OLYMPIA, Wash. - Washington state health officials are on heightened alert as tuberculosis (TB) cases are on the rise. According to the Washington State Department of Health , widespread disruptions in public health, healthcare services and missed TB diagnoses, because symptoms are similar between COVID-19 and TB, may have contributed to the rise locally and globally. In 2020, reported cases were down but officials said efforts to prevent COVID-19 may have reduced the spread or may have decreased due to delayed or missed TB diagnoses. Some people with TB may have also been misdiagnosed as having COVID-19. In 2021, there were 199 reported cases of TB, which was a 22% increase from 2020. So far in 2022, 70 cases have been reported. The DOH said 17 new cases all have connections with each other and several state prisons, which makes it the largest outbreak in the last two decades. "It’s been 20 years since we saw a cluster of TB cases like this," says Tao Sheng Kwan