A Syndemic and Non-Communicable Diseases in a Time of COVID-19

The United States is soaring past 8 million cases of COVID-19 as we enter a third wave. Reaching new highs for daily case counts, it’s hard not to see how this pandemic has trickled into every aspect of our lives. Moreover, as the holidays and cold weather quickly approach, it is likely that this will get worse.

One topic, of many, that is increasingly requiring discussion and more attention is the impact of this pandemic on those with pre-existing health conditions. Excess mortality due to COVID-19 is startling, and as the Centers for Disease Control and Prevention (CDC) noted, “an estimated 299028 excess deaths occurred from late January through October 3, 2020, with 198081 (66%) excess deaths attributed to COVID-19. The largest percentage increases were seen among adults aged 25–44 years and among Hispanic or Latino persons.”

The impact of the pandemic has been far-reaching and control measures have invariably impacted mental health. Quarantine/isolation, social distancing, business closures, and the general stress of living in a pandemic are all things that are impacting to us all, but especially those with existing mental health problems.

A research team recently focused on how the pandemic intensifies the effects felt by those already marginalized or vulnerable, as it is the intersection of biological and socioecological factors. Noting that “This diverse nexus was coined a “syndemic” by medical anthropologist Merrill Singer in the 1990s to describe the relationship between HIV/AIDS, substance use, and violence.

A “syndemic” is defined as a synergistic interaction between socioecological and biological factors, resulting in adverse health outcomes. The COVID-19 pandemic has escalated into a syndemic due to several driving factors, such as overcrowding, loneliness, uncertainty, poor nutrition, and lack of access to health services; consequently, depression, suicide, domestic violence, and psychiatric illnesses have significantly increased.”

The study emphasized that those living with non-communicable diseases are experiencing a syndemic in which this COVID-19 pandemic ultimately plays a significant role in their pre-existing medical conditions, exacerbating non-communicable diseases, and other factors like those of ecological and political backgrounds. COVID-19 has led to major disruptions in public health and healthcare services, especially in countries like Italy, Spain, Pakistan, Brazil, and even the United States.

After discussing these impacts, the researchers provided some strategies to help approach the syndemic condition, focusing on essential supplies and information dissemination, self-management support at the community level, revitalizing healthcare delivery, policy, advocacy, and research.

Noting the “reciprocal effect” COVID-19 and non-communicable diseases have on each other, they emphasized the need to address misinformation and fake news, especially on social media, as it fuels fear and panic. Pushing for those countries with low or middle-income, the authors emphasize the need to include the syndemic framework in their prevention efforts, but also larger health promotion work.

“If they fail to do so, the post-pandemic era could experience a great divide in health equity that could be much worse than ever before, undoing the progress made in developing healthcare policies and strengthening healthcare systems and infrastructure.” Ultimately, the COVID-19 pandemic has changed us irrevocably, but now more than ever we need to learn about the deep health disparities that it has underscored and take care to address them.