Every pandemic in history has had the greatest impact on poor and marginalized communities, going back to the Black Death—communities deprived of adequate nutrition, healthcare, and safe housing; and most likely to have chronic underlying conditions.
Viral and bacterial co-infection can lead to more severe disease. Patients with chronic chlamydia pneumonia can develop heart problems; patients with chronic strep or other types of chlamydia can develop kidney problems. Influenza patients can develop a stroke months after acute influenza has resolved. Inflammation can be a delayed response to pathogens and debris generated by the co-infections, weeks after the onset of acute infection and after resolution of the acute infection.
Understanding chronic disease and the unique impact of acute illness on different communities and different people will require acceptance of infectious causes of chronic disease, and routine testing for multiple pathogens and parasites. Chronic co-infection could be recognized as a risk factor for more severe acute disease.
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