The Use of COVID-19 Surveillance Measures in Detecting Cases of Tuberculosis (TB)

Round 1

Reviewer 1 Report

In this manuscript ‘The use of current Covid-19 surveillance measures in detecting cases of Tuberculosis,’ Sayed et al describe a case series of 4 patients from different backgrounds who were found to be ill at the airport in Saudi Arabia and were brought to the hospital, that ultimately led to diagnosis of TB cases. Their symptoms included hemoptysis and dyspnea. Authors believe that COVID-19 surveillance measures such as temperature-monitoring and contact tracing led to earlier detection of these cases with active TB.

 

Overall, the cases are well-summarized. While this paper has certainly been engaging, there are some issues in this paper that require explanation. Please see comments below for specific concerns.

 

·       I don’t completely agree with the authors that COVID-19 surveillance measures led to increased detection of active cases of TB. All 4 cases discussed in this manuscript presented with sudden onset worsening dyspnea, chest pain, and/or hemoptysis which are medical emergencies, and would have led to patient presenting to the hospital irrespective of COVID-19 surveillance measures. Not sure if temperature-checking and tracing applications had any role, and if it did, it would need detailed explanation under individual case histories that are described. Also, for each case, the authors say that TB was one of the top differentials before the diagnosis was even made, so not sure if COVID-19 surveillance measures played any role. Hence, the theme of this paper and conclusions would need to be softened further as it does not align well with the evidence presented. This is my biggest constructive criticism for the manuscript.

·       There are numerous grammatical errors that require proof-reading – it would be helpful to have it reviewed by someone with English language proficiency.

 

Minor comments:

Title – Covid-19 should be replaced with COVID-19 here and everywhere else.

 

Abstract – Line 11: spell out TB as it is used the first time.

 

Introduction

Line 22: patients with active TB can also be ‘asymptomatic’ but have concerning chest xray findings and positive sputum AFB. Need to better define active and latent TB per the WHO definitions as this sentence is partly erroneous.

Line 24: the number of active TB cases exceed latent TB cases in Saudi Arabia???? Looks like an erroneous statement. I don’t think the reference cited here talks about the number of active TB cases.

Line 26: would say ‘coronavirus disease of 2019 (COVID-19)’

Line 33: would complete the sentence after building, as it appears incomplete.

 

Methods

Would be helpful to describe the month and the year these 4 cases were seen to understand how far out into the pandemic this was seen

Line 45: remove ‘systematic’

Line 49: ‘All’ repeated twice, remove one of them

Line 50: spell CT, used first time

Line 51: remove ‘expert’ or ‘consultant’ as they mean the same

 

Results

Case 1: would add more details regarding social history

Line 63: ‘coughing blood’ can be replaced by ‘hemoptysis’

Line 106: add ‘was associated with more than…’

Line 92: here and for 3 other cases, please specify AFB ‘smear’ or ‘culture’ testing or both?

Line 126: what is ‘gluid’?

 

Discussion

Line 244: ‘pre-COVID life’ can be replaced by other phrase as it reads as informal. Similarly, ‘feverish’ in line 249. Also ‘alcohol gel’ in line 250 can be replace with ‘hand-based sanitizers’

Line 264: there is annual TB report in 2021 and even in 2022. Would encourage authors to not used outdated information and cite the most recent reference.

Line 283: Would add to the discussion that - this flu season, the seasonal flu level has increased drastically in the US due to mitigation of masking and other social distancing measures.

Line 298: Add ‘thus’ prior to prevent

Not sure what the relevance of different working backgrounds is and how is it pertaining to this manuscript, would elaborate further in discussion.

 

Conclusions

Line 301: would elaborate ‘these’ measures further for e.g., ‘COVID-19 surveillance measures’

 

Figures/Tables

Figures. Would use the image of CT chest instead of CXR, wherever CTs were done.

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

Dear Authors, the manuscript under review is a case series on four cases of TB detected through the covid19 surveillance. The paper is pretty well-written, however I have a few comments:

-          Please make a whole manuscript grammar English check.

-          In materials and methods, the first sentence (lines 42-43) needs to be rewritten since there is no verb. I think it could be like the following or something similar: “Patients presented at the emergency department at King Abdullah Bin Abdulaziz University Hospital (KAAUH) in Riyadh, Saudi Arabia, were screened to selected cases of TB identified thanks to the covid19 surveillance measures”. The same for lines 49-50 “All Radiological examination done to all patients including posteroanterior chest x-49 ray (CXR), CT chest with contrast and echocardiography”

-          In materials and methods, it would be helpful to add some information about the inclusion/exclusion criteria, the number of selected cases, etc etc.

-          I suggest implementing the reference list with the following: 10.1056/NEJMp2118145; 10.3390/healthcare10020386, 10.1016/S2213-2600(21)00161-2

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

I believe the necessary revisions have been made by the authors and the current updated manuscript can be accepted in its present form

Author Response

We thank the reviewer for the time taken to go through our manuscript, and we are pleased to hear that the necessary revisions addressed the previously raised concerns. We are also pleased to know that the issue concerning the language of the manuscript has been significantly improved and it is fine now.