CD is primarily transmitted through vectors, specifically triatomines or kissing bugs. However, infected blood transfusions or organ donations, contamination of food and drink as well as vertical transmission can persist. Infection is characterized by three phases: 
- incubation period lasting between 15-40 days
- acute phase of disease 
- indeterminate phase of disease characterized by no observable symptoms
- chronic phase of disease characterized by extensive organ damage to the cardiovascular and gastrointestinal systems. Chronic CD may lead to sudden death caused by stroke, brady-or-tachy arrhythmias and congestive heart failure. 


Pathogenesis & Clinical Manifestation of Chagas Disease

SARS-CoV-2 binds to the human angiotensin-converting enzyme 2 (ACE2) receptor that is expressed in the lungs, heart and vascular endothelium. This association may trigger an inflammatory response that could lead to myocardial injury and dysfunction. The immunogenic effects of infection by SARS-CoV-2 may result in the progression of CD. The burden of Chagas Disease is dependent on parasitic load and host factors, such as genetic susceptibility strength of the immune system. Covid-19 may trigger reactivation of CD in the indeterminate phase due to disease-induced immunosuppression. The primary concern is that the immunological and physiological effects of Covid-19 may increase parasitic load by depressing the immune system, triggering reactivation of Chagas Disease. This potential reactivation may be caused by a cytokine storm, therapeutics used to treat Covid-19 or the virus itself. 

Pathogenesis of Covid-19 and its Relation to Chagas Disease

Available literature detailing the immunological implications of concurrent infections of SARS-CoV-2 and chronic CD is relatively scarce. There is a new commitment to disseminate information about Covid-19 to Latin American communities affected by Chagas Disease. 

Tulane University

The socioeconomic and biological effects of Covid-19 have been historical and the overall impact of the virus has yet to be determined. However, it is without question that certain demographic groups are more vulnerable than others, especially those with preexisting medical conditions. Chagas Disease (CD) is a disorder caused by a parasite, Trypanosoma Cruzi, which affects multiple body systems, including the cardiovascular, digestive and central nervous systems. In fact, chronic CD primarily affects Latin American countries which have been overwhelmed by the pandemic; generally, individuals afflicted with CD suffer from poor healthcare, increasing the likelihood that CD goes undiagnosed and progresses to the chronic stage of infection. Generally, chronic Chagas Disease is characterized by severe cardiac disease resulting in heart attacks. Individuals with chronic CD are more susceptible to severe SARS-CoV-2 infections and have largely been excluded from Covid-19 public health campaigns. 

The Implications for People With Chronic Chagas Disease During the Covid-19 Pandemic

Zaidel, E. J., Forsyth, C. J., Novick, G., Marcus, R., Ribeiro, A., Pinazo, M. J., Morillo, C. A., Echeverría, L. E., Shikanai-Yasuda, M. A., Buekens, P., Perel, P., Meymandi, S. K., Ralston, K., Pinto, F., & Sosa-Estani, S. (2020). COVID-19: Implications for People with Chagas Disease. Global heart, 15(1), 69. https://doi.org/10.5334/gh.891

Covid-19: Implications for People with Chagas Disease

Pathogenic Effects of Covid-19 Related to Chagas Disease 

Covid-19 has disproportionately affected countries that are at risk for endemic tropical diseases. Public health experts are concerned with the distribution of resources which has led to health disparities that have left patients with chronic diseases largely unprioritized. Chagas Disease (CD) is endemic to certain Latin American countries, which have large populations of patients with chronic CD. These patients are aging, at risk for chronic chagas cardiomyopathy, are burdened by severe comorbidities and are socioeconomically vulnerable. The extension of this pandemic within poorer, more disadvantaged regions has placed a considerable strain on the healthcare system and the available medical professionals. 

Epidemiological Considerations of the Global Pandemic

Within the United States, Covid-19 has predominantly impacted socioeconomically vulnerable populations and Black and Latino communities. These racial inequities are intrinsically rooted in the socioeconomic disparities that have persisted, indicating which groups have the ability to self-isolate and afford quality healthcare. 

Covid-19: The Social Context & Access to Healthcare

Strong consideration of the social context is required to understand the entirety of the burden of Chagas Disease (CD). CD affects indigenous people, the economically underserved and migrants, which all have difficulty accessing healthcare. People who were previously living at or near the poverty level have borne the brunt of the economic impact of the pandemic. The current, precarious economic situation has forced many people living with CD to decide between treatment or other essential needs. 

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