Lakpa was aged 18 when she was admitted to Okhaldhunga Community Hospital (OCH) with a cough and weight loss. We diagnosed her as having sputum positive pulmonary tuberculosis, but she also tested positive for COVID-19, during the third wave of COVID-19 in Nepal in early 2022.

She was transferred to a COVID-isolation area at the same time as anti-TB treatment was commenced. She did not require oxygen and remained well from the point of view of COVID. We kept her for a few days to ensure that she was tolerating the TB medications. She was discharged to be followed up by her local health post staff to monitor the intensive phase of her TB treatment – this lasts for two months. She will be reviewed after this time at OCH to check her response and to have her sputum re-tested for TB. Hopefully, she will have become sputum negative by then.

It is ironic that she received her initial tuberculosis therapy in our ‘TB ward area’, not because she was TB sputum positive, but because she was COVID-19 positive.

We hope that soon we will be able to close the COVID-isolation area at OCH and re-open it to patients like Lakpa so that they can receive their full initial two months of ‘intensive phase’ treatment under our direct monitoring. This so-called ‘DOTS’ (directly observed therapy, short-course) is the mainstay of tuberculosis therapy worldwide and has led to increasing cure rates and decreasing prevalence rates globally.