death or recurrence of sickness after cure, and, diminishing patients’ ability to work, adds to the catastrophic personal and financial fallout from illness.

Tracing contacts of people confirmed to be sick with tuberculosis and making preventive treatment available to those at risk for the disease, could halve current numbers of TB cases among children in resource limited settings, according to researchers reporting a study of patients across a Kenya rural province.