Syndemic responses to COVID-19 should include an ecological dimension
Authors: Chris Kenyon
Journal: The Lancet (2020)

Richard Horton argued persuasively that COVID-19 should be addressed as a syndemic of biological and social interactions.1Horton R Offline: COVID-19 is not a pandemic.Lancet. 2020; 396: 874Summary Full Text Full Text PDF PubMed Scopus (632) Google Scholar When planning the "national revival"1Horton R Offline: COVID-19 is not a pandemic.Lancet. 2020; 396: 874Summary Full Text Full Text PDF PubMed Scopus (632) Google Scholar he calls for, I consider it crucial that this syndemic approach includes an ecological dimension. Studies have found that widespread anthropogenic ecosystem degradation has played a crucial role in explaining why the rate of emergence of zoonoses has been increasing over the past 40 years.2Jones BA Grace D Kock R et al.Zoonosis emergence linked to agricultural intensification and environmental change.Proc Natl Acad Sci U S A. 2013; 110: 8399-8404Crossref PubMed Scopus (635) Google Scholar For example, deforestation, intensified agriculture and livestock production, and climate change have been linked to the emergence of Ebola virus, HIV, Nipah virus, severe acute respiratory syndrome coronavirus 2, and Zika virus.3Carroll D Daszak P Wolfe ND et al.The Global Virome Project.Science. 2018; 359: 872-874Crossref PubMed Scopus (283) Google Scholar, 4Almond REA Grooten M Petersen T Living planet report—2020: bending the curve of biodiversity loss. WWF, Gland2020Google Scholar, 5Everard M Johnston P Santillo D Staddon C The role of ecosystems in mitigation and management of Covid-19 and other zoonoses.Environ Sci Policy. 2020; 111: 7-17Crossref PubMed Scopus (124) Google Scholar Unless reversed, the anthropogenic destruction of habitats will probably lead to the continued emergence of new zoonoses from the estimated 700 000 other unidentified viruses with zoonotic potential.3Carroll D Daszak P Wolfe ND et al.The Global Virome Project.Science. 2018; 359: 872-874Crossref PubMed Scopus (283) Google Scholar As argued in the recent Living Planet Report, COVID-19 is "nature sending us a message": we need to cut human consumption to within the planet's "safe operating space".4Almond REA Grooten M Petersen T Living planet report—2020: bending the curve of biodiversity loss. WWF, Gland2020Google Scholar For the vital reasons Horton outlines,1Horton R Offline: COVID-19 is not a pandemic.Lancet. 2020; 396: 874Summary Full Text Full Text PDF PubMed Scopus (632) Google Scholar this needs to be done in a way which promotes, rather than exacerbates, national and international socioeconomic equity. National revival plans could play an important role in this process but should be subordinate to international plans that are based on determinations of both global equity and ecological constraints. I declare no competing interests. Offline: COVID-19 is not a pandemicAs the world approaches 1 million deaths from COVID-19, we must confront the fact that we are taking a far too narrow approach to managing this outbreak of a new coronavirus. We have viewed the cause of this crisis as an infectious disease. All of our interventions have focused on cutting lines of viral transmission, thereby controlling the spread of the pathogen. The "science" that has guided governments has been driven mostly by epidemic modellers and infectious disease specialists, who understandably frame the present health emergency in centuries-old terms of plague. Full-Text PDF