Disease in Conflict: Study Found Covid-19 Exacerbated Link Between Global Conflict and Existing Respiratory Illnesses

Artwork by Brea Souders for TIME; Getty Images (8); Shutterstock (18)

Parts of the world facing conflict and humanitarian disaster tend to experience a high burden of disease, but their disease monitoring systems remain largely understudied. A study, led by the University of California, Irvine, found that the burden of respiratory infections, namely influenza-like illness (ILI) and severe acute respiratory illness (SARI), increased throughout northern Syria from 2016-2021, and was significantly exacerbated by the emergence of SARS-CoV-2.

Findings were published online in the International Journal of Infectious Diseases.

“In settings with limited resources, early warning systems for infectious disease outbreaks are critical for early detection and response,” explained corresponding author Maia Tarnas, a doctoral student at the UCI Program in Public Health. “This is especially true in regions like Syria, where millions have been forcibly displaced and left susceptible to disease by the weaponization of health, a variety of environmental hazards like extreme temperatures, overcrowding, and lack of resources needed for basic health and hygiene. We face an ever-increasing need for improved disease surveillance systems in these types of settings where infectious disease spreads easily.”

Tarnas and team conducted a retrospective analysis to identify trends in ILI, SARI, and COVID-19 cases in northern Syria as reported by the Early Warning, Alert and Response Network (EWARN), a syndromic surveillance system established in 2014 to serve areas outside of Syrian government control. The research team, which included faculty mentor and assistant professor of population health and disease prevention Daniel M. Parker, PhD, also used data on confirmed COVID-19 cases to assess the impact of the virus on ILI and SARI trends.

“We found increases in both ILI and SARI trends over the time period studied, and these findings support research done in other conflict-ridden settings where respiratory infections cause excess morbidity and mortality,” Parker said. “In 2020 there was a spike in SARI cases in adults,which likely corresponds to the onset of the COVID-19 outbreak in this region. We also saw a delay in the 2019-2020 seasonal peaks of ILI and SARI, which is likely attributed to a major northwestern offensive in the Idlib governorate..”

The study fills critical gaps in the existing literature on disease surveillance in war-torn settings and highlights the need for infectious disease monitoring in vulnerable regions of the world where public health infrastructure is limited or non-existent.

“We wanted to convey the magnitude of this issue through our study,” Tarnas said. “There’s a lot to be learned about the burden of disease in parts of the world affected by conflict, and this foundational knowledge is key in scaling up effective public health interventions that better monitor the spread of disease. In our paper, we show the value of having a surveillance system where symptoms and age are collected, and we illustrate the utility of these types of data in monitoring disease trends and detecting an outbreak of a novel disease.”

Tarnas continued: “Disease is an integral part of conflict, and given what we’ve learned about the importance of monitoring COVID-19 trends over the past three years – both nationally and internationally – this is an area to which greater public health attention should be focused.”

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