It is important to emphasize that the current New Coronavirus (SARS-CoV2) epidemic is not only the first major pandemic of the third millennium but also the first of the Anthropocene. By this we mean that it is not a sort of “bump in the road”, a random, sudden and unpredictable biological event, but rather a particularly dramatic episode, due to its mode of manifestation and its consequences at the health, social, economic-financial and political level (which are still not completely apprehended) of a long biological crisis which is the consequence of the “War on Nature” or, to quote the last two Papal encyclicals, on its “Common Home” by Homo sapiens sapiens.

A global biological and health crisis, moreover, which was widely predicted and announced as imminent for almost 20 years by scientists around the world and in particular by virologists, virus hunters and epidemiologists. As a matter of fact, we know since the beginning of this century that the world of microorganisms is in turmoil and that thousands of "new viruses" potentially lethal to humans (Ebola, Nipah, Hendra, Marburg but especially new subtypes of Flu-Orthomyxoviruses and Bat-Coronaviruses) are ready to spillover: from "reservoir species" that have housed them for millions of years, to animals crammed into intensive farms, to immense food markets and endless urban suburbs of the Southern Hemisphere, and finally to humans. This is due to climate change, the disruption of biological and microbiological ecosystems, unrestrained deforestation, increasingly all-pervasive chemical and physical pollution and the proliferation of megacities where tens of millions of human beings live in conditions of misery and promiscuity that have no precedent (at least in terms of size) in history.

In this sense we can say with absolute certainty that this is the first major pandemic of the Anthropocene: it is not an isolated and accidental event, but indeed a particularly dramatic episode of a chronic and rapidly progressive disease that affects the entire ecosphere and especially the biosphere and food chains and, consequently, the whole of humanity. It, therefore, makes no sense to plan to address it only with drugs and vaccines, which unfortunately is what the richest and most powerful Western countries are doing - no coincidence, the same countries who do not want to recognize and address the global ecological, climatic and biological crisis that they themselves have caused.

We often forget that a pandemic is a momentous event and that to truly understand what has happened, what is happening, and what will happen, we must refer to the global context and not only to local events. Let's start with two preliminary considerations.

The first is that a pandemic is a global event which has been predicted in detail for at least two decades: both with regard to the pathogenic agent (this is why Bat Coronaviruses have been studied for 15 years in all laboratories around the world), and with regard to the lack of preparedness of Western countries, despite the constant warnings of scientists.

The second consideration, equally fundamental, is that the pandemic is not an accidental event, a sort of "accident/acute illness" that struck the human population because a particularly virulent pathogen accidentally spread in a few months, killing two and a half million people. Or rather, it is not only that: on the contrary, it is a particularly dramatic stage of a "chronic disease" that affects the entire ecosphere and that has been irresponsibly produced, within a few decades, through a true "War on Nature" by a single species: Homo sapiens sapiens.

This first consideration is followed by a first remark: it is an indisputable fact that Asian countries, first of all China, but also South Korea, Japan, Cambodia, Vietnam, Hong Kong, Taiwan, Singapore have been able to stop the pandemic in the bud. It is also clear, to refute those who say that only authoritarian governments have been able to stop the pandemic by limiting civil liberties in a coercive and sometimes violent way, that Cuba, Australia, New Zealand, Iceland have done the same and have had very few deaths and minimal economic costs. All these countries have implemented precise strategies to contain the chains of infection, tracking and monitoring systems, organized quarantine areas and departments specifically dedicated to medium-severe and critical cases, implementing the gold standard in the management of pandemics: focusing on and strengthening primary health care.

At this point, a question must be asked: why is it that Western countries, although they are now aware that the only way to stop a pandemic in a short time is to put in place the abovementioned strategies of containment and tracking, even now, after a year, fail to implement them to identify and stop the chains of infection, at the risk of wasting the enormous effort made by health workers and of prolonging collective suffering?

