Abstract
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.
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Acharya, D., Liu, G., & Gack, M. U. (2020). Dysregulation of type I interferon responses in COVID-19. Nature Reviews Immunology, 20(7), 397–398. https://doi.org/10.1038/s41577-020-0346-x.
Ahmad, F., Anderson, R., Cisewski, J., & Sutton, P. (2022). Identification of Deaths With Post-acute Sequelae of COVID-19 From Death Certificate Literal Text: United States, January 1, 2020–June 30, 2022 (https://www.cdc.gov/nchs/data/vsrr/vsrr025.pdf.
Alvarez, M., Rodriguez-Roche, R., Bernardo, L., Vazquez, S., Morier, L., Gonzalez, D., Castro, O., Kouri, G., Halstead, S. B., & Guzman, M. G. (2006). Dengue hemorrhagic Fever caused by sequential dengue 1–3 virus Infections over a long time interval: Havana epidemic, 2001–2002. American Journal of Tropical Medicine and Hygeine, 75(6), 1113–1117. https://www.ncbi.nlm.nih.gov/pubmed/17172378.
AMA Policy Finder (2021). Long Covid https://policysearch.ama-assn.org/policyfinder/search/Long%20covid/relevant/1/.
Ariza, M. E. (2021). Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: The human herpesviruses are back! Biomolecules, 11(2). https://doi.org/10.3390/biom11020185.
Augustin, M., Schommers, P., Stecher, M., Dewald, F., Gieselmann, L., Gruell, H., Horn, C., Vanshylla, K., Di Cristanziano, V., & Osebold, L. (2021). Post-COVID syndrome in non-hospitalised patients with COVID-19: a longitudinal prospective cohort study. The Lancet Regional Health–Europe, 6.
Bach, K. (2022). New data shows long COVID is keeping as many as 4 million people out of work. Brookings. https://www.brookings.edu/research/new-data-shows-long-covid-is-keeping-as-many-as-4-million-people-out-of-work/.
Bai, F., Tomasoni, D., Falcinella, C., Barbanotti, D., Castoldi, R., Mulè, G., Augello, M., Mondatore, D., Allegrini, M., & Cona, A. (2022). Female gender is associated with long COVID syndrome: A prospective cohort study. Clinical Microbiology and Infection, 28(4), 611. e619-611. e616.
Bain, M. (2020). Jean production shows how Covid-19 has devastated the fashion industry. https://qz.com/1852462/the-impact-of-covid-19-on-the-worlds-garment-workers.
Bartsch, S. M., Ferguson, M. C., McKinnell, J. A., O’Shea, K. J., Wedlock, P. T., Siegmund, S. S., & Lee, B. Y. (2020). The potential Health Care costs and Resource Use Associated with COVID-19 in the United States. Health Aff (Millwood), 39(6), 927–935. https://doi.org/10.1377/hlthaff.2020.00426.
Battles, H., & Gilmour, R. (2022). Beyond Mortality Bioarchaeology International, 6(1–2), 23–40.
Berg, S. (2022). What doctors wish patients knew about long COVID. AMA. https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-long-covid.
Berger, Z., Altiery, D. E. J. V., Assoumou, S. A., & Greenhalgh, T. (2021). Long COVID and Health inequities: The role of primary care. Milbank Quarterly, 99(2), 519–541. https://doi.org/10.1111/1468-0009.12505.
Bull-Otterson, L., Baca, S., Saydah, S., Boehmer, T. K., Adjei, S., Gray, S., & Harris, A. M. (2022). Post–COVID conditions among adult COVID-19 survivors aged 18–64 and ≥ 65 years—United States, March 2020–November 2021. Morbidity and Mortality Weekly Report, 71(21), 713.
Business and Human Rights Resource Center (2022). Sri Lanka: Report alleges Brandix engaged in campaign of ‘reprisals and repression’ against unions and labour orgs. for exposing alleged COVID-19 violation at ‘superspreader’ company event. https://www.business-humanrights.org/en/latest-news/sri-lanka-report-alleges-brandix-engaged-in-campaign-of-reprisals-and-repression-unions-and-labour-orgs-for-exposing-alleged-covid-19-violation-at-superspreader-company-event/.
Buttery, S., Philip, K. E. J., Williams, P., Fallas, A., West, B., Cumella, A., Cheung, C., Walker, S., Quint, J. K., Polkey, M. I., & Hopkinson, N. S. (2021). Patient symptoms and experience following COVID-19: Results from a UK-wide survey. BMJ Open Respir Res, 8(1). https://doi.org/10.1136/bmjresp-2021-001075.
C-19 Long Haulers Advocacy Project (2022). https://www.longhauler-advocacy.org/long-covid-dashboard.
Callard, F., & Perego, E. (2021). How and why patients made Long Covid. Social Science and Medicine, 268, 113426.
Carfi, A., Bernabei, R., Landi, F., & Gemelli Against, C. P. A. C. S. G. (2020). Persistent symptoms in patients after Acute COVID-19. Journal of the American Medical Association, 324(6), 603–605. https://doi.org/10.1001/jama.2020.12603.
