THURSDAY, 1 OCTOBER 2020In the early hours of September 25th, Richard Horton, the editor-in-chief of The Lancet, a UK-based medical journal, published the cryptic tweet, “COVID-19 is not a pandemic”. Attached was a link to a short article explaining how our current approaches to tackle COVID-19 could be “far too narrow”. Rather than thinking about the virus solely as a biochemical entity with only pathological consequences, widening our descriptions of the virus to include the associated socioeconomic issues and non-communicable diseases (NCDs), such as obesity and heart disease, will lead to more effective COVID-19 mitigation, Horton argues. He emphasises the need to reject thinking of the current crisis as a pandemic, and instead opt for a ‘syndemic’ approach, a term coined by Merrill Singer that expresses the importance of considering how infectious diseases intertwine with latent biological and social factors that significantly impact their diagnosis, treatment, and prevention. Importantly, Horton believes that taking this syndemic approach will enable our policymakers to not only combat the biological threat that the virus poses, but the social and economic dangers, too.
Horton’s critique is the latest in a series of works urging governments to take a more holistic and nuanced approach when proposing strategies to mitigate the spread of the virus. For example, Prof. Alex Broadbent has written widely on the potentially deadly consequences of blanket, “one size fits all” COVID-19 strategies, instead proposing a rational cost-benefit analysis approach for responding to the virus. Similarly, Prof. John Ioannidis has emphasised the importance of considering the totality of evidence as our knowledge of the virus progresses and we gain more understanding of the harms and benefits of suppression measures. He urges us to consider not only the positive evidence supporting new drugs, vaccines, and social distancing measures, but also the negatives associated with these actions, such as the economic downturn caused by prolonged lockdowns and the disproportionate manner in which COVID-19 threatens specific demographics. Horton’s call for a new approach, one that goes beyond straightforward biological categorization, is thus in good company alongside some of the world’s leading authorities on science and public health policy.
A growing body of evidence is shedding light on the sociopolitical, racial, and gendered patterns of COVID-19’s impact, fueling the critiques explored above. One of the most striking features of the crisis is the disproportionate danger facing Black, Asian, and Minority Ethnic populations, who are more likely to contract the virus and suffer from lethal symptoms. Furthermore, women, particularly those from economically deprived backgrounds, are more vulnerable to economic suffering on account of COVID-19 due to the fact that they are more likely than men to lose their jobs. Looking at this phenomenon in more detail, Sophie Harman discusses the use of women as economic “shock absorbers” in periods of economic repair following an epidemic — they are frequently used as a source of free labour to care for children, the sick, and elderly in times of public health crises. This acts to prevent women advancing, both socially and economically. Furthermore, the assumed position of women as caregivers in many societies puts them in an especially vulnerable position when it comes to contracting infectious diseases, a fact observed by Harman in her work on the Ebola epidemic in 2016. The “shock absorber” phenomenon is just one of the many ways in which global health crises tend to act in a gendered manner, not affecting everyone equally as a “great leveler”, but rather following the contours of social and economic inequality extant in society. These patterns cannot, and should not, be explained physiologically, but rather highlight the need for an analysis of the features of COVID-19 that transcends mere biochemical classification.
The importance of quantifying the social factors that contribute to one’s experience of COVID-19 lies in their innate coupling with matters of health. Socioeconomic status has a profound impact on health, as do identity markers such as race and gender. For example, there is substantial evidence surrounding the decreased quality of health amongst poorer demographics, such as their elevated vulnerability towards certain NCDs. A syndemic approach is thus essential, as it discerns the close relationship between a multitude of health-related factors, the socioeconomic factors that contribute to one’s general health, and the actual risk of contracting SARS-CoV-2. Horton’s call for a switch from a pandemic to a syndemic approach supports the belief that we must not neglect the factors beyond those specific to COVID-19 itself that contribute to the spread of the virus. Ultimately, such a change in mentality could lead to a more holistic, interdisciplinary framework for designing coronavirus mitigation strategies.
As the number of cases across the globe begins to climb again, it seems as though the narrow perception of COVID-19 represented through epidemiological models and genome sequencing is failing to combat the very real human experience of the virus. Perhaps we should respond to Horton’s call to action, and begin to reconceptualise our current global health crisis not as a mere pathological pandemic, but rather as a complex syndemic that affects all parts of our lived experiences.
Charlotte Zemmel is an MSc. student in History and Philosophy of Science at Newnham College