Long Covid: A Syndemics Approach to Understanding and Response

Nearly one in five U.S. adults are impacted by long Covid. The health, social, and economic burdens of long Covid are complicated and trying. Although the causes of long Covid remain uncertain, emerging research suggests an infectious disease origin for at least some portion of cases. We draw on a grey and white literature, media reports, and postings on forums to examine the shared experiences of long Covid and the present argument for pathogen-pathogen interactions. Data suggest that long Covid disproportionately impacts communities that already experience disparities in health, specifically lower-educated, low-income, women of working age and minority ethnic groups as they have greater exposure to COVID-19 initially and experience the symptoms of long Covid more severely. Among these individuals, COVID-19 can play a role in reactivating viruses already present in the body (specifically herpesviruses) which accumulate over the course of a lifetime and generally persist in a dormant state. As such, long Covid may present as a syndemic in some communities – the clustering of synergistically interacting diseases, a consequence of deleterious social conditions. The syndemic nature of long Covid requires a syndemic response to address the intersecting social and biological drivers. At the population level, considerations of the social factors, disease co-morbidities including those dormant or yet to be diagnosed, need to be integrated into treatment protocols and public health responses.