Centers for Disease Control (2022). Demographic Trends of COVID-19 cases and deaths in the US reported to CDC. Centers for Disease Control. Retrieved January 10, 2023 from https://covid.cdc.gov/covid-data-tracker/#demographics.
Centers for Disease Control (2022a). Long COVID or Post-COVID Conditions. Retrieved January 12, 2023 from https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html.
Centers for Disease Control (2022b). Nearly One in Five American Adults Who Have Had COVID-19 Still Have Long COVID Retrieved January 12, 2023 from https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20220622.htm.
Centers for Disease Control (2023). Long COVID: Household Pulse Survey. Retrieved January 12, 2023 from https://www.cdc.gov/nchs/covid19/pulse/long-covid.htm.
Chen, T., Song, J., Liu, H., Zheng, H., & Chen, C. (2021). Positive Epstein-Barr virus detection in coronavirus Disease 2019 (COVID-19) patients. Scientific Reports, 11(1), 10902. https://doi.org/10.1038/s41598-021-90351-y.
Cherpes, T. L., Meyn, L. A., Krohn, M. A., & Hillier, S. L. (2003). Risk factors for Infection with herpes simplex virus type 2: Role of Smoking, douching, uncircumcised males, and vaginal flora. Sexually Transmitted Diseases, 30(5), 405–410. https://doi.org/10.1097/00007435-200305000-00006.
Collins, F. (2021). NIH launches new initiative to study Long COVID. The NIH Director. https://www.nih.gov/about-nih/who-we-are/nih-director/statements/nih-launches-new-initiative-study-long-covid.
Couzin-Frankel, J. (2022). Clues to Long Covid. Science. https://www.science.org/content/article/what-causes-long-covid-three-leading-theories.
Daboin, B. E. G., Bezerra, I. M. P., Morais, T. C., Portugal, I., Echeimberg, J. O., Cesar, A. E. M., Cavalcanti, M. P. E., Jacintho, L. C., Raimundo, R. D., Elmusharaf, K., Siqueira, C. E., & de Abreu, L. C. (2022). Deciphering Multifactorial Correlations of COVID-19 Incidence and Mortality in the Brazilian Amazon Basin [Article]. International Journal of Environmental Research and Public Health, 19(3), Article 1153. https://doi.org/10.3390/ijerph19031153.
Decman, V., Kinchington, P. R., Harvey, S. A., & Hendricks, R. L. (2005). Gamma interferon can block herpes simplex virus type 1 reactivation from latency, even in the presence of late gene expression. Journal of Virology, 79(16), 10339–10347. https://doi.org/10.1128/JVI.79.16.10339-10347.2005.
Department of Health and Human Services [DHHS] (2022a). National Research Action Plan on Long COVID.
Department of Health and Human Services [DHHS] (2022b). Services and Supports for Longer-Term Impacts of COVID-19.
Dogra, S. A., Shahid, H. J., Waqar, S., Bingham, D., Rahman, A., Maynard, S. A., Hussain, S., & Scott-Baumann, A. (2023). COVID-19, HEALTH INEQUALITIES AND THE LIVED EXPERIENCE OF BRITISH MUSLIMS. In S. A. Dogra (Ed.), British muslims, Ethnicity and Health Inequalities (pp. 19–46). Edinburgh University Press. http://www.jstor.org/stable/https://doi.org/10.3366/j.ctv32vqmvd.7.
Dowd, J. B., Palermo, T., Brite, J., McDade, T. W., & Aiello, A. (2013). Seroprevalence of Epstein-Barr virus Infection in U.S. children ages 6–19, 2003–2010. PLoS One, 8(5), e64921. https://doi.org/10.1371/journal.pone.0064921.
Drago, F., Ciccarese, G., Rebora, A., & Parodi, A. (2021). Human herpesvirus-6, -7, and Epstein-Barr virus reactivation in pityriasis rosea during COVID-19. Journal of Medical Virology, 93(4), 1850–1851. https://doi.org/10.1002/jmv.26549.
Drosos, A. A., Pelechas, E., & Voulgari, P. V. (2022). Long COVID from rheumatology perspective: A simple mimicker or promoter of autoimmunity? Clinical Rheumatology, 41(3), 957–958. https://doi.org/10.1007/s10067-022-06092-4.
Dryden, M., Mudara, C., Vika, C., Blumberg, L., Mayet, N., Cohen, C., Tempia, S., Parker, A., Nel, J., Perumal, R., Groome, M. J., Conradie, F., Ndjeka, N., Sigfrid, L., Merson, L., & Jassat, W. (2022). Post-COVID-19 condition 3 months after hospitalisation with SARS-CoV-2 in South Africa: A prospective cohort study. Lancet Glob Health, 10(9), e1247–e1256. https://doi.org/10.1016/S2214-109X(22)00286-8.
