Face Off: The Socio-Political Background of the COVID-19 Syndemic in USA

Introduction

Methods

Results

A. BIOLOGICAL PARAMETERS OF LIFE IN USA

1. 

General Life expectancy

Convincing experience tells that all individual life-length is biologically determined and it varies from species to species. The maximal possible life expectancy for humans is – say - 120 years [8]. However the actual average life expectancy depends on the people themselves i.e. the socio-political milieu of the time and place of living. The most used parameters of life expectancy are:

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Initial Life Expectancy (ILE) [9]: It is the expected number of years alive at the moment of birth;

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Residual Life Expectancy (RLE) [10] : It is the expected number of years alive at a certain age;

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Accomplished Life Expectancy (ALE): It is the final number of years alive at the moment of deaths. This parameter describes how well a person succeeded to live until the statistically expected (average) lifetime.

2. 

Age Normalized Death Rates, MR(i)

• The successive increase of the expectable years of individual lives - and the associated decrease of the MRs – was continuous, almost a century, without major variation (Figure 1).

Figure 1. Historical Life & Death in USA – 1033-2018.

Figure 1. Historical Life & Death in USA – 1033-2018.

However the contribution of different age-groups is very different. The Deaths Rates are close to zero for persons between ages ~ 4 to 50 but exponentially increases after 50 until the factual deaths. Medical and social healthcare improvements postpone, but never prevent the occurrence of natural deaths (Figure 2).

These continuous decrease of death rates has little effect on the age-related size of the population before age ~ 65 and over ~ 80 years. However the number and life-time of persons in the ‘transition age’ [65-80] are markedly increasing (Figure 3).

B. SOCIO- ECONOMIC PARAMETERS OF ‘LONGEVITY’

Longer life and the associated benefits are not free. Being alive is certainly very desirable (genetically programmed) condition, consequently the ‘maintenance fee’ can be very high. An objective approach to the life and death equation is possible only if a) the Life has some (any) measurable value for the involved persons and communities; b) the person and communities have the necessary resources -equivalent to this calculated value – to maintain and increase the number of years alive.

Medical and healthcare resources are only a small, but significant part of many options that people and societies possess to pay the price of longevity.

1. 

The ‘value’ of life.

Every individual life has an arbitrary monetary value. This is well known for some professionals, like military and insurance experts and they are coldly calculating and using this value. Private persons however are not supposed to know about it, even less, to speak about it. It is taboo.

The general, public consensus teaches, that the value of life is unmeasurable [11]. However there still may be a way to set a well measurable statistical value for lives in a group for statistical purposes (but never for valuing an individual person’s life). This is strictly limited for the calculation and comparison on the life-to-life bases.

It is supposed that when comparing two completely anonymous persons (we don’t know anything about them except their chronological age) the younger is reasonably more valuable - in this statistical, ‘live-to-live’ comparison test – than the older. The reasoning is very simple: the younger has more years to live (higher RLE value) than the older and consequently in case of death the loss of younger is higher than the loss of the older one. This mathematical/statistical reasoning may work, but only as long as you really don’t know anything individual about the compared persons, except their age.

2. 

The ‘price’ of increasing RLE (longevity).

Life is a free gift from the Nature (God?). It has no value for the Nature. Any values associated with Life are strictly human creations. A person’s life has value – first of all – for the person itself, followed by value for his/her family, friends, followed by the great society around him. Human lives are measured by other human lives. These values can be positive or negative, or both.

Apart from the never ending philosophical and religious speculations, the human lives - here and now – have strong positive value. The explanation is simple: more people prefer living than not. Consequently the count of all humans (defined as carriers of 44+2 chromosomes) is steadily increasing. The positive attitude to Life is expressed by two fundamentally different ways: reproduction and longevity.

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Survival and prosperity through reproduction: this is the original, collectivistic way of staying alive by propagating your individual chromosomes. This method is often the only one available.

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Survival and prosperity through longevity: this might be called the egoistic way, because it is based on concentrating the life experience in fewer number of individuals instead of dispersing it to many descendants.

