By Dr. Helen Scott
As we approach 2.5 million deaths globally from COVID-19 as I write this, we must begin to address the reality that we are not taking a broad enough approach to managing the outbreak.
Up until now, we have mostly viewed the cause of this global crisis as an infectious disease. Government interventions have focused on stopping viral transmission to control the spread of the virus. We are relying on measures like social distancing, hand-washing and lockdowns. Epidemiologists and infectious disease specialists are guiding governments by approaching COVID-19 in the same ways that we dealt with the plague more than 100 years ago.
But what we have learned so far tells us that the story of COVID-19 is not so simple. It could be said that we are not facing a pandemic, but rather, a syndemic — a synergistic epidemic.
Rather than solely facing an infectious disease outbreak, we are experiencing the intersection of two types of diseases: COVID-19 infection and chronic disease. Chronic diseases are those that go on for a long time and often do not completely go away. These include diabetes, obesity, heart disease and cancer. People who have “pre-existing conditions” or chronic diseases who become infected with COVID-19 are more likely to get sicker, to be hospitalized and to die.
Chronic diseases do not happen randomly in our communities. They are connected to deeply embedded patterns of inequality. When you overlay chronic diseases and COVID-19 on a background of social and economic disparity, the adverse effects of each are amplified.
If COVID-19 is indeed a syndemic, the threats we face require a more nuanced approach to protecting health in our communities.
The most important outcome of looking at COVID-19 as a syndemic is to underline its social origins. The vulnerability of older citizens, persons of colour, minority ethnic communities and “essential workers” who are often poorly paid with fewer job protections, brings forth the stark reality that no matter how protective a vaccine, a purely biomedical solution to COVID-19 will not be successful.
Unless we devise policies and programs to reverse profound disparities, our societies will never be truly protected from COVID-19. As Dr. Merrill Singer from the University of Connecticut describes, “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.”
I would add one further advantage to diagnosing COVID-19 as a syndemic. Our communities need hope. We are possibly advancing toward an economic crisis. This will not be solved by a drug or a vaccine. Addressing COVID-19 as a syndemic will invite us to cast a larger vision as we rebuild in its aftermath — encompassing education, employment, nutrition and food systems, tax structures, and housing. It will create an opportunity to not only build back better, but to build back fairer.
Dr. Helen Scott is an epidemiologist and assistant professor at the Dalla Lana School of Public Health, University of Toronto. A resident of Lindsay, she works at the World Health Organization. Scott has worked on global health and public health programs in Canada and around the world for 20 years. She is tackling chronic diseases caused by the obesity epidemic through her newly launched program, www.WeightLossMasterclass.ca.