Dyal, J., Grant, M., Broadwater, K. (2020). COVID-19 Among Workers in Meat and Poultry Processing Facilities ― 19 States. MMWR Morb Mortal Wkly Rep, 69, 557–561. https://doi.org/10.15585/mmwr.mm6918e3.
EnSpark Consulting (2023). What We Heard: Engagement Report for National Academies of Sciences, Engineering, and Medicine Committee on Examining the Working Definition for Long COVID. http://nationalacademies.org/docs/DD8E87E8161DD0ED2EA0625D300E9C2F72CC0AAE9038.
Evans, M. K. (2020). Health Equity - Are we finally on the Edge of a New Frontier? New England Journal of Medicine, 383(11), 997–999. https://doi.org/10.1056/NEJMp2005944.
Farah, T. (2022). People of Color with Long COVID Face Uphill Battle to Be Heard. Scientific American. https://www.scientificamerican.com/article/people-of-color-with-long-covid-face-uphill-battle-to-be-heard/.
Fernandez-de-Las-Penas, C., Martin-Guerrero, J. D., Pellicer-Valero, O. J., Navarro-Pardo, E., Gomez-Mayordomo, V., Cuadrado, M. L., Arias-Navalon, J. A., Cigaran-Mendez, M., Hernandez-Barrera, V., & Arendt-Nielsen, L. (2022). Female sex is a risk factor Associated with Long-Term Post-COVID related-symptoms but not with COVID-19 symptoms: The LONG-COVID-EXP-CM Multicenter Study. J Clin Med, 11(2). https://doi.org/10.3390/jcm11020413.
Forsberg, V. C. (2020). COVID-19 and private health insurance coverage: frequently asked questions https://crsreports.congress.gov.
Gacek, R. R. (2002). The biology of neurotropic viruses. Advances in Oto-Rhino-Laryngology, 60, 1–11. https://doi.org/10.1159/000059259.
Galvani, A. P., Parpia, A. S., Pandey, A., Zimmer, C., Kahn, J. G., & Fitzpatrick, M. C. (2020). The imperative for universal healthcare to curtail the COVID-19 outbreak in the USA. EClinicalMedicine, 23, 100380. https://doi.org/10.1016/j.eclinm.2020.100380.
Gammazza, M., Légaré, S., Bosco, L., et al. (2020). Human molecular chaperons share with SARS-CoV-2 antigenic epitopes potentially capable of eliciting autoimmunity against endothelial cells: Possible role of molecular mimicry in COVID-19. Cell Stress Chaperons, 25, 737–741. https://doi.org/10.1007/s12192-020-01148-3.
Gao, P., Liu, J., & Liu, M. (2022). Effect of COVID-19 vaccines on reducing the risk of long COVID in the Real World: A systematic review and Meta-analysis. International Journal of Environmental Research and Public Health, 19(19). https://doi.org/10.3390/ijerph191912422.
Garcia-Martinez, F. J., Moreno-Artero, E., & Jahnke, S. (2020). SARS-CoV-2 and EBV coinfection. Med Clin (Engl Ed), 155(7), 319–320. https://doi.org/10.1016/j.medcle.2020.06.010.
Georghiou, T., & Appelby, J. (2020). Are more black, Asian and minority ethnic people dying with COVID-19 than might be expected? Nuffield Trust. https://www.nuffieldtrust.org.uk/news‐item/are‐more‐black‐asian‐and‐minority‐ethnic‐people‐dying‐with‐COVID‐19‐than‐might‐be‐expected.
Giamarellos-Bourboulis, E. J., Netea, M. G., Rovina, N., Akinosoglou, K., Antoniadou, A., Antonakos, N., Damoraki, G., Gkavogianni, T., Adami, M. E., Katsaounou, P., Ntaganou, M., Kyriakopoulou, M., Dimopoulos, G., Koutsodimitropoulos, I., Velissaris, D., Koufargyris, P., Karageorgos, A., Katrini, K., Lekakis, V., Lupse, M., Kotsaki, A., Renieris, G., Theodoulou, D., Panou, V., Koukaki, E., Koulouris, N., Gogos, C., & Koutsoukou, A. (2020). Complex Immune Dysregulation in COVID-19 patients with severe Respiratory Failure. Cell Host & Microbe, 27(6), 992–1000e1003. https://doi.org/10.1016/j.chom.2020.04.009.
Global Labor Justice (2021). Sri Lankan Unions Demand Post COVID-19 World Bank Group Investment in Garment Sector Protect Workers. https://globallaborjustice.org/sri-lankan-unions-demand-post-covid-19-world-bank-group-investment-in-garment-sector-protect-workers/.
Gold, J. E., Okyay, R. A., Licht, W. E., & Hurley, D. J. (2021). Investigation of long COVID prevalence and its relationship to Epstein-Barr Virus Reactivation. Pathogens, 10(6). https://doi.org/10.3390/pathogens10060763.
Gravlee, C. C. (2020). Systemic racism, chronic health inequities, and COVID-19: A syndemic in the making? Am J Hum Biol, 32(5), e23482. https://doi.org/10.1002/ajhb.23482.
