COVID-19 is not a pandemic. It is a syndemic. The syndemic nature of the threat we face means that a more nuanced approach is needed if we are to protect the health of our communities.
A syndemic is not merely a comorbidity. 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. In the case of COVID-19, attacking NCDs will be a prerequisite for successful containment.
What accounts for Sweden’s high Covid death rate among the Nordics? One factor could be Sweden’s lighter lockdown. But we suggest 15 other possible factors. Most significant are: (1) the “dry-tinder” situation in Sweden (we suggest that this factor alone accounts for 25 to 50% of Sweden’s Covid death toll); (2) Stockholm’s larger population; (3) Sweden’s higher immigrant population; (4) in Sweden immigrants probably more often work in the elderly care system; (5) Sweden has a greater proportion of people in elderly care; (6) Stockholm’s “sport-break” was a week later than the other three capital cities; (7) Stockholm’s system of elderly care collects especially vulnerable people in nursing homes. Other possible factors are: (8) the Swedish elderly and health care system may have done less to try to cure elderly Covid patients; (9) Sweden may have been relatively understocked in protective equipment and sanitizers; (10) Sweden may have been slower to separate Covid patients in nursing homes; (11) Sweden may have been slower to implement staff testing and changes in protocols and equipage; (12) Sweden elderly care workers may have done more cross-facility work; (13) Sweden might have larger nursing homes; (14) Stockholmers might travel more to the Alpine regions; (15) Sweden might be quicker to count a death “a Covid death.” We give evidence for these other 15 possible factors. It is plausible that Sweden’s lighter lockdown accounts for but a small part of Sweden’s higher Covid death rate.
Review of autopsy reports enabled the determination of the relative contributions of undiagnosed COVID-19 and lockdown restrictions on deaths. Of the 67 autopsies done at our hospital during the first 2 months of lockdown, only two autopsies identified COVID-19 that was undiagnosed before death. More frequently, reduced access to health-care systems associated with lockdown was identified as a probable contributory factor (six cases) or possible contributory factor (eight cases) to death. These causes included potentially preventable out-of-hospital deaths such as acute myocardial infarction and diabetic ketoacidosis, in which patients contacted the health services by telephone and were advised to self-isolate at home rather than attending hospital. Direct reference to financial or work pressures caused by COVID-19 was identified in three of ten cases of suicide.
Lockdowns may reduce the peak of transmission and recovery rates but not the number of critical cases or overall mortality.
Lastly, government actions such as border closures, full lockdowns, and a high rate of COVID-19 testing were not associated with statistically significant reductions in the number of critical cases or overall mortality.
…full lockdowns and early border closures may lessen the peak of transmission, and thus prevent health system overcapacity, which would facilitate increased recovery rates.
Most Flu Is Asymptomatic
On average, roughly 20% of the unvaccinated had serologic evidence of influenza infection, but up to three quarters of the infected were asymptomatic. The proportions did not vary significantly between seasonal and pandemic influenzas. The pandemic H1N1 strain was associated with less severe symptoms than the seasonal H3N2 strain.NEJM Journal Watch, 17 March 2014
Pharmaceutical companies are putting pressure on scientific results says Philippe Douste-Blazy, Cardiology MD, Former France Health Minister.
The observation that the greatest reduction in COVID-19 cases was achieved under the combined [social distancing] intervention is not surprising. However, the assessment of the additional benefit of each intervention, when implemented in combination, offers valuable insight. Since each approach individually will result in considerable societal disruption, it is important to understand the extent of intervention needed to reduce transmission and disease burden.
The effectiveness and societal impact of quarantine and social distancing will depend on the credibility of public health authorities, political leaders, and institutions. It is important that policy makers maintain the public’s trust through use of evidence-based interventions and fully transparent, fact-based communication.
It has become clear that a hard lockdown does not protect old and frail people living in care homes—a population the lockdown was designed to protect.3 Neither does it decrease mortality from COVID-19, which is evident when comparing the UK’s experience with that of other European countries.
In 2016, WHO1 recommended that the dengue vaccine CYD-TDV (Dengvaxia; Pasteur, Lyon, France), the first dengue vaccine, licensed for use in adults and children aged 9 years or older, be considered for use in highly endemic regions where at least 70% of 9-year-old children had previously been infected with dengue. The Philippines was the first country to introduce Dengvaxia on a large scale in selected highly endemic regions, targeting about 1 million children aged 9–10 years. In November, 2017, an excess risk of hospitalisation for dengue and severe dengue in vaccinees who had not had a previous dengue infection at the time of vaccination was reported,2 on the basis of retrospective analyses3 of data from the Dengvaxia phase 3 trials, using a novel non-structural protein 1 (NS1) based antibody assay. Following a reanalysis of these data,3 the Philippine Dengvaxia programme was suspended. However, by the time the programme had been suspended, more than 830 000 children had received at least one of the three recommended Dengvaxia doses. The news about the safety concerns in dengue-naive vaccinees led to major public outcry, with loss in vaccine confidence that extended to routine childhood vaccines.4
Corruption is embedded in health systems. Throughout my life—as a researcher, public health worker, and a Minister of Health—I have been able to see entrenched dishonesty and fraud. But despite being one of the most important barriers to implementing universal health coverage around the world, corruption is rarely openly discussed. In this Lecture, I outline the magnitude of the problem of corruption, how it started, and what is happening now. I also outline people’s fears around the topic, what is needed to address corruption, and the responsibilities of the academic and research communities in all countries, irrespective of their level of economic development. Policy makers, researchers, and funders need to think about corruption as an important area of research in the same way we think about diseases. If we are really aiming to achieve the Sustainable Development Goals and ensure healthy lives for all, corruption in global health must no longer be an open secret.
Multidisciplinary research priorities for the COVID-19
pandemic: a call for action for mental health science
PDF download of the paper available from The Lancet: https://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366(20)30168-1.pdf