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Wales could see the return of sanatoriums to help treat patients with tuberculosis if people don't come forward for treatment for the disease, public health officials are warning.
The bacterial infection affects around 100 people here each year with one in 10 of those dying from the disease - although usually connected to other health problems or old age.
But doctors have told ITV Cymru Wales that because of the pandemic, they expect people to come forward later than usual with TB - and that if cases go undetected, it can become resistant to multiple drugs.
“TB has not gone away, it's an ever present danger,” Dr Gwen Lowe, a consultant in communicable disease for Public Health Wales said.
“There is effective treatment but if the treatment breaks down or the supervision of the treatment breaks down or we get increasing drug resistance then we will see the situation deteriorate - more cases of TB and that’s where we’re in trouble.’
What is TB?
Tuberculosis can occur anywhere in the body but is only infectious if it is present in the lungs. Symptoms of TB include:
Night sweats where you have to change the bed sheets and your clothes
To contract TB you need to be exposed to an infectious person for around eight hours. Those living in cramped conditions, drug and alcohol users and people living in prison are more likely to contract TB in the lungs.
The standard treatment is six months long using different drugs at different times. As it's intensive for the patient, but must be stuck to in order to be effective, there are public health powers that can be used to isolate individuals who pose a risk to the wider community.
Doctors in Wales are trying to eliminate TB as a ‘homegrown’ disease, but still half of all patients here were born in the UK.
Following the coronavirus outbreak, doctors expect to find cases of TB later which means patients will have been infectious for longer, spreading the disease before they have been diagnosed.
Dr Gwen Lowe described the public health situation around TB as “precarious.”
“TB is under control, but it’s actually on a knife edge. The reason it is under control is all the intensive efforts to find cases, make sure people take their treatment, make sure they take their treatment properly.
"If they don’t, they will remain infectious, TB will spread but also we will get the development of multi-drug resistant tuberculosis, that can be difficult to treat and sometimes, rarely, it can be impossible to treat.
When tuberculosis records began to be collected before the First World War there were an estimated 30,000 cases of TB in Wales a year, of which 10,000 people would die.
The situation led to the creation of sanatoria, hospitals where those with TB were sent away from the rest of the population to prevent the spread of the disease.
Now, most people are treated in the community and in some cases, on isolation wards in hospitals. But Dr Lowe said the return of a sanatorium concept for the treatment of TB is "a real possibility" because of the risk of the rise of multi-drug resistant strains of the disease.
"It’s a really real possibility. If we get difficult or impossible to treat tuberculosis or we get it in sufficient numbers that it overwhelms normal outpatient services, then we may well see the return of sanatoriums."
Modern sanatoria or dedicated TB clinics are already in use in the Netherlands for patients with particularly hard to treat cases. TB patients stay at these specialist hospitals for the duration of their treatment.
If you have symptoms of TB you should see your GP, especially if you’ve had a persistent cough for three weeks. Information about local TB services in Wales is available by calling 02920 335 121.