In a 2017 New Yorker profile, Ophelia Dahl, one of the founders of the nonprofit Partners in Health, described the 2014 Ebola outbreak in West Africa as “acute on chronic.” What she meant was that the immediate harms of the outbreak came on top of the ongoing structural issues faced by West African populations, such as poverty and poorly resourced health systems. The term acute on chronic is used in medicine to describe situations when someone with a chronic condition, such as chronic obstructive pulmonary disease, also develops an acute condition, such as pneumonia. As expected in such a situation, the chronic underlying condition impacts the course and outcome of the acute condition.
I found acute on chronic to be a useful way to think about my work at the time, but it’s been an idea I’ve dwelled on more and more since the COVID-19 pandemic upended our world. It’s an illuminating way to think about what COVID-19 has done to our societies, and why it has affected different populations in such different ways.