Guzman, M. G., Kouri, G., Bravo, J., Soler, M., & Martinez, E. (1991). Sequential Infection as risk factor for dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) during the 1981 dengue hemorrhagic Cuban epidemic. Memorias Do Instituto Oswaldo Cruz, 86(3), 367. https://doi.org/10.1590/s0074-02761991000300011.
Ham, D. (2022). Long-Haulers and Labor Market Outcomes. Working Paper. Federal Reserve Bank of Minneapolis. Opportunity and Inclusive Growth Institute. https://doi.org/10.21034/iwp.60.
Hentschel, C. B., Abramoff, B. A., Dillingham, T. R., & Pezzin, L. E. (2022). Race, ethnicity, and utilization of outpatient rehabilitation for treatment of post COVID-19 condition. PM R, 14(11), 1315–1324. https://doi.org/10.1002/pmrj.12869.
Hill, L., & Artiga, S. (2022). COVID-19 Cases and Deaths by Race/Ethnicity: Current Data and Changes Over Time. https://www.kff.org/coronavirus-covid-19/issue-brief/covid-19-cases-and-deaths-by-race-ethnicity-current-data-and-changes-over-time/.
Hoshino, Y., Katano, H., Zou, P., Hohman, P., Marques, A., Tyring, S. K., Follmann, D., & Cohen, J. I. (2009). Long-term administration of valacyclovir reduces the number of Epstein-Barr virus (EBV)-infected B cells but not the number of EBV DNA copies per B cell in healthy volunteers. Journal of Virology, 83(22), 11857–11861. https://doi.org/10.1128/JVI.01005-09.
Huang, Y., Pinto, M. D., Borelli, J. L., Mehrabadi, A., Abrahim, M., Dutt, H. L., Lambert, N., Nurmi, N., Chakraborty, E. L., Rahmani, R., A. M., & Downs, C. A. (2022). COVID symptoms, Symptom clusters, and predictors for becoming a long-hauler looking for clarity in the haze of the pandemic. Clinical Nursing Research, 31(8), 1390–1398. https://doi.org/10.1177/10547738221125632.
Human Rights Watch (2019). When We’re Dead and Buried, Our Bones Will Keep Hurting: Workers’ Rights Under Threat in US Meat and Poultry Plants.
Iacurci, G. (2022). Long Covid may be ‘the next public health disaster’ — with a $3.7 trillion economic impact rivaling the Great Recession. https://www.cnbc.com/2022/11/30/why-long-covid-could-be-the-next-public-health-disaster.html.
Ives, A. M., & Bertke, A. S. (2017). Stress Hormones Epinephrine and corticosterone selectively modulate herpes Simplex Virus 1 (HSV-1) and HSV-2 productive Infections in adult sympathetic, but not sensory, neurons. Journal of Virology, 91(13). https://doi.org/10.1128/JVI.00582-17.
Jog, N. R., Young, K. A., Munroe, M. E., Harmon, M. T., Guthridge, J. M., Kelly, J. A., Kamen, D. L., Gilkeson, G. S., Weisman, M. H., Karp, D. R., Gaffney, P. M., Harley, J. B., Wallace, D. J., Norris, J. M., & James, J. A. (2019). Association of Epstein-Barr virus serological reactivation with transitioning to systemic Lupus Erythematosus in at-risk individuals. Annals of the Rheumatic Diseases, 78(9), 1235–1241. https://doi.org/10.1136/annrheumdis-2019-215361.
Kim, E. J., Marrast, L. & Conigliaro, J. (2020). COVID-19: Magnifying the Effect of Health Disparities. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-020-05881-4.
Klein, S. L., & Flanagan, K. L. (2016). Sex differences in immune responses. Nature Reviews Immunology, 16(10), 626–638. https://doi.org/10.1038/nri.2016.90.
Kotfis, K., Lechowicz, K., Drozdzal, S., Niedzwiedzka-Rystwej, P., Wojdacz, T. K., Grywalska, E., Biernawska, J., Wisniewska, M., & Parczewski, M. (2021). COVID-19-The potential Beneficial Therapeutic effects of Spironolactone during SARS-CoV-2 Infection. Pharmaceuticals (Basel), 14(1). https://doi.org/10.3390/ph14010071.
Kriesel, J. D., Gebhardt, B. M., Hill, J. M., Maulden, S. A., Hwang, I. P., Clinch, T. E., Cao, X., Spruance, S. L., & Araneo, B. A. (1997). Anti-interleukin-6 antibodies inhibit herpes simplex virus reactivation. Journal of Infectious Diseases, 175(4), 821–827. https://doi.org/10.1086/513977.
Le-Trilling, V. T., & Trilling, M. (2015). Attack, parry and riposte: Molecular fencing between the innate immune system and human herpesviruses. Tissue Antigens, 86(1), 1–13. https://doi.org/10.1111/tan.12594.
