The Lancet's Richard Horton has made the case for considering covid-19 infection from a different perspective, believing that a broader redefinition is needed.
Syndemic from the Greek word "together" "people" includes the subheading word "disease" and is thus purely a group of diseases that involve the people together.
Pandemic (pandemos) is what affects all people and more specifically an infection that involves several continents in a short time, spreading on a global scale.
In contrast, syndemic is given by the interaction between an infection and other noncommunicable diseases (such as diabetes, obesity, hypertension) and often representative of socio-economic aspects that interact with the infection, negatively influencing its course.
The now evident correlation between severity of clinical manifestations from Covid-19 and co-morbidity is undeniable; in fact, we know that the infection can run completely asymptomatically through the infectious vehicle (man), be associated with nonspecific upper respiratory tract infection such as cough, cold, fever, or in severe cases cause bilateral interstitial pneumonia up to respiratory distress syndrome and multi-organ involvement.
The most severe manifestation, which may result in admission to an intensive care unit or sub-intensive care unit, would seem to be preponderant in those with at least one other pathology, usually metabolic, cardiovascular, respiratory or autoimmune (however with a pro-inflammatory cytokine basis) such as precisely diabetes, obesity etc.
For example, the obese patient generally has altered respiratory mechanisms (increased resistance in the airways, altered gas exchange and low lung volume as well as reduced muscle strength) such that, regardless of sars-cov-19 infection, he or she is predisposed to pictures of pneumonia associated with hypo-ventilation, pulmonary hypertension and cardiac stress.
In addition, obesity is often associated with cardiovascular disease and diabetes mellitus, but even in a patient who has a body mass index in the normal range (18.5-24.99) but who suffers from hypertension, dyslipidemia, insulin dependence, prediabetes there is a natural susceptibility to infections and an altered immune response.
It should also be considered that Covid-19 infection manifests itself with trends of particular severity in geographic settings where poverty, socioeconomic reasons, high population density, low health care, low cultural level, and social promiscuity are particularly embedded in the geopolitical fabric.
A practical example is provided by rural communities and American farmers often left without primary, maternity or emergency care.
If those without access to basic medical care, in desperation, migrate, they themselves become an infectious vehicle, driven solely by the need to find a cure to their condition.
In addition, extreme weather events, deforestation and desertification, hurricanes, decline of ecosystems that sustain life and food security, dwindling freshwater reserves, as well as irrational agricultural exploitation of the land, resulting in an increase in the average recorded temperature on the planet are at the root of migratory flows of humans and animals to more favorable climatic conditions.
In fact, there is ample evidence that the emergence and spread of SARS-CoV-2 appears to be linked to urbanization, habitat destruction, live animal trade, intensive livestock farming, and global travel.
At the University of Massachusetts at Boston, at the Centerfor Governance and Sustainability, Professor Maria Ivanova has observed the combination of variables that she sees influencing the world stating that these factors "have the potential to influence and amplify each other in ways that could create a global systemic collapse.
It is essential then, in light of the above, once the socio-economic reasons for the Covid-19 infection are intuited, a manifestation of a larger problem, much of the responsibility for which lies with humans, to intervene with the aim of avoiding the synergistic chain of variables that could be prevented by thinking from a collective and global perspective of protecting the planet.
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