Before 2020, advances to eradicate TB, which is spread person to person through the air, were underway globally. It was considered by many public health experts to be a feasible goal, since tools are available to identify and treat it. But the prevalence of the disease in Mexico, and immigration along the border, has made it a longtime health concern in these communities.
In areas with high traffic of immigrants, such as Cameron County, TB is a serious health concern. Cameron sits at the southernmost tip of Texas, and each year millions of people cross to and from Mexico at the four border crossings in the Brownsville region. Brownsville is the county’s seat and largest city. In 2019, before COVID-19, Texas’ 32 border counties had an average TB incidence of 8.4 cases per 100,000 people — more than double that of the state overall and nearly triple the national rate.
Since the pandemic began, though, some tuberculosis clinics in border areas have been performing fewer tests, receiving fewer referrals from local hospitals and providers and treating fewer patients. [TB program supervisor with Cameron County’s health department Narciso] Lopez and others who do this public health work every day on the ground agree it’s not likely less TB is circulating. Instead, they say, COVID-19 testing and treatment have claimed so much attention and energy that TB has been pushed off the radar, threatening to reverse decades of progress in eliminating it.
Lopez said his county’s tuberculosis department usually gets around 40 to 60 patients a year.
“And then, all of a sudden, we went down to 20 during the COVID pandemic,” he said.
The numbers seem to be bouncing back. In 2022, Lopez said, the county’s clinics saw 35 TB patients. But that’s still lower than pre-pandemic levels.
Hidalgo County, which neighbors Cameron to the west, experienced a similar trend in 2020, when its number of confirmed TB cases was cut in half from the previous year, dropping from 71 cases to 36, according to Jeanne Salinas, tuberculosis program manager of the county health department. The county also performed hundreds fewer TB tests.
Since 2020, Salinas said, tuberculosis has been “overlooked” as a diagnosis for patients reporting “prolonged cough or cough with blood, losing weight [and] having fevers.” After COVID-19 became everyone’s overriding concern, these patients — who included new immigrants as well as people who regularly traveled across the border for work or to visit family on the other side of it — were tested for COVID-19. Salinas said it was only if the symptoms persisted that patients would perhaps be evaluated for tuberculosis. This lag time allowed the illness to progress in individual patients and potentially spread in the community.
This reflects a nationwide trend. According to the Centers for Disease Control and Prevention, U.S. tuberculosis incidence rates “decreased steadily” from 1993 to 2019. In 2020, though, there was a “sharp” decline of nearly 20% in recorded cases, which the CDC materials suggest may be due to “delayed or missed TB diagnoses or a true reduction in TB incidence related to pandemic mitigation efforts and changes in immigration and travel.” But because TB is more contagious than COVID-19 (its particles stay in the air longer), steps like masking and distancing are less effective. So, Salinas argues the former.
This story was from a couple of months ago and it’s been sitting in the drafts. I looked at it again, and did a Google news search to see if anything had changed since then but didn’t find anything, so I figured I’d go ahead and hit publish. TB tends to be a disease of poverty, and as noted the rates are higher in Texas near the border. It’s curable and detectable by test, and as with other respiratory diseases its spread can be mitigated, but all that requires health care infrastructure that we lack in the rich parts of the state, let alone immigrant communities along the border. Basically, it’s another problem the state isn’t going to do anything about. And now we know, since the session is over, it’s not even on the radar.