COVID-19 has forced a reckoning about how we live, and in particular how exposure to disease risks are unevenly distributed . This contribution explores connections between the COVID-19pandemic, chronic disease and conditions of chronic crisis among the urban poor . We suggest two issues in urgent need of attention in the long and short term are : 1) the underestimatedburdens of chronic disease among the urban poor, and 2) the chronic states of crises which contribute to these chronic conditions and their under-recognition . We contend that the burden of ‘ pre-existing ’ conditions in informal settlements is under-diagnosed and poorly managed in communities . In order to address these burdens, for COVID-19 and beyond, we must recognise they are a product of the protracted crisis which is everyday life for many of the urban poor, for whom illness is one of the many everyday struggles and consistent quality care is out of reach . For many people living on the margins, crisis is the norm, yet both this and its impacts on health are underestimated; for change to be realised, this must be the starting point.