“Addressing COVID-19 means addressing hypertension, obesity, diabetes, cardiovascular and chronic respiratory diseases, and cancer,” wrote Richard Horton, editor-in-chief of The Lancet journal in a comment piece published on 26 September.
The piece, evocatively titled, ‘COVID-19 Is Not a Pandemic’, highlighted the need for a broader understanding of managing the disease outbreak, and of taking into account its massive implications for non-communicable diseases and its disproportionate impact on various social groups.
Therefore, COVID-19 can be seen as a syndemic, writes Horton.
“But what we have learned so far tells us that the story of COVID-19 is not so simple. Two categories of disease are interacting within specific populations—infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and an array of non-communicable diseases (NCDs).”Richard Horton
“These conditions are clustering within social groups according to patterns of inequality deeply embedded in our societies. The aggregation of these diseases on a background of social and economic disparity exacerbates the adverse effects of each separate disease. COVID-19 is not a pandemic. It is a syndemic.”
According to MedicineNet, a syndemic is ‘a set of linked health problems involving two or more afflictions, interacting synergistically, and contributing to excess burden of disease in a population. Syndemics occur when health-related problems cluster by person, place, or time.”
Quoting Singer and colleagues from 2017, Horton said, “A syndemic approach provides a very different orientation to clinical medicine and public health by showing how an integrated approach to understanding and treating diseases can be far more successful than simply controlling epidemic disease or treating individual patients.”
The call to look at the social, environmental and economic factors affecting and being affecting by the outbreak is the need of the hour. Only such a holistic approach could truly mitigate the impact of the virus and other parallel disease burdens on the world population. “The most important consequence of seeing COVID-19 as a syndemic is to underline its social origins.”
“The vulnerability of older citizens; Black, Asian, and minority ethnic communities; and key workers who are commonly poorly paid with fewer welfare protections points to a truth so far barely acknowledged—namely, that no matter how effective a treatment or protective a vaccine, the pursuit of a purely biomedical solution to COVID-19 will fail. Unless governments devise policies and programmes to reverse profound disparities, our societies will never be truly COVID-19 secure.”Richard Horton
In conclusion, the editor-in-chief points towards the costs of viewing COVID-19 only as a pandemic, considering the multiple ways that can exclude a ‘broader but necessary prospectus’. “Our societies need hope. The economic crisis that is advancing towards us will not be solved by a drug or a vaccine. Nothing less than national revival is needed. Approaching COVID-19 as a syndemic will invite a larger vision, one encompassing education, employment, housing, food, and environment."
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