193. Impact of COVID-19 Pandemic on Pulmonary Tuberculosis Evaluations and Diagnosis at a Large Safety Net Hospital in Los Angeles, California

BACKGROUND: There is significant global concern that the COVID-19 pandemic may negatively impact tuberculosis (TB) control. This is a descriptive analysis of TB evaluations and diagnosis during 2019 (pre COVID-19 period) and 2020 (COVID-19 period) at the largest safety net hospital in Los Angeles County (LAC+USC Medical Center). METHODS: The medical records of patients diagnosed with pulmonary TB from January 1, 2019 to December 31, 2020 were identified through laboratory and electronic medical records. We included all patients with ≥ 1 sputum positive result for Mycobacterium tuberculosis (MTB) culture and reviewed their Xpert MTB/RIF MTB PCR. RESULTS: Table 1 shows summary of results. During the COVID-19 period, the number of patients evaluated for pulmonary TB decreased by 64% compared to the previous year (Figure 1). The proportion of patients with culture-confirmed TB disease however, was nearly identical (P=0.913) (Table 1). Sputum acid-fast bacilli (AFB) smear positivity increased 52% to 64% during COVID-19 (P=0.324) and disease severity as measured by chest radiograph, was significantly higher during the COVID-19 period (P = 0.031) (Figure 2). [Image: see text] Trend of sputum AFB smear and culture samples collected from January 1, 2019 to December 31, 2020. [Image: see text] Summary of results of patients diagnosed with pulmonary TB from January 1, 2019 to December 31, 2020 at LAC+USC Medical Center. [Image: see text] Results of two-sample test for proportions of 2019 vs 2020 for cavitary lesions, extent of disease, and sputum positive AFB smear microscopy. CONCLUSION: These preliminary results suggest that when compared to the previous year, the number of pulmonary TB evaluations decreased by 64% during the COVID period. Whereas the proportion of patients diagnosed with TB disease was similar, TB patients during the COVID-19 period had more advanced disease at diagnosis, as measured by sputum smear AFB microscopy and disease severity on chest radiograph (P=0.031). These data suggest potentially consequential interruptions and delays in pulmonary TB diagnosis during the COVID-19 period. DISCLOSURES: Susan Bulter-Wu, PhD , Cepheid (Consultant)