Over the months, the measures to prevent the spread of Covid-19 have been tightened or made more flexible in different parts of the world depending on the increase or decrease in cases.
While many countries in Europe are re-restricting social activities and ordering quarantines after registering a record number of cases, New Zealand, for example, went to its lowest alert level.
However, this strategy to deal with the coronavirus is, in the opinion of many scientists, too limited to stop their advance.
“All our interventions have focused on cut viral transmission routes, to control the spread of the pathogen, “Richard Horton, editor-in-chief of the prestigious scientific journal, recently wrote in an editorial The Lancet.
But the story of covid-19 is not that simple.
On the one hand, Horton says, is the SARS-CoV-2 (the virus that causes covid-19) and on the other, a series of non-communicable diseases. And these two elements interact in a social and environmental context characterized by a deep social inequity.
These conditions, Horton argues, exacerbate the impact of these diseases and therefore we must consider covid-19 not as a pandemic, but as a sindemia.
This is not a simple change in terminology: understanding the health crisis that we are going through from a broader conceptual framework opens the way to find more appropriate solutions.
One plus one is more than two
The term syndemic (a neologism that combines synergy and pandemic) is not new.
It was coined by the American medical anthropologist Merrill Singer in the 90s to explain a situation where “two or more diseases interact in such a way as to cause damage greater than the mere sum of these two diseases “.
“The impact of this interaction is also facilitated by social and environmental conditions that somehow join these two diseases or make the population more vulnerable to their impact,” Singer explains to BBC Mundo.
The interaction with the social aspect is what makes it not simply a comorbidity.
The concept emerged when the scientist and his colleagues were researching drug use in low-income communities in the US more than two decades ago.
They found that many of those who injected drugs suffered from a number of other diseases (tuberculosis, sexually transmitted diseases, among others), and researchers began to wonder how these coexisted in the body, and concluded that, in some cases, the combinationon amplified the damage.
In the case of covid-19, “we see how it interacts with a variety of pre-existing conditions (diabetes, cancer, heart problems, and many other factors), and we see a disproportionate rate of adverse outcomes in impoverished, low-income and ethnic minority communities“, explica Singer.
And diseases such as diabetes or obesity – which are risk factors for covid-19 – are more common in low-income individuals, adds Tiff-Annie Kenny, a researcher at Laval University in Canada, in conversation with BBC Mundo. who works in the Arctic with populations affected by food insecurity, climate change and housing conditions that make it difficult to comply with sanitary recommendations such as washing hands or maintaining social distance.
But isn’t this the case for most diseases? Most of the time, don’t they have a greater impact on groups with less access to health, food, education and hygiene? Are they not almost always enhanced when combined with another or with an underlying medical condition?
As for biological interaction, this is not necessarily always the case, the scientist emphasizes.
“There is growing evidence that influenza and the common cold are contrasynddemics. In other words, the situation is not getting worse. If a person is infected with both (viruses), one (of the diseases) does not develop. ”
And as for the social aspect, the key element in the case of a syndicate is that adds the interaction of diseases.
Change of strategy
Analyzing the situation through the lens of the syndemic, says Kenny, allows us to move from the classical epidemiology approach to the risk of transmission, to a view of the person in their social context.
It is a position shared by many scientists who believe that to stop the advance and impact of the coronavirus it is crucial to pay attention to the Social conditions that make certain groups more vulnerable to the disease.
“If we really want to end this pandemic whose effects have been devastating on people, on health, on the economy, or with future pandemics of infectious diseases (we have seen one after another coming more and more frequently: AIDS, Ebola , SARS, zika and now covid-19), the lesson is that we have to address underlying conditions that make a syndicate possible, “says Singer.
“We have to address structural factors that make it more difficult for the poor to access health or an adequate diet, “he adds.
“The risk of not doing so is facing another pandemic such as Covid-19 in the time it takes for an existing disease to escape from the animal world and pass to humans, as has been the case with Ebola and Zika, and that it will continue to occur as we continue to encroach on wild species space, or as a result of climate change and deforestation. ”
The editor of The Lancet Richard Horton is conclusive: “No matter how effective a treatment or how protective a vaccine is, the search for a purely biomedical solution for COVID-19 will fail.”
And he concludes: “Unless governments design policies and programs to reverse deep disparities, our societies will never be truly safe from COVID-19.”
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