Pathogenesis: A History of the World in Eight Plagues

by Jonathan Kennedy

Richard Horton, editor of The Lancet, argues that the devastation wrought by coronavirus in the UK and the U.S. should be understood as a “syndemic” or “synergistic epidemic.” In other words, the impact of the coronavirus pandemic can only be understood if we take into account the pre-existing pandemics of poverty and obesity that were already ravaging wealthy societies. In rich nations, poor people tend to have jobs which they cannot do from home; they travel by public transport and live in crowded housing, often with multiple generations. As a result, they are more likely to be exposed to the pathogens than wealthier people. To make matters worse, poor people are also more likely to have risk factors that could make them very ill if they contract Covid-19. These include obesity and non-communicable diseases such as diabetes, asthma or chronic lung disease. In the UK, adults in the poorest parts of the country were almost four times more likely to die from coronavirus than those in the wealthiest areas.[71] In the U.S., death rates were four and a half times higher among the poorest people than those with the highest incomes at the height of the pandemic.