With more than 70,000 years of history, it is the oldest pandemic in humanity. It is hard to think that it is present in a city like Barcelona, but it is. Serveis Clínics, in Sarrià-Sant Gervasi, is the only tuberculosis center in Spain. The coronavirus is increasing deaths from this disease, which has ceased to be monitored and detected.
is the infectious disease and, at the same time, the oldest pandemic of humanity: the human being lives with her from the Paleolithic. Nowadays, a quarter of the population this unknowingly infected and every year there are around the world 10 million cases. The tuberculosis It was, before covid-19, the leading cause of death of infectious origin in the world. Many people consider it eradicated and it is not. In Catalonia there are around a thousand cases each year. Anyone can get infected and suffer from it.
“In these two years, the coronavirus a large part of the health resources has been eaten and that has shocked also in tuberculosis. The WHO estimates that they have been detected 18% fewer cases during 2020. And, if you don’t detect it, the disease evolves and continues to spread,” warns the epidemiologist at the Barcelona Public Health Agency (Aspb). Joan Pau Millet, in turn co-medical director of Services Clinics. Serveis Clinics is a social health center of Barcelona, located in Sarrià-Sant Gervasi, specialized in the comprehensive treatment of tuberculosis. Is he only tuberculosis hospitalization center in Spain and the benchmark for all of Catalonia. the coronavirus will increase mortality by tuberculosis in about 400,000 more cases by covid-19, according to estimates. In 2020 there was 7% more deaths compared to 2019. “It’s already a global public health problem and it will be a first order problem in the coming years,” warns this epidemiologist.
Serveis Clínics was created in 1993, the same year that the WHO declared tuberculosis as a global public health emergency,just as it was done with covid-19 in 2020,” Millet specifies. objective of the center was and is to treat the most vulnerable people From a medical point of view but also from a social point of view, since they are usually people with problems to carry out the isolation minimum of two weeks (like that of covid-19, while the patients are contagious) and continue with the treatment the six months that this lasts. Currently, at Serveis Clínics, day and night, some 47 patients of all ages, of which 80% are foreigners. In addition to hospitalization, this tuberculosis center has support teams (so-called ‘Etoda’) that administer the outpatient treatment. Serveis Clínics, which works in a multidisciplinary manner and in coordination with other actors in the tuberculosis program, has managed to greatly reduce the number of tuberculosis cases in Catalonia, by favoring healing and preventing contagion.
70,000 years of history
Tuberculosis is a contagious disease, yes, although less than covid-19. This is because the bacteria (tuberculosis is caused by one type of tuberculosis: Koch’s bacillus) they replicate to slower than viruses. It may seem less serious for this reason, but doctors warn that tuberculosis coexists with the human being from approximately 70,000 years. “And we have not been able to eradicate it. Starting in the 1950s, with the antibiotics, we began to cure her”, emphasizes the pulmonologist Xavier Casas, also co-medical director of Serveis Clínics.
This disease is spread by air and, although it can affect all the organs of the body, It mainly damages the lung. “When it affects the lung, symptoms are similar to those of covid-19: fever, cough… And also hemoptysis, which is the emission of blood through the mouth from the respiratory tract. Tuberculosis causes cavities in the lung and causes it to bleed,” continues Casas. That quarter of the world’s population (about 2 billion people) that has tuberculosis infection latent tuberculosis (that is, in a state of rest, without clinical manifestations) could develop the disease if his defenses were lowered.
A quarter of the world’s population has latent infection and could develop tuberculosis if their defenses are lowered
As the head of the Aspb Epidemiology Service explains, Christina Rios, tuberculosis is sometimes difficult to detect because it has “very nonspecific symptoms.” “In a city like Barcelona It’s hard to think of her in the face of a cough, for example. The fact that the entire health system has focused on covid has meant that this more unspecific disease is neglected,” he explains. Like the coronavirus, tuberculosis requires a good contact Study, something that in Barcelona has stopped being done due to the pandemic, since the available resources have only allowed prioritize the “most serious and contagious” cases.
long treatments
When Serveis Clínics opened in the early 1990s, the incidence of tuberculosis in Barcelona was “extremely high”: about 70 cases per 100,000 inhabitants. Now, with the covid-19 indicators skyrocketing, it may not seem so high. “However, covid-19 is cured in a week. For tuberculosis you need vseveral months of treatment”, Millett warns. “The patient profile changed a lot over the years. In the 1990s, tuberculosis was closely linked to HIV”, Add.
Patients arrive at Serveis Clínics through screening in soup kitchens, searching for cases on the street and from hospitals
Now the profile of the Serveis Clínics patient is, for the most part, that of a vulnerable person. Many of them are foreigners. Some use drugs and, at the time they were diagnosed, They slept in the street. “These people find it even more difficult to follow the treatment because it is long. During the time they are here, we try to develop tools to be able to reintegrate better into society once they leave”, explains Casas. Thus, not only doctors work at Serveis Clínics, but also psychologists, physical therapists, social workers and occupational therapists. Patients arrive referred through the screenings in soup kitchens Or the active search for cases on the street, but above all from the medical reports that arrive from the hospitals of Catalonia.
Not just “poor”
Although Serveis Clínics is aimed at vulnerable patients and tuberculosis has traditionally been associated with poverty, this disease can affect people from any social sector. “It is not a disease only of the poor. There are also patients in the more affluent neighborhoods. you can get infected on the plane or in the subway. There are studies of it. However, the incidence is usually higher in disadvantaged districts such as Ciutat Vella”, Millett points out. The people with weaker immune systeml (such as transplant recipients, immunosuppressed or patients with cancer treatments) are usually more likely to get tuberculosis.
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One of the great problems that tuberculosis has been facing for two decades is resistance to antibiotics
Although since the middle of the last century progress has been made in the cure of tuberculosis, from the year 2000 there began to be problems due to the appearance of antibiotic resistance. In fact, Serveis Clínics is also reference center to care for patients with these types of problems. “That’s why, in addition to treating TB-associated diseases, we often give patients 3 or 4 types of antibiotics, so that there is no resistance”, emphasizes the pulmonologist Xavier Casas. Tuberculosis, he warns, is still a “global public health emergency”. And it will be more so in the coming years. Every year 1.5 million people die in the world, of which 250,000 are children.