A modelling analysis published in Clinical Infectious Diseases estimated that COVID-19-era disruptions (2020–2023) may be linked to ~2,784 additional US TB notifications (95% UI, 2,164–3,461) and ~1,138 additional TB deaths (95% UI, 1,076–1,201) through 2035. Using a Bayesian transmission-dynamic model, Swartwood et al. projected 135,187 TB notifications vs 132,417 without the pandemic (2.1% higher) and 16,566 TB deaths vs 15,428 (7.4% higher) from 2020–2035.

Why It Matters To Your Practice

• TB notifications fell sharply in 2020–2022, driven mainly by reduced accurate diagnosis and treatment initiation — setting up a potential “catch-up” rise in cases through 2035.

• Delayed diagnosis can mean patients present later and sicker, increasing transmission risk and mortality (including possible COVID-19 coinfection effects).

• Primary care, urgent care, and community clinics are where missed TB often shows up first — especially in patients with persistent respiratory symptoms or systemic “B” symptoms.

Clinical Benefits

• Earlier suspicion and testing (e.g., IGRA/TST plus targeted imaging and sputum testing when indicated) can reduce time-to-treatment and downstream spread.

• More consistent risk-based screening (recent immigration, congregate settings, immunosuppression, prior exposure) can identify latent TB infection before progression.

• Clear follow-up pathways for abnormal chest imaging or prolonged cough/fever/night sweats can reduce loss to follow-up after initial visits.

Managing Risks

• Avoid anchoring on common viral/bronchitic diagnoses when cough persists >2–3 weeks, symptoms recur, or weight loss/night sweats/hemoptysis are present.

• Use appropriate infection-control steps when TB is possible (masking, rooming considerations, prompt public health notification per local protocol).

• Consider drug–drug interactions and toxicity monitoring when treatment starts (e.g., rifamycins with anticoagulants, OCPs, some antivirals; baseline LFTs when indicated).

The Bottom Line

• The model suggests pandemic-era TB diagnostic and care disruptions may translate into ~2,784 additional TB cases and ~1,138 additional TB deaths in the US through 2035.

• For NPs and PAs, the highest-yield response is earlier TB consideration, risk-based screening, and tighter follow-up/testing pathways to reduce delayed diagnoses.