Lehmann, C., Karnik, R., & Sherer, R. (2022). It is Time to Recognize the Severity of Post-Acute Sequelae of COVID-19 (PASC). The Open COVID Journal, 2666–9587/22.
Lemke, M. K., Apostolopoulos, Y., & Sönmez, S. (2020a). A novel COVID-19 based truck driver syndemic? Implications for public health, safety, and vital supply chains [Note]. American Journal of Industrial Medicine, 63(8), 659–662. https://doi.org/10.1002/ajim.23138.
Lemke, M. K., Apostolopoulos, Y., & Sönmez, S. (2020b). Syndemic frameworks to understand the effects of COVID-19 on commercial driver stress, health, and safety. Journal of Transport & Health, 18. https://doi.org/10.1016/j.jth.2020.100877.
Liu, J., Zhang, S., Wu, Z., Shang, Y., Dong, X., Li, G., Zhang, L., Chen, Y., Ye, X., Du, H., Liu, Y., Wang, T., Huang, S., Chen, L., Wen, Z., Qu, J., & Chen, D. (2020). Clinical outcomes of COVID-19 in Wuhan, China: A large cohort study. Ann Intensive Care, 10(1), 99. https://doi.org/10.1186/s13613-020-00706-3.
Lladós, G., Massanella, M., Coll-Fernández, R., Rodríguez, R., Hernández, E., Lucente, G., López, C., Loste, C., Santos, J. R., España-Cueto, S., Nevot, M., Muñoz-López, F., Arrieta, S. S., Brander, C., Durà, M. J., Cuadras, P., Bechini, J., Tenesa, M., Martinez-Piñeiro, A., Herrero, C., Chamorro, A., Garcia, A., Grau, E., Clotet, B., Paredes, R., & Mateu, L. (2023). Vagus nerve dysfunction in the Post-COVID-19 Condition. The Lancet. https://doi.org/10.2139/ssrn.4479598. & Germans Trias Long-COVID Unit
Lofti, M., Hamblin, M., & Rezaei, N. (2020). COVID-19: Transmission, prevention, and potential therapeutic opportunities. Clinica Chimica Acta, 508, 254–266. https://doi.org/10.1016/j.cca.2020.05.044.
Mahajan, U. V., & Larkins-Pettigrew, M. (2020). Racial demographics and COVID-19 confirmed cases and deaths: A correlational analysis of 2886 US counties. J Public Health (Oxf), 42(3), 445–447. https://doi.org/10.1093/pubmed/fdaa070.
Makoni, M. (2022). The long shadow of COVID-19 in Africa. Lancet Respir Med, 10(11), 1016. https://doi.org/10.1016/S2213-2600(22)00398-8.
Mansell, V., Dykgraaf, H., Kidd, S., M., & Goodyear-Smith, F. (2022). Long COVID and older people. The Lancet Healthy Longevity, 3(12), e849–e854. https://doi.org/10.1016/S2666-7568(22)00245-8.
McDowell, T. (2017). The complexity of the international food industry. Int J Soc Syst Sci, 9(1), 1–28.
McQuillan, G., Kruszon-Moran, D., Flagg, E., & Paulose-Ram, R. (2018). Prevalence of herpes simplex virus type 1 and type 2 in persons aged 14–49: United States, 2015–2016.
Mendenhall, E. (2016). Syndemic suffering: Social Distress, Depression, and Diabetes among Mexican immigrant women. Routledge.
Mendenhall, E. (2020). The COVID-19 syndemic is not global: Context matters. The Lancet, 396(10264), P1731. https://doi.org/10.1016/S0140-6736(20)32218-2.
Michelen, M., Manoharan, L., Elkheir, N., Cheng, V., Dagens, A., Hastie, C., O’Hara, M., Suett, J., Dahmash, D., Bugaeva, P., Rigby, I., Munblit, D., Harriss, E., Burls, A., Foote, C., Scott, J., Carson, G., Olliaro, P., Sigfrid, L., & Stavropoulou, C. (2021). Characterising long COVID: A living systematic review. BMJ Glob Health, 6(9). https://doi.org/10.1136/bmjgh-2021-005427.
Mizrahi, B., Sudry, T., Flaks-Manov, N., Yehezkelli, Y., Kalkstein, N., Akiva, P., Ekka-Zohar, A., Ben David, S. S., Lerner, U., Bivas-Benita, M., & Greenfeld, S. (2023). Long covid outcomes at one year after mild SARS-CoV-2 Infection: Nationwide cohort study. Bmj, 380, e072529. https://doi.org/10.1136/bmj-2022-072529.
Montales, M. T., Chaudhury, A., Beebe, A., Patil, S., & Patil, N. (2015). HIV-Associated TB Syndemic: A growing clinical Challenge Worldwide. Front Public Health, 3, 281. https://doi.org/10.3389/fpubh.2015.00281.
Ni, W., Yang, X., Yang, D., Bao, J., Li, R., Xiao, Y., Hou, C., Wang, H., Liu, J., Yang, D., Xu, Y., Cao, Z., & Gao, Z. (2020). Role of angiotensin-converting enzyme 2 (ACE2) in COVID-19. Critical Care, 24(1), 422. https://doi.org/10.1186/s13054-020-03120-0.