The first pandemic of the Anthropocene

It is equally important to ask ourselves about the fundamental causes of the pandemic that, as we said, can not be seen as a simple “bump in the road”. For at least 20 years now, not only virologists and so-called virus hunters have identified thousands of potentially pandemic viruses, but the entire international scientific community has described the devastating effects of wild deforestation, of the massive urbanization of tens of millions of humans and animals in monstrous megacities, of bio-invasions and rapid transformations of microbial-viral ecosystems that can promote the emergence of new pathogens which are capable of making the fateful "spillover". In particular, the principal new reservoir of potentially lethal pandemic viruses such as Ebola, Marburg, Nipah, Hendra and precisely Bat-Corona-viruses has been studied at length: the bat. And it has been understood that it's now constant presence in the suburbs of megacities in the South o represents an increasingly looming threat.

More generally, there is now abundant scientific literature showing how climate change, the transformation of ecosystems and in particular of microbial ecosystems, the deplorable conditions of animals in intensive farming, food markets and in some research laboratories, the pollution of the atmosphere in large cities, the hydrosphere and in particular aquifers, but especially the biosphere and food chains, are phenomena closely related to each other. These are all effects of the dramatic acceleration of the exploitation of the resources of the ecosphere which has been implemented in just a few decades by man and which defines and connotes the Anthropocene.

The age of pandemics

What few people seem to understand is that these basic considerations should be placed at the core of critical reflection on what is happening and inspire the strategies necessary not only to address the pandemic in progress but also to prevent and deal more properly and effectively with the expected future pandemics. It should be clear by now that if we continue to deforest, to maintain intensive livestock and food markets such as those in Southeast Asia, to build megacities, to pollute the air we breathe with tons of ultrafine particles that inflame the arteries and arterioles in our body at an increasingly early age, we will helplessly observe the rapid increase of two concurrent and complementary epidemiological phenomena. On the one hand, the “epidemiological transition” that has been taking place for at least three decades, consisting in a continuous increase of chronic diseases with a strong inflammatory component: atherosclerosis and cardiovascular diseases, endocrine-metabolic and autoimmune diseases, cancer, neurodegenerative diseases and neurodevelopmental disorders. On the other hand, the materialization of the dreaded "pandemic era" due to the continuous increase of zoonoses: i.e. the spillover of new pathogens to humans from animals which we keep in painful and unnatural conditions.

It is extremely important to emphasize that if the abovementioned issues are not tackled at the root and urgently, not only will we not stop the devastating increase in chronic/non-communicable diseases, but we risk being overwhelmed by acute/infectious pandemics just as, and even more, devastating than the present one, not least because both pandemics appear to be mutually complementary and synergistic.

Pandemic or syndemic?

At this point, we must add another piece to the puzzle and recall an important contribution to the interpretation of the current pandemic, especially with regard to the peculiarities of its clinical manifestations and epidemiology, by the editor-in-chief of The Lancet, Richard Horton.

In a short but widely disseminated editorial, Horton criticized the dominant approach to Covid, stating that it is not just a pandemic, but a syndemic, a term coined thirty years ago by an anthropologist who noted that diseases manifest themselves in different forms because they interact with each other relative to social and economic factors specific to a given population. As for SARS-CoV-2, it is evident that the virus essentially affects people suffering from chronic non-communicable diseases and according to patterns of inequalities typical of Western societies.

Horton's thesis is important and we agree with it in part. There is no doubt that the current pandemic has become the disaster we know because and to the extent that it has acted on debilitated organisms. This Coronavirus, in fact, does not in itself have a lethality rate (LT) similar to that of the dreaded H5N1/1997 avian flu, which kills 50% of the people it infects (a higher LT than Variola major, the smallpox virus), nor of the two previous potentially pandemic Coronaviruses, SARS-CoV/2002 of the first SARS and MERS-CoV/2012, which had LTs between 10% and 30%. Although highly contagious, SARS-CoV-2 has an official LT of about 2% (about 10 times higher than common influenza viruses) and causes few severe forms (5-10%) and very few critical cases (2-3%) only in chronically or complexly ill individuals.

