When the first cases of COVID-19 were registered in the Kyrgyz Republic in late March, the Kyrgyz Government announced a state of emergency in some parts of the country, with strict lockdown measures in order to contain the epidemic. On March 23, the Ministry of Health (MOH) issued a decree to convert the specialized 30-bed ward for treatment of patients with multidrug-resistant TB (MDR-TB) at the National Tuberculosis Center (NTC) to host COVID-19 patients, as well as the main building of the NTC with 196 additional beds as a reserve.
The decision to treat COVID-19 patients at the NTC posed serious challenges for infection control and put health workers at high risk of contracting the disease. For TB patients who are particularly vulnerable to COVID-19, it also posed a new risk of TB/COVID co-infection. USAID, as a longstanding partner of the National TB Program (NTP), immediately provided assistance to contain the risk of infection. The USAID Cure Tuberculosis Project assisted the NTP in revising and strengthening infection control protocols and conducted a full-day training for 50 NTP staff on the new measures. The strengthened infection control measures increased the capacity of medical personnel working on the frontlines of the epidemic, minimized the risk to their health, and reduced the risk of infection among TB patients.
“When you put on personal protective equipment, your life instinct kicks in and you try to remember all you’ve learned. Instead of panicking, it’s better to receive reliable information and learn how to behave in different situations. Emergency situation! What do we do? Like astronauts, we need new information, because there is always new knowledge on the topic,” says Elena Zhdanova, the head of the MDR-TB Unit of the NTC and the First Anti-COVID-19 Brigade Leader. Special brigades were established to work in 14-day shifts, alternating with 14 days of self-isolation. Together with her team, Zhdanova applied the strengthened infection control measures during their shifts in the Red Zone – the repurposed MDR-TB Unit and the adjacent areas within the NTC.
In addition to the direct impacts on the MDR-TB ward of the NTC, the COVID-19 epidemic and emergency situation affected the TB service system as a whole. Restrictions on movement during lockdown made it difficult for TB doctors from the regions to travel regularly to the meetings of the central Conciliums, the medical councils that make decisions on diagnosis and treatment of individual DR-TB cases.
Tuberculosis patients also could not travel to health facilities to receive their daily dose of drugs. USAID support helped draft a decree for the Ministry of Health on provision of TB services under emergency conditions. The decree allowed the Conciliums to transition their weekly meetings online, and allowed TB patients to receive a 14-day supply of drugs at a time. USAID also supported developing guidelines for providing video-observed treatment using the internet, mobile communications, and the help of community-based treatment supporters in order to ensure patients continued to take their drugs as prescribed. The decree was adopted by the MOH on April 8, allowing doctors to make critical decisions about diagnosis remotely and to continue providing life-saving treatment to TB patients without interruption.
