Trends in Active Tuberculosis Cases Diagnosed in New York City During the COVID-19 Pandemic

Objectives: The number of active tuberculosis (TB) cases reported in New York City in 2020 declined 20% from 2019. To describe this decrease, we examined the characteristics of TB patients before and during the COVID-19 pandemic. Methods: We compared the characteristics of 2 groups of TB cases: (1) cases in New York City’s TB surveillance registry diagnosed during the pandemic (March 1, 2020–February 28, 2022) and the stay-at-home order PAUSE (Policies that Assure Uniform Safety for Everyone) (March 23–June 7, 2020) and (2) cases diagnosed before the pandemic (March 1, 2018–February 29, 2020). Results: We identified 1088 patients with TB before the pandemic and 945 patients with TB during the pandemic; 62 patients were diagnosed with TB during PAUSE (53% fewer compared with the same dates in 2019). During the pandemic versus before the pandemic, a significantly higher proportion of patients were hospitalized at diagnosis (66.3% vs 60.1%; P < .001). During PAUSE versus before the pandemic, a higher (but not significantly higher) proportion of patients with pulmonary TB had a positive respiratory acid-fast bacilli smear result (63.5% vs 57.8%; P = .42) and cavitation on chest imaging (48.1% vs 39.0%; P = .19). The median duration of TB symptoms before diagnosis was 58 days during the pandemic and 45 days before the pandemic ( P = .02). During the pandemic, a higher (but not significantly higher) proportion of patients died before treatment start (3.3% vs 2.0%; P = .08) and before treatment completion (9.0% vs 6.8%; P = .07) compared with before the pandemic. Conclusions: TB diagnoses precipitously declined during PAUSE. Disease severity and symptom duration increased among patients during the COVID-19 pandemic, indicating that TB diagnoses may have been delayed and that TB may have been underdiagnosed during the pandemic in New York City.