However, it must be emphasized that it is not true that COVID only kills the elderly. This is a simplification. SARS-CoV-2 actually kills individuals with endothelial dysfunction, that is, people with chronically inflamed arteries. These are predominantly people who are obese, have diabetes or are suffering from systemic atherosclerosis (which, as we know, is an inflammatory disease) and therefore from hypertension and cardiovascular diseases. Certainly, most of them are elderly, but many elderly people have non-severe forms and some young people and even some children may, although rarely, experience severe or critical forms. SARS-CoV-2 hooks in fact the ACE-2 receptors that are located not only in the upper airways and lungs, but also in the arteries and arterioles of all organs and tissues and, when it finds them already inflamed, it literally triggers potentially lethal systemic immune-inflammatory reactions, which often cannot be controlled with currently available therapies (perhaps only the plasma of cured individuals and/or massive doses of non-specific IgG and cortisone could be useful). We must also emphasize that it is increasingly evident that severe cases are due to the concomitant presence of a second trigger, which on the one hand paves the way, and on the other hand greatly enhances the action of the virus: ultrafine particulate matter (UP).

The first pan-syndemic of the Anthropocene

In this sense, Horton's thesis is even more important and helps us understand why Covid affects more severely the elderly in the most polluted areas of the Western world (in Italy, the Po Valley) who have been exposed for decades to this second, very powerful inflammatory trigger, which already causes (according to the World Health Organization) at least 10 million deaths each year. It also helps us understand why people who are obese or have diabetes are most at risk, given that these are systemic inflammatory endocrinopathies "triggered" by a massive and early exposure (already in utero) to UP and other pollutants (endocrine disruptors, etc..) which are able to induce alterations in the programming of cells and tissues: epigenetic diseases, then, not genetic, such as most of the chronic inflammatory and cancer diseases that are spreading in the world, also among young people. Finally, it helps us understand why Western cities are the most affected: because it is here that the endothelia of the vessels of millions of people have been exposed for decades to air pollution and in particular to UP, which on the other hand increases the virulence of SARS-CoV2 acting both as a predisposing factor (determining endothelial dysfunction), as well as an associated trigger (as demonstrated by the peaks of Covid related to pollution levels).

We can therefore say that today we have both a true pandemic (as SARS-CoV-2 is a virus sufficiently contagious and virulent to cause, in a few months, millions of deaths around the planet), and a syndemic. We might even call it the first pan-syndemic of the third millennium, or of the Anthropocene since as we have seen, it is a consequence of both the very rapid transformation by man of microbial and social ecosystems, and of the equally rapid epigenetic de-programming of developing organisms, which characterizes the richest and most industrialized countries, and which is also rapidly spreading to the megacities in the South.

At this point, it is easy to answer our initial question: why are Western countries still not able to put in place, after more than a year after the outbreak of the pandemic, the classic strategies of tracking and containment of infection that have proved useful and probably necessary to stop the pandemic but instead rely entirely on mass vaccine-prophylaxis? Indeed, it seems clear that Western countries do not intend to question not only the effectiveness of their hospital-centric health systems but also and above all the project (dominant for several decades) of biomedicine increasingly drug-centric and high-bio-tech. Moreover, they do not intend to recognize and address the real deep and systemic eco-biological causes of the pandemic: the destruction of entire ecosystems and biomes, the ongoing climate crisis, the rapid depletion of water and food resources, the increasingly widespread and capillary pollution of all sectors of the ecosphere.

In this sense, the warning of some scientists that we have entered the "era of pandemics" applies to both acute/transmissible and chronic/non-transmissible diseases: both are consequences of the increasingly accelerated disruption of the ecosphere caused by Homo sapiens, epiphenomena of a chronic and rapidly progressive disease that affects the entire biosphere (and especially the micro-biosphere) – they are not simple "biological accidents" which can be solved with specific remedies such as drugs and vaccines.

At this point, we can only hope for the success of the great "challenge" of Western science and economic systems to put in place in record time vaccine platforms which are in fact experimental (RNA vaccines, recombinant adenovirus) and at the same time safe and able to induce quickly enough and at the global level herd immunity against SARS-CoV-2 (which, according to the same multinational companies that produce the vaccines, is unlikely to be achieved), in order to avoid millions of more deaths and the collapse of entire health systems and economies.

However, we must emphasize that even for the success of mass vaccine-prophylaxis campaigns, it is urgent and necessary in the short term to implement strategies to contain the chains of infection and systems for tracking and monitoring; in the medium to long term, it is necessary to strengthen primary health care and to prepare a radical transformation of health systems, which must be re-oriented in terms of health promotion and disease prevention of both acute/infectious and chronic/non-communicable diseases.

(Traduzione di Stella De Sabata).