Bispo Júnior José Patrício, Santos Djanilson Barbosa Dos
Instituto Multidisciplinar de Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brasil.
Centro de Ciências da Saúde, Universidade Federal do Recôncavo da Bahia, Santo Antônio de Jesus, Brasil.
Cad Saude Publica. 2021 Oct 8;37(10):e00119021. doi: 10.1590/0102-311X00119021. eCollection 2021.
This essay aims to present and discuss the theoretical framework for the COVID-19 syndemic. The first part presents the foundations and principles of syndemic theory. For the purposes of this essay, syndemic was defined as a process of synergic interaction between two or more diseases, in which the effects are mutually enhanced. We discussed the three principal typologies of syndemic interaction: mutually causal epidemics; epidemics interacting synergically; and serial causal epidemics. In the second part, COVID-19 is analyzed as a syndemic resulting from the interaction between various groups of diseases and the socioeconomic context. The theoretical model considered the interaction between COVID-19 and chronic noncommunicable diseases, infectious and parasitic diseases, and mental health problems. The essay addressed how social iniquities and conditions of vulnerability act at various levels to increase the effect of COVID-19 and other pandemics. The last section discusses the need for comprehensive, multisector, and integrated responses to COVID-19. A model for intervention was presented that involves the patient care and socioeconomic dimensions. In the sphere of patient care, the authors defend the structuring of strong and responsive health systems, accessible to the entire population. The economic and social dimension addressed the issue of reclaiming the ideals of solidarity, the health promotion strategy, and emphasis on social determinants of health. In conclusion, the lessons learned from the syndemic approach to COVID-19 call on government and society to develop policies that link clinical, sanitary, socioeconomic, and environmental interventions.
本文旨在介绍和讨论新冠综合征的理论框架。第一部分阐述了综合征理论的基础和原则。就本文而言，综合征被定义为两种或更多疾病之间的协同相互作用过程，其中各种效应相互增强。我们讨论了综合征相互作用的三种主要类型：相互因果的流行病；协同相互作用的流行病；以及连环因果的流行病。在第二部分中，新冠疫情被分析为各种疾病群体与社会经济背景相互作用所导致的一种综合征。该理论模型考虑了新冠疫情与慢性非传染性疾病、传染病和寄生虫病以及心理健康问题之间的相互作用。本文探讨了社会不平等和脆弱性状况如何在各个层面发挥作用，以增强新冠疫情及其他大流行病的影响。最后一部分讨论了针对新冠疫情采取全面、多部门和综合应对措施的必要性。文中提出了一个干预模型，该模型涉及患者护理和社会经济层面。在患者护理领域，作者主张构建强大且反应迅速、全体民众都可利用的卫生系统。经济和社会层面涉及恢复团结理念、健康促进战略以及对健康的社会决定因素的重视等问题。总之，从针对新冠疫情的综合征方法中吸取的经验教训呼吁政府和社会制定将临床、卫生、社会经济和环境干预措施联系起来的政策。
