The tuberculosis rate among Inuit in Canada fell by more than 60 per cent between 2019 and 2020, but there’s no guarantee the reduction is the good news it appears to be.
The Public Health Agency of Canada released tuberculosis statistics on Thursday that provide a national snapshot of TB rates during the first year of the pandemic, when non-COVID-19 medical services were scaled back and the public-health workers who normally trace TB outbreaks were consumed with the new coronavirus.
That means cases of active TB in Canada may have gone undiagnosed and untreated, as the World Health Organization says has been the case in other countries. In 2020, global TB death rates, fuelled by pandemic-era neglect, rose for the first time in more than a decade.
“The way people accessed health care services [in 2020] was markedly different than any time in the recent past because of COVID,” said Faiz Ahmad Khan, a respirologist and TB specialist who works in Montreal and Nunavik, the Inuit region of Northern Quebec. “So we don’t know whether the rates represent a true reduction in TB or a delay in diagnosis.”
What is clear is that TB rates in Inuit communities remained far higher than the national average rate in 2020, which is why Inuit leaders are calling on the federal Liberals to devote $141-million over the next eight years to fulfill their promise to eliminate TB in Canada’s Inuit regions by 2030.
Justin Trudeau’s government made the elimination promise in co-operation with national organization Inuit Tapiriit Kanatami, or ITK. Ottawa initially committed $27.5-million to the campaign, money that was divided among Canada’s four Inuit regions: Inuvialuit in the Northwest Territories, Nunavik in Northern Quebec, Nunatsiavut in northern Labrador and the territory of Nunavut.
ITK president Natan Obed and Indigenous Services Minister Patty Hajdu released a joint statement Thursday acknowledging the lower TB case rate among Inuit in 2020, while warning it is too early to say how the pandemic might have affected those rates.
The new Public Health Agency of Canada data, released to mark World TB Day, show there were 72.2 active cases of TB per 100,000 diagnosed in Inuit patients in 2020, compared to a national case rate of 4.7 per 100,000. The rates were 14.3 for foreign-born residents, 13.6 for First Nations and 2.8 for Métis.
Despite being 15 times higher than the national average, the TB rate among Inuit in 2020 was down significantly from 188.7 cases per 100,000 in 2019 and from a 10-year annual average of 184.14 per 100,000 from 2010 to 2019.
TB rates in Inuit communities can fluctuate from year to year, depending on the presence or absence of outbreaks, because the overall number of Inuit in Canada is so small – about 65,000 in total.
Tuberculosis rates in Inuit regions are in many ways a reflection of the poverty and overcrowded living conditions that many in those communities face, according to Aluki Kotierk, the president of Nunavut Tunngavik Inc., the lead Inuit organization for Nunavut.
“We know that housing has an impact on health. We know that food, or the lack of food, has an impact on health,” she said in an interview before the new data were published. “Even before the pandemic, those two issues – housing and food insecurity – were having a profound impact on tuberculosis rates.”
Howard Njoo, Canada’s deputy chief public health officer, echoed that. “We all know it’s the social determinants of health,” he told The Globe and Mail Thursday. “It’s overcrowding, it’s access to health care services, it’s the legacy of colonialism.”
Active tuberculosis infections, which are caused by a bacterium that spreads through the air and usually lodges in the lungs, can cause fever, weight loss, night sweats, fatigue and a chronic, sometimes bloody cough.
Antibiotics can cure active TB and prevent “sleeping TB” – a latent infection that doesn’t cause symptoms and isn’t contagious – from turning into a symptomatic infection.
Latent TB is most often caught during contact-tracing investigations that commence after a sick patient is diagnosed with TB. During the pandemic, many of those public-health contact tracers were redeployed to chase the coronavirus.
If left untreated, TB can be fatal. There were 69 tuberculosis deaths in Canada in 2020, according to the Public Health Agency of Canada.
Fifty of those deaths were among foreign-born Canadians, another population with higher-than-average TB rates. New Canadians originally from countries with high TB burdens sometimes arrive in Canada with no idea they are carrying a dormant TB infection that could become active years later.
The public-health agency said five of the deaths were among Indigenous Canadians, but didn’t specify if any were Inuit.
Dr. Ahmad Khan, the Montreal respirologist, was one of the co-authors of a study published last year in the Journal of Infectious Diseases that found fewer patients at three TB centres in Montreal and Toronto started treatment for latent and active TB infections in the early months of the pandemic than in the pre-COVID-19 era – a signal that people were going undiagnosed.
“For active TB,” he said, “we may be seeing people presenting when their disease is more severe, and individuals will be more sick.”
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