What is a syndicate and what can it mean to consider the coronavirus crisis in this way?

What is a syndicate and what can it mean to consider the coronavirus crisis in this way?

Covid-19 Unsplash/@fusion_medical_animation

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Covid-19 Unsplash/@fusion_medical_animation

The summer of 2020, after a few months of the harshest confinement humanity has ever experienced in modern times, looked like it was going to be a turning point towards the end of the SARS-CoV-2 crisis, a type of coronavirus that has already caused the death of a million people worldwide and that particularly in Spain has become a problem that has come to baffle to the World Health Organization (WHO) itself. The medical literature on this coronavirus has been enormous in recent months, and dozens of articles are published every day with possible advances on causes, consequences or treatments that could stop the symptoms of covid-19. Some days ago, ‘The Lancet’ published another article that, however, seemed to go in another direction and tried to explain what is really happening in the world with this virus.

Richard Horton, editor of the prestigious scientific journal (and who at the time advocated the urgent implementation of social distancing and closure policies to combat the increase in infections), signed this article, entitled ‘Covid-19 is not a pandemic‘. Far from going in the same direction as the denialist current who believes that the coronavirus is an invention and that wearing a mask is nothing more than a “sign of cowardice” By being treated as a “gag” to frighten the population, what Horton intends is to go a step further with respect to the consieración of this disease. What started out being treated as an epidemic, moved to pandemic category last March, according to the WHO itself: this it did not imply considering the most lethal coronavirus than it was to date, but it was a new disease with worldwide spread and for which there was practically no type of immunity in the population, making the impact or severity of it greater than, for example, in a seasonal outbreak.

And what is it, if it is not a pandemic? Horton explains it quite clearly in his article: “All of our interventions have focused on trying to cut the transmission lines of the virus, with the aim of controlling the spread of the pathogen (…). But what we have learned so far , and that the history of covid-19 dictates, it is not that simple. There are two categories of diseases that interact within specific populations, infection with respiratory syndrome (SARS-CoV-2) and a variety of non-communicable diseases. conditions are clustering within social sectors according to patterns of inequality deeply rooted in our societies“He explains. Thus,” the aggregation of these diseases in a context of social and economic disparity exacerbates the adverse effects of each disease separately.

What is a syndicate?

“Covid-19 is not a pandemic. It is a syndemic. And the syndemic nature of the threat we face implies that we have to have a more nuanced approach if we want to protect the health of our communities, “says Horton. ‘Sindemia’ is a neologism that comes from the sum of two already known terms, synergy and epidemic, defined for the first time by the anthropologist American Merrill Singer in the 90s, precisely in the journal ‘The Lancet’. There he argued that the syndemic approach reveals very important biological and social interactions for prognosis, treatment and health policies. Although it is defined as the sum of two or more concurrent or sequential disease outbreaks or outbreaks in a population that exacerbate the prognosis and burden of disease, Horton emphasizes that this is not a simple “comorbidity.”

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“Syndicates are characterized by biological and social factors between conditions and states, interactions that increase a person’s susceptibility to harm or worsen their existing pathologies. In the case of covid-19, targeting non-communicable diseases could be a prerequisite for successful containment (…). Tackling covid-19 means tackling hypertension, obesity, diabetes, chronic cardiovascular or respiratory diseases or cancer, “says Horton. And, in the words of the editor of ‘The Lancet’, paying more attention to these non-communicable diseases It is a pending task not only for the richest nations, but it is also a cause that has not received attention in the developing countries.

The economic crisis will not be solved with a treatment or a vaccine, the social inequalities of the population must be reversed

For Horton, the “most important consequence” of considering covid-19 a syndicate and not a pandemic is “underline your social originsThe vulnerability of older people, ethnic minority communities, blacks, Asians, key workers who generally have the lowest wages and the least social protection all point to a so far little known truth: that no matter how effective a treatment is or what a vaccine protects, because the search for a purely biodemic solution for COVID-19 is going to fail “, he indicates. Thus, for the editor of ‘The Lancet’ the only way for a country to be completely safe against COVID-19 is to establish programs and policies to “reverse these deep disparities” among the population.

In this way, Horton points out that the aggressive economic crisis caused by this disease cannot be solved with a treatment or a vaccine. “Nothing less than a national revival is needed. Viewing covid-19 as a syndemic invites a major review, one that includes education, employment, housing, food and the environment. Seeing covid-19 solely as a pandemic excludes this perspective, as extensive as it is necessary. ”


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