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“It’s been 20 years since we saw a cluster of TB cases like this.”

That’s a quote from Tao Sheng Kwan-Gett, MD, MPH, Washington state’s chief science officer. He commented in April on the 17 new cases of tuberculosis, which are all connected with each other and with several prisons in Washington.

Health officials worldwide and in the US are still waiting to see if the drop in TB cases in 2020 represents a true reduction or if the decrease resulted from suspected cases being misdiagnosed as COVID-19 or being missed altogether due to lack of care access during lockdowns.

In Washington’s case, Kwan-Gett believes, “The [COVID] pandemic has likely contributed to the rise in cases and the outbreak in at least one correctional facility.”

In 2021, cases began to rise when 199 cases of TB disease were reported, a 22% increase from 2020. As of April this year, 70 cases have been reported in Washington and officials continue to monitor the situation closely.

Contributing to the challenge is the decrease in TB reporting in 2020, during the first year of the pandemic. While efforts to prevent COVID-19 could also reduce the spread of TB, health officials in Washington are concerned “the decrease could also have been due to delayed or missed TB diagnoses because of strains in the health care system.”

Some of these strains, like labor shortages for instance, continue even as more severe COVID variants are subsiding. At the same time, public health departments in areas experiencing increasing levels of TB will need to find a way to boost access to TB testing and treatment in the community to get the disease under control.

The labor-intensive documentation requirements around directly observed therapy required for TB and other communicable diseases is an issue that compounds the demands on nurses already taxed in under-staffed organizations. This challenge can be eased for public health departments that implement an electronic health record like ezEMRx. The system helps by eliminating multiple duplicative entries and automating reporting. Nurses spend less time on documentation and accuracy increases, as the system limits the range of inputs and prompts the user when a likely error is detected.

For patients with access to the necessary technology, ezEMRx also enables telehealth visits. Replacing some in-person visits with remote observation frees up time in busy nurses’ schedules to serve more patients per day and to serve closer to the top of their license more often.

Upgrading to electronic recording and documentation of TB testing and treatment can help public health departments do more with less and ease the impact of healthcare labor shortages.

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