Nikiphorous, E., Alpizar-Rodriguez, D., Gastelum-Strozzi, A., Bunch, M., & Pelaez-Ballestas, I. (2021). Syndemics & syndemogenesis in COVID-19 and rheumatic and Musculoskeletal Diseases: Old challenges, new era. Rheumatology, 60(5), 2040–2045.
Pan, D., Sze, S., Minhas, J. S., Bangash, M. N., Pareek, N., Divall, P., Williams, C. M., Oggioni, M. R., Squire, I. B., Nellums, L. B., Hanif, W., Khunti, K., & Pareek, M. (2020). The impact of ethnicity on clinical outcomes in COVID-19: A systematic review. EClinicalMedicine, 23, 100404. https://doi.org/10.1016/j.eclinm.2020.100404.
Paolucci, S., Cassaniti, I., Novazzi, F., Fiorina, L., Piralla, A., Comolli, G., Bruno, R., Maserati, R., Gulminetti, R., Novati, S., Mojoli, F., Baldanti, F., & San Matteo Pavia, C. T. F. (2021). EBV DNA increase in COVID-19 patients with impaired lymphocyte subpopulation count. International Journal of Infectious Diseases : Ijid : Official Publication of the International Society for Infectious Diseases, 104, 315–319. https://doi.org/10.1016/j.ijid.2020.12.051.
Pencavel, J. (2014). Higher Education, Productivity, and earnings: A review. The Journal of Economic Education, 22(4), 00220485.00221991.10844727.
Perego, E., Callard, F., Stras, L., Melville-Jóhannesson, B., Pope, R., & Alwan, N. (2020). Why the patient-made term ‘long covid’ is needed. Wellcome Open Research, 39(1), 73–97. https://doi.org/10.12688/wellcomeopenres.16307.1.
Price-Haywood, E. G., Burton, J., Fort, D., & Seoane, L. (2020). Hospitalization and mortality among black patients and White patients with Covid-19. New England Journal of Medicine, 382(26), 2534–2543. https://doi.org/10.1056/NEJMsa2011686.
Proal, A. D., & VanElzakker, M. B. (2021). Long COVID or post-acute sequelae of COVID-19 (PASC): An overview of biological factors that may contribute to persistent symptoms. Frontiers in Microbiology, 12, 698169. https://doi.org/10.3389/fmicb.2021.698169.
Proal, A. D., Lindseth, I. A., & Marshall, T. G. (2017). Microbe-microbe and host-microbe interactions drive microbiome dysbiosis and inflammatory processes. Discovery Medicine, 23(124), 51–60. https://www.ncbi.nlm.nih.gov/pubmed/28245427.
Puntmann, V. O., Carerj, M. L., Wieters, I., Fahim, M., Arendt, C., Hoffmann, J., Shchendrygina, A., Escher, F., Vasa-Nicotera, M., Zeiher, A. M., Vehreschild, M., & Nagel, E. (2020). Outcomes of Cardiovascular Magnetic Resonance Imaging in patients recently recovered from Coronavirus Disease 2019 (COVID-19). JAMA Cardiol, 5(11), 1265–1273. https://doi.org/10.1001/jamacardio.2020.3557.
Quinn, K. G., Harris, M., Sherrod, D., Hunt, B. R., Jacobs, J., Valencia, J., & Walsh, J. L. (2023). The COVID-19, racism, and Violence syndemic: Evidence from a qualitative study with black residents of Chicago [Article]. SSM - Qualitative Research in Health, 3, 100218. https://doi.org/10.1016/j.ssmqr.2023.100218.
Rattay, P., Michalski, N., Domanska, O. M., Kaltwasser, A., De Bock, F., Wieler, L. H., & Jordan, S. (2021). Differences in risk perception, knowledge and protective behaviour regarding COVID-19 by education level among women and men in Germany. Results from the COVID-19 snapshot monitoring (COSMO) study. PLoS One, 16(5), e0251694. https://doi.org/10.1371/journal.pone.0251694.
Reddit (2022). R/Coronavirus.
Robertson, M. M., Qasmieh, S. A., Kulkarni, S. G., Teasdale, C. A., Jones, H., McNairy, M., Borrell, L. N., & Nash, D. (2022). The epidemiology of long COVID in US adults. Clinical Infectious Diseases. https://doi.org/10.1093/cid/ciac961.
Shahid, H. J., & Dogra, S. A. (2022). The Muslim Gaze and the COVID-19 syndemic [Article]. Religions. https://doi.org/10.3390/rel13090780., 13(9), N.PAG-N.PAG.
Shanshal, M., & Ahmed, H. (2021). COVID-19 and herpes simplex virus Infection: A cross-sectional study. Cureus, 13(9), e18022. https://doi.org/10.7759/cureus.18022.
