1st October 2020

Musings.......

Pandemic or Syndemic ? 

The great William Shakespeare famously wrote - “ What is in a name ?”.  In the present scenario we must say that everything is in a name. 

Up until the World Health Organisation (WHO) recognised COVID19 as a pandemic - many did not take the disease seriously. It was when it was officially declared as a Pandemic - it positioned the virus as something that should now concern ‘us’ and became something that should be taken seriously. 

Infectious disease epidemics is generally portrayed in the Western world as a problem of the post colonial “developing” third world country.   According to them “Epidemics” and “disease” occur out there !! 

Recent examples include the Zika Virus in the jungles of South America, the Ebola in civil war ravaged Congo,Middle East Respiratory Syndrome (MERS) in Saudi peninsula, SARS in Southern China and Nipah in our own Kerala. 

However, COVID19 has challenged all these western world post colonial perceptions - that infectious disease epidemics are fundamentally a non- Western concern. 

Europe and USA had become the epicentre of the virus, before flattening out the curve and the epicentre shifted to India.  Both Europe and USA are now experiencing second and even third waves of the virus. 

All focus of Governments and health workers have been in cutting lines of virus transmission up until now, to control the spread of the pathogen. 

However, the matter is not that simple. We are facing a twin attack of - 

- [ ] Infection with SARS- CoV2 

- [ ] Non Communicable Diseases (NCD) as comorbidities

The total number of people living with comorbidities is growing. NCDs like Diabetes, Hypertension, Obesity, Cardiovascular and Respiratory diseases, Cancer can all be considered comorbidities. 

Any plan of addressing COVID19 should also include a Syndemic management plan. 

The notion of a Syndemic was first conceived by Merrill Singer,  a medical Anthropologist in early 1990s and her work was published in the medical journal Lancet. 

So what is a Syndemic ? 

A Syndemic is a situation when two or more epidemics interact synergistically to produce an increased burden of disease in a population. 

It is now a well established fact that the COVID19 is here to stay. It may even become endemic, according to the WHO. 

Meanwhile, with the ongoing Monsoon season in South Asia - there is a possibility of the world facing a Syndemic scenario with increased cases of Dengue and Malaria. 

The second wave of infection, when it happens will be effecting those with weakened immunity. 

Already the world is facing the menace of Antibiotic resistance on top of comorbidities.  It will become a medical nightmare in managing a second wave whenever it occurs. 

As it is, it is becoming more and more difficult in treating secondary bacterial infections due to Antibiotic resistance. 

We have heard the catchphrase that COVID19 “does not discriminate” and can kill individuals from all social strata and geographical locations. However is it really true ? 

Is it not a fact that vast majority of deaths from COVID19 is among the elderly and those with comorbidities. The death among young healthy population is comparatively negligible. 

Most important consequence of seeing COVID19 as a Syndemic is to underline its social origins. The vulnerability of older citizens, minority ethnic communities, tribals, SC/ST communities in India, the poor and downtrodden is for everyone to see. 

Unless Governments decide policies and programmes to reverse disparities, our society will never be truly COVID19 secure. 

Merrill Singer wrote in Lancet journal in 2017  -    “ 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 diseases or treating individual patients.”  

The looming economic crisis will not be solved only with a wonder drug or vaccine. It is true that the world is eagerly awaiting a vaccine or cure for the virus, but that is just half the problem. 

Approaching the COVID19 as a Syndemic would give a larger vision to the problem - including education, employment, housing, food and environment. 

Past incidents of Syndemic 

- [ ] The 1957 Asian influenza pandemic caused deaths not only due to primary viral infection, but also due to secondary bacterial infection among influenza patients. It was a viral- bacterial syndemic ! 

- [ ] Studies have shown that in Kenya, 5% of HIV infections are due to higher infecting capacity among malaria infected HIV patients. 

It is said that names can influence behaviour. The Health Belief Model (HBM) developed by Irwin Rosenstock, a behavioural psychologist- suggest that a persons health related behaviours ultimately comes from his/her desire to avoid illness. 

The behavioural model also recognise the importance of “ cues to action” or triggers which set in motion the process of adopting a desired behaviour. 

Here lies the importance of getting familiarised with terms like Pandemic and Syndemic which would raise an alarm and help people behave in desirable ways like for eg. Wearing masks and maintain social distancing. 

So if you ask me “ What’s in a Name?”, I would say - “ A lot “. 

Food for Thought.......

Pandemic - A pandemic is declared when a new disease for which people have no immunity spreads around the world. 

Epidemic- An epidemic is a large outbreak, one that spreads among a population or region. It is less severe than pandemic due to a limited area of spread. 

Endemic- A disease is called endemic when the presence or usual prevalence of its infectious agent is constant within a given geographical area or population group. 

RC

rohitchennithala.blogspot.com

rohitchennithala.home.blog