Chart 2. Main research questions on COVID-19 and tuberculosis, by field of study.
| Field of study | Research question |
|---|---|
| Human exposure and immunology | When and where did COVID-19 first appear? What are the main immunological consequences of exposure to Mycobacterium tuberculosis and SARS-CoV-2? |
| Epidemiology | What is the real impact of COVID-19 on the epidemiology of tuberculosis and vice-versa? To what extent can SARS-CoV-2 trigger latent tuberculosis to evolve into active tuberculosis? |
| Transmission | What is the relevance of COVID-19 transmission via surface contamination, fecal-oral route, and aerosols versus droplet transmission? What is the relevance of transmission occurring from asymptomatic individuals? What are the implications for the prevention of transmission? |
| Signs and symptoms | What are the signs and symptoms possibly supporting the initial differential diagnosis between the two diseases? |
| Comorbidities | What is the role of different comorbidities on the incidence and mortality of the two diseases separately and when they are combined? |
| Vaccine | What is the real effectiveness and epidemiological impact of the COVID-19 vaccination program that has recently begun? What about vaccination of specific groups, such as the elderly and immunocompromised individuals? Is the BCG vaccine protective against COVID-19? |
| Other preventive measures | What are the most effective prevention measures (hand washing, use of personal protection equipment, physical distancing, other mitigation measures such as curfews and lockdowns, etc.) in different COVID-19 epidemiological scenarios? |
| Rapid diagnostics | What are the feasibility, importance, and potential impact of combined rapid diagnostics? |
| Treatment | What treatment is effective against COVID-19? Are corticosteroids necessary? Is there a relevant drug-to-drug interaction to monitor specifically? What is the importance of providing oxygen supplementation or invasive/noninvasive ventilation, and when should they be initiated? Are treatment outcomes different in patients with the tuberculosis/COVID-19 combination? What is the need for pulmonary rehabilitation following tuberculosis or COVID-19? Is pulmonary rehabilitation effective? |
| Case definition | What is the final case definition and associated criteria for classification of COVID-19, which are still subject to updates? |
| Stigma | What types of stigma are associated with the two diseases, and what can be done to prevent that? |
| Policy development | What have we learned in terms of policy development, risk communication, rapid implementation of travel policies, and quarantine restrictions, etc., one year after the beginning of the COVID-19 pandemic? |
| Resource mobilization | Can the rapid but sometimes chaotic resource mobilization experienced during the COVID-19 pandemic be used in order to prepare rational, comprehensive epidemic prevention/control plans for the future? Can this resource mobilization include benefits for tuberculosis prevention as well? |
| Economic impact | What is the overall cost of the COVID-19 pandemic to the global economy? To what extent will the COVID-19 epidemic create an additional economic burden that will impact the tuberculosis epidemic in the future? |
| Stress on health care systems | What is the real stress imposed by the two diseases on health care systems presently and in the coming future? |
| Data availability | How can we improve surveillance data to make evidence-based decisions? |