Simonnet, A., Engelmann, I., Moreau, A. S., Garcia, B., Six, S., El Kalioubie, A., Robriquet, L., Hober, D., & Jourdain, M. (2021). High incidence of Epstein-Barr virus, cytomegalovirus, and human-herpes virus-6 reactivations in critically ill patients with COVID-19. Infect Dis Now, 51(3), 296–299. https://doi.org/10.1016/j.idnow.2021.01.005.
Singer, M. (2009). Introduction to Syndemics: A systems Approach to Public and Community Health. Jossey-Bass.
Singer, M. (2010). Pathogen-pathogen interaction: A syndemic model of complex biosocial processes in Disease. Virulence, 1(1), 10–18. https://doi.org/10.4161/viru.1.1.9933.
Singer, M., & Rylko-Bauer, B. (2021). The syndemics and Structural Violence of the COVID pandemic: Anthropological insights on a Crisis. Open Anthropological Research, 1(1), 7–32.
Singer, M., Bulled, N., Ostrach, B., & Mendenhall, E. (2017). Syndemics and the biosocial conception of health. Lancet, 389(10072), 941–950. https://doi.org/10.1016/S0140-6736(17)30003-X.
Singer, M., Bulled, N., & Leatherman, T. (2022). Are there global syndemics? [Article]. Medical Anthropology, 41(1), 4–18. https://doi.org/10.1080/01459740.2021.2007907.
Smith, D. (2022). Dr Anthony Fauci: long Covid is an ‘insidious’ public health emergency. The Guardian. https://www.theguardian.com/society/2022/oct/17/fauci-interview-long-covid-risk-emergency-response-coronavirus.
Spears, T. (2022). Long COVID patient struggles accessing disability benefits. https://abc57.com/news/abc57-sound-off-long-covid-patient-struggles-accessing-disability-benefits.
Stowe, R. P., Peek, M. K., Cutchin, M. P., & Goodwin, J. S. (2012). Reactivation of herpes simplex virus type 1 is associated with cytomegalovirus and age. Journal of Medical Virology, 84(11), 1797–1802. https://doi.org/10.1002/jmv.23397.
Su, Y., Yuan, D., Chen, D. G., Ng, R. H., Wang, K., Choi, J., Li, S., Hong, S., Zhang, R., Xie, J., Kornilov, S. A., Scherler, K., Pavlovitch-Bedzyk, A. J., Dong, S., Lausted, C., Lee, I., Fallen, S., Dai, C. L., Baloni, P., Smith, B., Duvvuri, V. R., Anderson, K. G., Li, J., Yang, F., Duncombe, C. J., McCulloch, D. J., Rostomily, C., Troisch, P., Zhou, J., Mackay, S., DeGottardi, Q., May, D. H., Taniguchi, R., Gittelman, R. M., Klinger, M., Snyder, T. M., Roper, R., Wojciechowska, G., Murray, K., Edmark, R., Evans, S., Jones, L., Zhou, Y., Rowen, L., Liu, R., Chour, W., Algren, H. A., Berrington, W. R., Wallick, J. A., Cochran, R. A., Micikas, M. E., Wrin, T., Petropoulos, C. J., Cole, H. R., Fischer, T. D., Wei, W., Hoon, D. S. B., Price, N. D., Subramanian, N., Hill, J. A., Hadlock, J., Magis, A. T., Ribas, A., Lanier, L. L., Boyd, S. D., Bluestone, J. A., Chu, H., Hood, L., Gottardo, R., Greenberg, P. D., Davis, M. M., Goldman, J. D., & Heath, J. R. (2022). Multiple early factors anticipate post-acute COVID-19 sequelae. Cell, 185(5), 881–895e820. https://doi.org/10.1016/j.cell.2022.01.014.
Subramanian, A., Nirantharakumar, K., Hughes, S., Myles, P., Williams, T., Gokhale, K. M., Taverner, T., Chandan, J. S., Brown, K., Simms-Williams, N., Shah, A. D., Singh, M., Kidy, F., Okoth, K., Hotham, R., Bashir, N., Cockburn, N., Lee, S. I., Turner, G. M., Gkoutos, G. V., Aiyegbusi, O. L., McMullan, C., Denniston, A. K., Sapey, E., Lord, J. M., Wraith, D. C., Leggett, E., Iles, C., Marshall, T., Price, M. J., Marwaha, S., Davies, E. H., Jackson, L. J., Matthews, K. L., Camaradou, J., Calvert, M., & Haroon, S. (2022). Symptoms and risk factors for long COVID in non-hospitalized adults. Nature Medicine, 28(8), 1706–1714. https://doi.org/10.1038/s41591-022-01909-w.
Survivor Corps (2022). Retrieved February 3, 2023 from https://www.survivorcorps.com.
Sylvester, S. V., Rusu, R., Chan, B., Bellows, M., O’Keefe, C., & Nicholson, S. (2022). Sex differences in sequelae from COVID-19 Infection and in long COVID syndrome: A review. Current Medical Research and Opinion, 38(8), 1391–1399. https://doi.org/10.1080/03007995.2022.2081454.
