Around the world, most of us have a family member or friend who has died from COVID-19, or know those who have. We are told it is a “pandemic”, which is a contagious disease that spreads exponentially through a population. At the beginning I accepted this description. But while writing this book the Delta variant took off in England and even some who have been vaccinated caught it. At the same time it was credibly reported that its spread was due to the Prime Minister deciding to keep the UK open to travellers from India, where Delta was known to be spreading, because he wanted to go there to sign a trade deal. As a consequence, in April 2021, over 40,000 went back and forth and between 500 and 1,000 carried the Delta variant to England from India, according to the BBC. Then there is the role of India’s Prime Minister, Narendra Modi. He encouraged attendance at vast Hindu religious ceremonies which generated an intense reproduction of SARS-COV-2 (the name of the actual virus — COVID-19 is the name of the disease in humans). Experts had warned that crowded conditions that concentrate viral spread are ideal for generating new variants. This was apparently the origin of Delta.
Another cause of the rapid spread of Delta in England was that many of those coming from India were returning citizens of the UK who live in overcrowded conditions and are unable to completely “self-isolate”, so that young people from their households become carriers. In my country, bad housing suffered by immigrant communities has regenerated the disease. Are those who then catch it suffering from the modern slums of Bradford as well as COVID-19’s Delta variant?
In the 1990s, Merrill Singer, an American medical anthropologist, and others, developed an approach designed to identify the social interactions behind the spread and mortality rates of disease, as well as the biological causes. They concluded that public conditions and personal circumstances interacted “synergistically” with a disease and its clusters. They termed the pattern of its mortality rates as a “syndemic”. Writing in the British medical journal The Lancet, its editor Richard Horton applied the term to what is happening with COVID-19. He observed, “we must confront the fact that we are taking a far too narrow approach to managing this outbreak of a new coronavirus”. It was scything down people with pre-existing conditions who became a source of its transmission because of their need for treatment. “The vulnerability of older citizens; Black, Asian, and minority ethnic communities; and key workers who are commonly poorly-paid and with fewer welfare protections” meant that the mortality of the disease has “social origins” not just biological ones. “This is not a pandemic,” Horton concluded, “it is a syndemic”. What we are now experiencing around the planet is not the impact of a disease spreading evenly across human populations as a plague. We are living through the interaction of a range of causes. If we really want to manage and limit its impact, Horton concludes, we need to approach COVID-19 as a syndemic, so that we can gain “a larger vision, one encompassing education, employment, housing, food, and environment”.
