Catch 22 – The Syndemic and the Rest of Us

                   From the Edna Bennett Pierce Prevention Center,

               Penn State, College of Health and Human Development

It’s complicated. Add the human body in an overpopulated world to nasty lifeforms and pseudo-lifeforms we generically refer to as “germs” – viruses, bacteria, malevolent parasites, struggling to reproduce – and what happens or can happen can become deadly and unpredictable. Climate change pushes germs and their carriers to migrate, impairs life-sustaining agriculture and creates vulnerabilities that make humans more likely to be infected and for those infections to be more serious. We may be delighting in the fact that so much of America seems headed towards that fabled herd immunity that we are missing the rising threats “elsewhere,” even as vaccine skeptics amongst us continue to resist obvious paths to immunity.

What epidemiologists are beginning to witness, with trepidation, is when still fully uncontained prior viral epidemics face new explosive pandemics, the combination can produce a much more dangerous pattern of mutation, new toxic variants if you will: a syndemic. That combination has a current incarnation, COVID meets HIV/AIDS, rearing its ugly mutating head in South Africa. While HIV/AIDS has killed roughly 32 million people globally over the last four years, treatments have evolved seriously to contain the disease, but the disease has definitely not been eradicated. And not all HIV/AIDS victims have access to those miraculous containment treatments, nor are those treatments effective in all of those infected. 

For those billions of COVID-unvaccinated people, exacerbated by those with HIV/AIDS, the threat to the rest of the vaccinated world is horribly obvious: global hordes of unvaccinated people, especially those with preexisting vulnerability, create a fertile breeding ground for combination and mutation quite capable of reigniting a new pandemic surge, spreading one or more coronavirus strains unresponsive to the current vaccines. Global commerce and travel insure that at some level a major vaccine resistant variant anywhere could easily become a major vaccine resistant variant everywhere. Even if we could shut down that global interaction (close to impossible), the consequences could trigger an economic meltdown beyond anything we have ever experienced.

As the above graphic illustrates, a COVID-driven syndemic thrives on variables even beyond parallel epidemic-level diseases. Inherent distrust of vaccines, lack of sufficient grassroots education, unavailability of vaccines, an inadequate healthcare system, poverty and racial/ethnic bias all play a role in spreading disease and facilitating mutations that can impact us all. What happens in those rather large areas where coronavirus is not contained can easily come back to haunt those arrogant richer nations who have sufficiently embraced containment efforts and vaccination priorities… but have simply ignored that external breeding ground they have left unattended.

Writing for the June 3rd daily coronavirus alert from the Los Angeles Times, Russ Mitchell presents an example of this rising threat: “[Over] the course of the COVID-19 pandemic, there has been little evidence to suggest that people with HIV are more likely to become infected with the coronavirus — or that they’re more likely to develop a serious case of COVID-19 if they do become infected… But now researchers in South Africa have come across a patient whose HIV had not been well controlled with medication. The coronavirus seems to have had a field day with her, my colleague Melissa Healy reports.

“The patient, a 36-year-old woman who was diagnosed with HIV back in 2006, contracted the coronavirus in September. She spent nine days in the hospital and was treated with supplementary oxygen, but she never became seriously ill with COVID-19… Yet it took her immune system nearly eight months to shake her coronavirus infection. During that time, the virus underwent multiple genetic changes, some of them potentially dangerous.

“The geneticists and infectious-disease specialists who cared for the patient suspect her uncontrolled HIV paved the way for her long-lasting coronavirus infection, which in turn gave the coronavirus ample opportunity to acquire mutations that could result in yet another variant of concern.

“The researchers don’t know whether any of the mutations detected in the South African patient wound up spreading to other people. But they said it’s probably not a coincidence that so many troubling variants have emerged in places like South Africa’s KwaZulu-Natal province, where more than 25% of adults have HIV.

“Indeed, her case underscores a difficult truth: Rich nations like the U.S. can blanket their citizens with COVID-19 vaccines, but they’ll still be vulnerable as long as the coronavirus is spreading in other places where a lack of vaccine has kept immunization rates low… That’s especially true in countries like South Africa, where HIV infections are common but often undetected.” 

Indeed, COVID-19 has a nasty habit of surging in nations and states that once bragged about their inherent low infection rates. Nations that emerged from lockdowns too quickly, a plague in much of Europe today, have awakened to new waves of coronavirus infections as shortages of vaccines combine with local skepticism to draw out the pandemic. Too many people just do not accept that they cannot resume life as normal without serious efforts at containment. And areas where infections have traditionally been low – where internal travel is not routine – are beginning to watch a slow, creeping movement of people spread the disease where it was not expected.

I’m Peter Dekom, and as performing artist Lenny Kravitz once sang, “It ain’t over till it’s over,” and this coronavirus pandemic ain’t remotely over yet!