We Treat Comorbidity but Ignore Stress: A Biological Gap in Pandemic Preparedness

Article type: Opinion / Perspective This opinion article argues that, although pandemic preparedness plans appropriately prioritise individuals with comorbidities for medical intervention, they largely overlook the ongoing stress experienced by high-risk populations. This oversight represents a significant biological issue. Chronic stress alters immune system regulation via neuroendocrine–immune pathways, leading to impaired control of inflammation and diminished antimicrobial responses. Drawing on examples from COVID-19 and high-risk groups, the article contends that structured support to reduce stress, including both clinical and community-based counselling, should be regarded as essential resilience infrastructure rather than optional assistance. The objective is not to replace medical care but to address a critical preparedness gap. This manuscript is a preprint and has not yet undergone peer review.