The industrially more developed countries (higher BNP) are on the ‘longevity’ way: they restrain their aggression to others and invest into healthcare. The ‘longevity’ investments seems to be logical, when the religious believe in the ‘life-after-this-life’ became unrealistic for more and more persons. The “believe in God” philosophy is successively replaced by the “believe in yourself” or - even worse - “believe in your doctor” mentality.

There are three different approaches to try setting a measurable and comparable value on the human life. *First: the value of life for the individual himself can be based on the statistical calculation of alive/dead ratio for all individuals (or the RLE) in the same age. It directly gives an objective comparison with other individuals in the same and different age-groups. *Second: the value of life for the collective depends on the accumulated number of available years alive for all individuals in the same age-group, i.e. it is RLE multiplied by the size (#) of the group (Figure 4). This two calculations give very similar results, as expected, except minor differences depending on the variation in the size of the age-groups.

*Third: the value of life can be estimated even based on the Annual Per Capita Healthcare Costs [12] by age. Historical records indicate the correlation between increasing Life Expectancy and the healthcare costs, in every developed industrial country (Figure 5A).

Figure 5A. Development & Costs of ‘Longevity’ in Leading Countries. Bars indicate healthcare costs ($/year/capita). Lines indicate Life Expectancy at Birth (ILE, Y: years). AUS: Australia, CAN: Canada, GBR: Great Britain, JPN: Japan, USA: United States of America. The values in USA are emphasized by red color and thick line.

Figure 5A. Development & Costs of ‘Longevity’ in Leading Countries. Bars indicate healthcare costs ($/year/capita). Lines indicate Life Expectancy at Birth (ILE, Y: years). AUS: Australia, CAN: Canada, GBR: Great Britain, JPN: Japan, USA: United States of America. The values in USA are emphasized by red color and thick line.

The rapid increase of healthcare costs, in the proximity of death, is not surprising. However the increase of per capita costs for senior-care in USA is very large compared to other equally well developed western countries (Figure 5B).

Figure 5B. Annual per Capita Healthcare Costs by Age. The lines indicate the age-dependency of healthcare costs ($, value in 2015) and comparison in some well developed countries in 2012 [13].

Figure 5B. Annual per Capita Healthcare Costs by Age. The lines indicate the age-dependency of healthcare costs ($, value in 2015) and comparison in some well developed countries in 2012 [13].

3. 

Calculation of the cost/benefit ratio of a rational health care.

A neutral approach to estimate the benefit of healthcare is the calculation of its costs [14] in relation to changes of RLE. However it is necessary to keep in mind that any change of RLE depends on a large number of factor and not only on medical (and related) efforts (Figure 6).

Figure 6. AGE v. HEALTHCARE COSTS IN USA. The Residual Life Expectancy (green line) and the Annual Healthcare Costs (red line) were expressed as % of the maximal available for different age categories of the population. The ratio of these two values (C/V) is indicated (Blue shaded area).

Figure 6. AGE v. HEALTHCARE COSTS IN USA. The Residual Life Expectancy (green line) and the Annual Healthcare Costs (red line) were expressed as % of the maximal available for different age categories of the population. The ratio of these two values (C/V) is indicated (Blue shaded area).

C. THE INTERFERENCE OF COVID PANDEMIC WITH THE NORMAL LIFE OF AMERICANS

1. 

Excess Mortality [XM] during the Coronavirus pandemic (COVID-19) [15]

COVID added a new category of deaths to the traditional ‘all-cases-mortality’. It is called ‘Excess-Covid-Mortality (XCM) because it occurred simultaneously with the appearance of the virus infections and the pandemic-associated life changing conditions.

Excess Deaths of all causes including Covid Deaths [XD] = Total counts of Reported Deaths of all causes under pandemic [TRD] – Total Projected (or expected) Deaths of all causes without Covid pandemic [TPD]. The XD is often expressed as P-score (%)

XD=TRD – TPD

P-score = (TRD – TPD) / TPD

Excess mortality is a more comprehensive measure of the total impact of the pandemic on deaths than the confirmed COVID-19 death count alone. It captures not only the confirmed deaths, but also COVID-19 deaths that were not correctly diagnosed and reported as well as deaths from other causes that are attributable to the overall crisis conditions.

