Home / Opinion / Columns /  Say it right, Covid-19 is a syndemic, not a pandemic

Last week, there was fresh confirmation that the coronavirus pandemic curve for India was finally beginning to flatten. The weekly average of daily new cases dropped to little over 70,000 compared to over 92,000 cases a month ago.

In the normal course of things, this together with the growing expectations about a vaccine roll-out next year should be a huge cause for relief. Not if you have read a recent piece published in The Lancet, which, to put it bluntly, argues that we may well be missing the woods for the trees.

The claim is that by focusing all our energies on tackling covid-19, we are understating the extent of the health threat facing countries like India. This is because there is not one, but two categories of disease which are interacting within specific populations: infection with severe acute respiratory syndrome caused by covid-19, and an array of existing non-communicable diseases (NCDs). Worryingly, the latter is something which was already threatening to overwhelm India even before covid-19 pandemic struck.

“(The) aggregation of these diseases on a background of social and economic disparity exacerbates the adverse effects of each separate disease," the Lancet report said, before adding, most worryingly: “Covid-19 is not a pandemic. It is a syndemic."

This distinction is very important to comprehend as we (and policy planners) try to get our heads around this once-in-a-century pandemic.

A syndemic, first coined in the mid-1990s by Merrill Singer, an American medical anthropologist, is not merely a comorbidity. It is much worse.

“Syndemics are characterised by biological and social interactions between conditions and states, interactions that increase a person’s susceptibility to harm or worsen their health outcomes," the piece, written by the editor of The Lancet, Richard Horton, said before making a key conclusion: “In the case of covid-19, attacking NCDs will be a prerequisite for successful containment."

Viewed this way, our perception of the threat from covid-19 goes from one, which is rather binary, to one that is far more nuanced. This rewiring of our perception forces a harsh reality check. Essentially the health risks from covid-19 only add to the already heightened risks embedded in rapidly spreading non-communicable diseases for a developing country like India. And, this is why this epidemic is dangerous.

Even before covid-19 struck, six out of 10 Indians were estimated to die from NCDs such as cancer and heart attack. As the joint study by the Indian Council of Medical Research, Public Health Foundation of India and Institute for Health Metrics and Evaluation, released last year revealed, this shift in the disease burden from communicable diseases has come about over the last three decades.

This, even while child and maternal malnutrition continue to cause premature deaths (an estimated six million children die before they are five years old) and tuberculosis, the incidence of which in India at 31% is the highest in the world, according to the World Health Organization, continues to be a threat.

In short, covid-19 is forcing India to wake up to the brutal consequences of neglect of its social and health fabric over the last seven decades.

Worse, the discovery of the vaccine is not the solution to the health travails of the populace. Even if it does help in containing the spread of the covid-19 virus, it does not provide a lasting solution. At best it is just kicking the can down the road. Addressing the syndemic is the only solution. And this requires a holistic approach which empowers people socially and economically. Failure to do so will exact severe costs.

It goes without saying that those at the bottom of the pyramid will fare the worst. We have already seen since March that the lives-versus-livelihood debate has had the deepest impact on the socially and economically disenfranchised.

The challenge is clear, and Horton sums up best the ideal public response: “Approaching covid-19 as a syndemic will invite a larger vision, one encompassing education, employment, housing, food and environment. Viewing covid-19 only as a pandemic excludes such a broader, but necessary prospectus."

Anil Padmanabhan is managing editor of Mint.

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