Tabacof, L., Tosto-Mancuso, J., Wood, J., Cortes, M., Kontorovich, A., McCarthy, D., Rizk, D., Mohammadi, Breyman, N., E., Nasr, L., Kellner, C., & Putrino, D. (2020). Post-acute COVID-19 syndrome negatively impacts health and wellbeing despite less severe acute infection. medRxiv, 2020.2011.2004.20226126. https://doi.org/10.1101/2020.11.04.20226126.
Taylor, L. (2023). Covid-19: Vaccination reduces severity and duration of long covid, study finds. BMJ, 380, p491. https://doi.org/10.1136/bmj.p491.
Tenforde, M. W., Devine, O. J., Reese, H. E., Silk, B. J., Iuliano, A. D., Threlkel, R., Vu, Q. M., Plumb, I. D., Cadwell, B. L., Rose, C., Steele, M. K., Briggs-Hagen, M., Ayoubkhani, D., Pawelek, P., Nafilyan, V., Saydah, S. H., & Bertolli, J. (2022). Point prevalence estimates of activity-limiting long-term symptoms among U.S. adults >/=1 Month after reported SARS-CoV-2 Infection, November 1, 2021. Journal of Infectious Diseases. https://doi.org/10.1093/infdis/jiac281.
Tolbert, J. (2020). What issues will uninsured people face with testing and treatment for COVID-19? https://www.kff.org/coronavirus‐COVID‐19/fact‐sheet/what‐issues‐will‐uninsured‐people‐face‐with‐testing‐and‐treatment‐for‐COVID‐19/.
Verma, D., Thompson, J., & Swaminathan, S. (2016). Spironolactone blocks Epstein-Barr virus production by inhibiting EBV SM protein function. Proc Natl Acad Sci U S A, 113(13), 3609–3614. https://doi.org/10.1073/pnas.1523686113.
Verma, D., Church, T. M., & Swaminathan, S. (2021). Epstein-Barr Virus Lytic Replication induces ACE2 expression and enhances SARS-CoV-2 Pseudotyped Virus Entry in epithelial cells. Journal of Virology, 95(13), e0019221. https://doi.org/10.1128/JVI.00192-21.
Wallis, C. (2020). Why Racism, not race, is a risk factor for dying of COVID-19. Scientific American. https://www.scientificamerican.com/article/why-racism-not-race-is-a-risk-factor-for-dying-of-covid-191/.
Wapner, J. (2020). Covid-19: Medical expenses leave many americans deep in debt. Bmj, 370, m3097. https://doi.org/10.1136/bmj.m3097.
Whitley, R. J., Kimberlin, D. W., & Roizman, B. (1998). Herpes simplex viruses. Clinical Infectious Diseases, 26(3), 541–553. https://doi.org/10.1086/514600. quiz 554 – 545.
Willen, S. S., Knipper, M., Abadia-Barrero, C. E., & Davidovitch, N. (2017). Syndemic vulnerability and the right to health. Lancet, 389(10072), 964–977. https://doi.org/10.1016/S0140-6736(17)30261-1.
Woolhandler, S., Himmelstein, D. U., Intersecting, U. S., & Epidemics (2020). COVID-19 and Lack of Health Insurance. Annals of Internal Medicine, 173(1), 63–64. https://doi.org/10.7326/M20-1491.
World Health Organization [WHO] (2020). Massive proportion of world’s population are living with herpes infection. https://www.who.int/news/item/01-05-2020-massive-proportion-world-population-living-with-herpes-infection.
Xie, Y., & Al-Aly, Z. (2022). Risks and burdens of incident Diabetes in long COVID: A cohort study. Lancet Diabetes Endocrinol, 10(5), 311–321. https://doi.org/10.1016/S2213-8587(22)00044-4.
Xu, R., Zhou, Y., Cai, L., Wang, L., Han, J., Yang, X., Chen, J., Chen, J., Ma, C., & Shen, L. (2020). Co-reactivation of the human herpesvirus alpha subfamily (herpes simplex virus-1 and varicella zoster virus) in a critically ill patient with COVID-19. British Journal of Dermatology, 183(6), 1145–1147. https://doi.org/10.1111/bjd.19484.
Yancy, C. W. (2020). COVID-19 and African americans. Journal of the American Medical Association, 323(19), 1891–1892. https://doi.org/10.1001/jama.2020.6548.
Zubchenko, S., Kril, I., Nadizhko, O., Matsyura, O., & Chopyak, V. (2022). Herpesvirus Infections and post-COVID-19 manifestations: A pilot observational study. Rheumatology International, 42(9), 1523–1530. https://doi.org/10.1007/s00296-022-05146-9.
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Singer, M., Bulled, N. Long Covid: A Syndemics Approach to Understanding and Response. Applied Research Quality Life 19, 811–834 (2024). https://doi.org/10.1007/s11482-023-10266-w
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DOI: https://doi.org/10.1007/s11482-023-10266-w