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Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study

BMJ 2020; 369 doi: (Published 21 April 2020) Cite this as: BMJ 2020;369:m1443

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Persistence of viral RNA in stool samples from patients recovering from covid-19

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Re: Management and outcome of tuberculosis as the pandemic of Covid-19 in China

Dear Editor,

Covid-19 and tuberculosis (TB) have many similarities, both are respiratory tract-based infectious diseases, and the population is generally susceptible. Stool samples from intestinal tuberculosis patients can also be pathological confirmed by rapid molecular detection Wang et al. reported a case of covid-19 complicated with tuberculous meningitis. DNA detection of mycobacterium tuberculosis in cerebrospinal fluid (PCR fluorescence probe) was positive in the cerebrospinal fluid. The course of this patient progressed rapidly, and he died 14 days after the onset of the disease.(1) During the epidemic of SARS and MERS, there are also patients coinfected with TB in SARS or MERS.(2-4) The impact of concurrent tuberculosis and other air-borne communicable disease is not conclusive, but most researchers think the disease is more likely to worsen especially in hospitalization patients or with symptoms for a longer time.(5-8)

China has a heavy burden of tuberculosis and is the place where covid-19 epidemic began. The Joint Prevention and Control Mechanism of the State Council in China accurately implemented the regional policy and took different management and control measures according to the incidence of regional diseases ranking low-risk, medium-risk and high-risk areas.(9) On the one hand, strong administrative systems accelerated control this outbreak, also limiting people’s daily life, including TB patients. On the other hand, covid-19 patients were often admitted to tuberculosis wards. which in turn decreased medical resources for TB patients. Above issues affected the general diagnosis and treatment of TB patients especially for critically ill patients.

Under this circumstance, the CDC adopted measures that community or rural doctors deliver anti-tuberculosis drugs to their homes or by express delivery to ensure TB patients adhere to regular medication. Meanwhile, more patients chose to communicate with doctors on the Internet platform. The above measures can ensure that TB patients continued to take medicine and insisted on taking medicine safely during the time of quarantine.

Active control of covid-19 to restore normal social order as soon as possible is conducive to the treatment of TB patients. Chinese society has been strictly quarantined for about two months. When the epidemic began to be controlled, TB patients can also be treated normally, which shortens the isolation time of TB patients.

Shuihua Lu, Shanghai Public Health Clinical Center, Fudan University.
Heng Yang, Shanghai Public Health Clinical Center, Fudan University.
Lu Xia, Shanghai Public Health Clinical Center, Fudan University.

We have no conflicts of interest to declare.

1. Wang L, Cai , Luo HT, et al. A case of coronovarius disease 2019 with tuberculous meningitis. Zhonghua Shen Jing Ge Za Zhi 2020,53. doi: 10.3760/cma.j.cn113694-20200302-00134.
2. Liu W., Fontanet A., Zhang PH., et al. Pulmonary tuberculosis and SARS, China. J Emerg Infect Dis 2006;12(4):707-09. doi: 10.3201/eid1204.050264 pmid:167155872006-04-01.
3. Alfaraj SH, Al-Tawfiq JA., Altuwaijri TA., Memish ZA. Middle East Respiratory Syndrome Coronavirus and Pulmonary Tuberculosis Coinfection: Implications for Infection Control. Intervirology 2017;60(1-2):53-55. doi: 10.1159/0004779082017-01-01.
4. Low JG., Lee CC., Leo YS., et al. Severe acute respiratory syndrome and pulmonary tuberculosis. Clin Infect Dis 2004;38(12):e123-25. doi: 10.1086/421396 pmid:152276352004-06-15.
5. Mendy J, Jarju S, Heslop R, et al. Changes in Mycobacterium tuberculosis-Specific Immunity With Influenza co-infection at Time of TB Diagnosis. Front Immunol 2018;9:3093. doi: 10.3389/fimmu.2018.03093 pmid:306624432018-01-20.
6. Walaza S., Tempia S., Dawood H., et al. Influenza virus infection is associated with increased risk of death amongst patients hospitalized with confirmed pulmonary tuberculosis in South Africa, 2010-2011. BMC Infect Dis 2015;15:26. doi: 10.1186/s12879-015-0746-x pmid:256239442015-01-27.
7. Walaza S, Cohen C, Nanoo A, et al. Excess Mortality Associated with Influenza among Tuberculosis Deaths in South Africa, 1999-2009. Plos One 2015, 10(6) :e129173. doi: 10.1371/journal.pone.0129173.
8. Abadom TR., Smith AD., Tempia S, et al. Risk factors associated with hospitalisation for influenza-associated severe acute respiratory illness in South Africa: A case-population study. Vaccine 2016;34(46):5649-55. doi: 10.1016/j.vaccine.2016.09.011 pmid:27720448.
9. The Joint Prevention and Control Mechanism of the State Council issued the guidance on Scientific Prevention and Control, accurate Policy, Division and Classification to do a good job in the Prevention and Control of COVID-19 's epidemic situation. In, 2020. [cited 2020 Apr 17].

Competing interests: No competing interests

26 April 2020
Shuihua Lu
"Heng Yang, Lu Xia". Shanghai Public Health Clinical Center, Fudan University
Shanghai Public Health Clinical Center, Fudan University
2901 Caolanggong Road, Shanghai,201516,China