In the article, the author is not denying that COVID-19 is a pandemic, but sustains that we are faced with a situation that goes beyond this condition and uses the term “syndemic”, to characterize the current scenario, meaning that the situation we are living in transcends the notion of a pandemic as there are synergic health issues that impact the health of communities in these social and economic contexts 3.
It is an interesting way to pose a matter which has been amply discussed and has important consequences. One of the forms this discussion has taken is related to the link between biological and social issues. A vision too focused on the virology and molecular aspects, or even on the clinical or physiopathological aspects, usually lose sight that the relationship among the viral particles and human beings is given in specific environments, set by economic, sociopolitical, and cultural dynamics.
Different experts advocate for this complex approach which links the biological dimension of the epidemic phenomenon with its social dimension from different disciplines and action fields such as the history of epidemics, anthropological medicine, social medicine, medical sociology, and evolutionary biology, or biogeography.
Among several possible, I will only provide two examples to illustrate the matter. In his analysis of the flu epidemics and the COVID-19 pandemic, evolutionary biologist Rob Wallace insists on sustaining that the fundamental role of the current agro-industrial model is the trigger to the processes that are turning viruses more dangerous to humankind. Lastly, his socio-environmental perspective connects to a political-economic view to highlight the increased virulence of some viruses and the way they are directly linked to how agribusinesses operate, and particularly industrial farms in the contemporary world 4.
We have analyzed something similar in our research group registered with the Colombian Administrative Department for Science Technology and Innovation (Colciencias, for its Spanish acronym) as a Group of Socio-Historic Studies on Health and Social Protection, involving the focus on the social history of medicine with critical political economy to research the development of flu pandemics and more recently, the COVID-19 pandemic.
What we have discovered is that a pandemic is not a natural matter; that we humans are social beings and as such we understand and act in face of pandemics; that the social relationships are relationships of power and are present in the sanitary action to face them; that the history of the processes matters a lot to understanding its genesis; that institutional actions are impacted by the so-called «dependence of the trajectory», and what we a currently living is a new manifestation of the civilization crisis we endure, as humanity, for a few years now 5.
This idea,—used by health professionals as well as medical anthropologists with slightly different meanings—referencing both the interaction of two or more epidemics resulting from an excess of the disease load; as the complexities that carry the interaction of social, psychological, and biological factors that come together to comprise the emerging health issues 6.
As said by researchers Merrill Singer of the Center for Community Health Research at the Hispanic Health Council and Scott Clair of the Institute for Social and Behavioral Research of Iowa State University in an article published in 2003 entitled “Syndemics and Public Health: reconceptualizing disease in bio-social context”, the term “syndemic” refers not only to the simultaneous occurrence in time and space, of two or more diseases or health issues but also to the health consequences for the biological and social interactions amongst the current health conditions.
The concept allows highlighting the existence of multiple health problems that interact and make the epidemiological and sanitary scenario more complex in a determined time frame.
This today is crucial, as we have been in this pandemic for months and this has led us to a “COVIDization” of public health and sanitary assistance that turns inadequate.
The health problems of people did not disappear because of the existence of the pandemic, even if they are far from hospital centers and postponed their visit both to physicians and other health practitioners. With the slow lifting of the restrictions in mobilization and flexibilization of the social distancing measures, other diseases and traditional health issues are again visible.
In fact, many diseases, transmissible or not, and many chronic diseases are spreading among social groups according to the rooted inequality patterns of our society. The complication degree of these diseases, due to the neglect caused by the anguish produced by COVID-19, is still to be assessed. So we can say that more than just living in an exclusive pandemic situation, we are facing the complexity of a syndemic situation that we need to face with clarity and decisiveness.
2 In the now extensive literature over COVID-19 one can see that the term is used in masculine, although sometimes it is used in feminine. In this context, the feminine term is privileged; to make it clearer we are speaking of a disease. Therefore COVID-19 is the disease, while SARS-CoV-2 is the virus. https://www.rae.es/noticias/crisis-del-covid-19-sobre-la-escritura-de-coronavirus
5 https://unperiodico.unal.edu.co/pages/detail/covid-19-y-salud-mutar-para-vivir/; https://www.upo.es/revistas/index.php/americania/article/view/2742; https://revistas.udea.edu.co/index.php/fnsp/article/view/342049; unperiodico.unal.edu.co/pages/blog/detail/las-consecuencias-sociopoliticas-de-la-pandemia/
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