Should the convergence between the social and biological vulnerabilities of black communities and the COVID-19 pandemic be considered?

The context of the COVID-19 pandemic has highlighted the structural inequalities and vulnerabilities experienced by black communities in the world, and in Brazil it is no different. The data generated in Brazil demonstrate that Brazilian inequality is alarming. Underreporting, non-prioritization of data that consider the variable race and color, and social groups in social vulnerability, help the unequal instrumentalization of epidemiological surveillance; many deaths from the black population are not being accounted for. Structural racism and the invisibility of the black population have been intensified with the pandemic. There is emerging evidence that COVID-19 may disproportionately affect black people, who in addition to the vulnerability resulting from socio-spatial conditions, appear to be more susceptible to contamination with a more serious and lethal outcome. Finally, biological differences, such as impaired functioning of the immune response, can be increased by structural racism. In this sense, we reinforce that possible relationships between social and biological vulnerabilities of black communities and the SARS-CoV-2 infection pandemic need to be considered and investigated.

Should an intersection between visceral leishmaniasis endemicity and the COVID-19 pandemic be considered?

The COVID-19 pandemic caused by the infection with the novel Coronavirus SARS-CoV-2, revealed individual and global vulnerabilities, in which we highlight the social, economic, and political aspects and the health systems' organization in the countries. Brazil remains with a high transmission rate and presents a centripetal distribution as observed through a more sustained growth in the number of municipalities affected, outlining a profile of invasion of poor communities. Several vulnerabilities overlap with precarious housing conditions, lack of basic sanitation, malnutrition, and endemicity for neglected chronic diseases such as visceral leishmaniasis (VL). COVID-19 and VL evidently do not share clinical features, but exactly because of the distinct immunopathogenesis between the diseases, patients with VL may present a vulnerability in the immune system against antiviral responses. Considering that VL susceptibility seems to be related to an inefficient and polarized immune response, it is likely that in endemic areas, the overlap of social weaknesses added to individual vulnerability by immune polarization may aggravate the COVID-19 condition. In this sense, we reinforce that possible relationships between endemic neglected diseases such as VL and pandemic SARS-CoV-2 infection need to be further considered and investigated.