Critical medical ecology and SARS-COV-2 in the urban environment: a pragmatic, dynamic approach to explaining and planning for research and practice

Abstract

Background Practitioners and researchers in the midst of overwhelming coronavirus disease 2019 (COVID-19) outbreaks are calling for new ways of looking at such pandemics, with an emphasis on human behavior and holistic considerations. Viral outbreaks are characterized by socio-behaviorally-oriented public health efforts aimed at reducing exposure and prevention of morbidity/mortality once infected. These efforts involve different points-of-view, generally, than do those aimed to understand the virus’ natural history. Rampant spread of SARS-CoV-2 infection in cities clearly signals that urban areas contain conditions favorable for rapid transmission of the virus. Main text The Critical Medical Ecology model is a multidimensional, multilevel way of viewing pandemics comprehensively, rooted simultaneously in microbiology and in anthropology, with shared priority for evolution, context, stressors, homeostasis, adaptation, and power relationships. Viewing COVID-19 with a Critical Medical Ecological lens suggests three important interpretations: 1) COVID-19 is equally — if not more — a socially-driven disease as much as a biomedical disease, 2) the present interventions available for primary prevention of transmission are social and behavioral interventions, and 3) wide variation in COVID-19 hospitalization/death rates is not expected to significantly be attributable to a more virulent and rapidly-evolving virus, but rather to differences in social and behavioral factors — and power dynamics — rather than (solely) biological and clinical factors. Cities especially are challenged due to logistics and volume of patients, and lack of access to sustaining products and services for many residents living in isolation. Conclusions In the end, SARS-CoV-2 is acting upon dynamic social human beings, entangled within structures and relationships that include but extend far beyond their cells, and in fact beyond their own individual behavior. As a comprehensive way of thinking, the Critical Medical Ecology model helps identify these elements and dynamics in the context of ecological processes that create, shape, and sustain people in their multidimensional, intersecting environments.

Non-medical COVID-19-related personal impact in medical ecological perspective: A global multileveled, mixed method study

“…This cross-sectional, multi-level, convergent mixed-methods study assessed a range of beliefs, practices, and experiences relating to COVID-19, prevention efforts, and ancillary health and non-medical issues that may impact these beliefs, practices, and experiences. The overall paradigm guiding the design is the Critical Medical Ecological model (36) that accounts for the multilevel, multidimensional quantitative and qualitative data comprising this study (see Figure 1). The aim of the quantitative component is to explain contributions and associations of various medical ecological variables across multidimensional domains and levels of organization on COVID-19-related non-medical personal impact.…”

“…Shown in Figure 1, quantitative and qualitative variables that were assessed for association with respondents’ non-medical COVID-19 Impact Score were applied to the Critical Medical Ecology framework previously described. (36) This model and conceptual structure of variables impacts the selection of analytic methods used to develop multilevel quantitative and qualitative explanatory models of non-medical COVID-19 impact.…”

“…Specifically, the model considers sociocultural, biological, health care, and abiotic circumstances at individual, household, and community levels and is well-suited for analysis of COVID-19 and multilevel modeling. (36, 37)…”

Sewage surveillance system using urological wastewater: Key to COVID-19 monitoring?

“…Current RT-PCR-based tests are sufficiently sensitive to illustrate the presence of infected patients in a geographical area by analysis of its wastewater [68] . Rapid and regular testing and isolation of COVID-19 patients is regarded highly important to contain viral spread, and while serum tests are available to identify individual patients, the daily application and determination is logistically challenging, especially in densely populated urban areas [72] . Moreover, the COVID-19 pandemic is significantly complicated and aggravated by viral transmission between non-symptomatic human carriers [ 73 , 74 ].…”

Conducting an immersive community-based assessment of post-hurricane experience among Puerto Ricans: lived experience of medical ecology in an environmental disaster and migration

“…Working amidst the devastation of the hurricanes, an appropriate framework needed to be implemented to capture the complex human-ecological calamity that resulted from the mentioned natural disasters. The Critical Medical Ecological paradigm [ 22 , 30 ] provided a useful heuristic device to examine human interactions with their environment, comprehensively defined to include physical, social, political, and biological elements [ 31 – 33 ]. This analytical framework prioritizes multidimensional social (including economic, demographic, and cultural) relationships and biological aspects of community members while acknowledging the interdependent role of bioenvironmental factors and their associations with disease [ 34 ].…”