When 1 + 1 does not equal 2 – 10/03/2021 – Marcia Castro

Since the Sars-CoV-2 virus appeared in Brazil, almost 600,000 people killed by Covid-19, disproportionately affect the most vulnerable individuals and regions. The virus alone is not responsible for this heavy and unequal burden. Local social and economic contexts, prevalence and risk factors of non-communicable diseases (such as obesity), as well as environmental changes and political leadership, facilitate the spread and concentration of Covid-19 and exacerbate its repercussions in certain populations and geographies.

This local dynamic is described by the concept of syndromes, which is still of little use. In other words, social, economic, political and environmental factors influence the pattern of disease transmission, and the simultaneous and synergistic occurrence of two or more diseases causes more harm than just the sum of the consequences of each disease. This dynamic often leads to increased inequality.

For example, the northern region, which historically observed development models aimed at exploiting natural resources, ignoring local needs and culture, lacking sanitation, running water and access to health services, suffering from deforestation and fires, was one of the Regions where the consequences of Covid-19 have been most severe, with record losses in years of life expectancy due to the epidemic. In addition, Brazil is facing an epidemic of overweight and obesity (more severe among people with less than years of education), Cases that react to Covid-19 resulting in an increased risk of death.

Here I list three reasons why we discuss Covid-19 using the concept of syndromes.

First, understanding Covid-19 as a syndromic disease requires analyzing data in spatial and social detail, allowing distinctions between groups and regions at risk, identification of inequalities in exposure to disease, access to services, and the ability to adhere to control measures. Only this detailed analysis guarantees health monitoring from a human rights perspective.

Second, you don’t solve what you don’t know. Effective control requires detailed knowledge of the various factors that influence the local spread of disease. In the case of Covid-19, this includes Access to transportation and health services, housing quality, unregulated and comorbidities, among others. This knowledge, generated from a human rights perspective, requires cooperation between different fields of science and highlights the need for different actions, many of which depend on cooperation between different sectors of government. Multisectoral responses, based on multidisciplinary knowledge and implemented locally, are the best way to control syndromes and reduce historical structural disparities.

Third, if there is synergy between diseases, control of them cannot be isolated. Analysis of Covid-19 from the perspective of the concept of syndromes allows to identify control measures that benefit different diseases, to enhance cooperation between national control programmes, and to improve the use of resources.

The nearly 600,000 deaths from Covid-19 are the result of the deadly synergy between the pandemic, multiple epidemics, and inequality, environmental changes and policy decisions. Answers that address the causes of this synergy are vital to alleviating structural problems in society. Without it, epidemics/pandemics of the future will repeat the current scenario, punish the most vulnerable, increase inequality, and perpetuate social injustice.

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