• Globally, the total number of excess deaths is estimated to be two to four times higher than the reported number of confirmed deaths due to COVID-19 (incl. both deaths confirmed by specific laboratory (viral) test or not [16]). The WHO confirmed [17] that the total number of excess deaths is substantially higher than the number of confirmed deaths due to COVID-19. Consequently the XM is the sum of two distinct categories

a. 

Total Covid Deaths (TCD) category contains cases there close connection to virus had been established, reported and became part of the COVID statistic:

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there the Covid virus was the Underlying Couse of Death (UCOD) and it was confirmed by specific laboratory viral test (true Covid Deaths – [CD+]) and

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there the Covid was suspected as contributor to the deaths but it hadn’t been confirmed by viral test (‘hearsay’ Covid Deaths – [CD?]) [5].

b. 

Complementary Covid Deaths (CCD) category contains all kinds of excess deaths which occurred under the pandemic but association to Covid virus itself was not possible to establish and it hadn’t been part of the official Covid statistic. It is speculated that CCM is the result of life changing conditions associated with the extensive COVID regulations rather than the virus itself [18].

2. 

Effect on the Size of the Population in USA

The numerically large excess mortality caused by the COVID pandemic had very little visible effect on the population of a very large country, like USA (Figure 6). (Compare to Figure 3).

Figure 6. Pre- and Post-COVID Population by Age and Years. The population count of USA, by age, before- (2015-2019) and under (2020-2023) the pandemic were compared.

Figure 6. Pre- and Post-COVID Population by Age and Years. The population count of USA, by age, before- (2015-2019) and under (2020-2023) the pandemic were compared.

The estimated count of the total population grow with ~ 8 M persons during the pandemic, compared to the 5 years average directly before the COVID events. (Table 1)

3. 

Effect on the Detailed Mortality Parameters

However a very detailed analyses and comparison of all possible age groups (0-100 years old persons) with each other revels some restructuring of the population pattern (Figure 7 and Table 2). The negative change of MR in age groups (0-14) pinpoints the possible “beneficiaries” of the pandemic.

The calculated weekly Excess COVID Mortality (XCM) was up to 60 % over the historically expected ‘usual’ counts of deaths, corresponding to the well-known COVID mortality peeks. Less kids (age 0-14 years) died during the pandemic than expected suggesting that at least one group of people might have benefited from the exceptional rules under 2020-2023. The average XCM didn’t return to the original zero value at the end of this period of records (Figure 8).

An even deeper look at the nature and origin of the extra deaths under COVID pandemic is possible when dividing it into its natural subgroups as described above. It is especially valuable to have a closer look at the ratio of deaths which were possible to connect to the COVID virus (TCD) and those which were not possible to connect to the virus at all (CCD). (Table 3 and Figure 9A,B).

The average P-Score of the population (all ages) was around 20-25% during the first two years of the pandemic, but it dropped to the 5-10% level 2022-2023 and remained above zero after. Both components of the extra deaths (XCD) showed the similar pattern of changes.

However the virus related (TCD) and unrelated (CCD) components were changing differently. This difference depends on the definition of the COVID mortality.

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Relying on the official definition - that pools the ‘true’ [CD+] cases with the un-supported ‘hearsay’-based causes [CD?] - the CCD/XCD ratio is starting ~35% but increasing to ~ 60% by time. (Upper part of Table 3 and Figure 9A)

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Using the evidence-based definition, that requests that the diagnosis is substantiated by specific laboratory viral test, the count of true-COVID deaths [CD+] is lower than reported and the corresponding CCD is higher: the CCD/XCD ratio is starting at ~ 50% with a slight increase by the years (~60%). (Lower part of Table III and Figure 9B).

These differences have no practical consequences today, the XCD counts remain the same, and ‘death is death’. However it might have significance when objectively evaluating the true magnitude of the COVID danger and compare it to the value of the human reaction.

Figure 9A. Origin & Components of Excess Covid Associated Mortality – Using CDC method. The bars (left axis) represent the reported (R) and projected (P) counts of the population, the calculated excess COVID associated mortality (XCM); the total reported count of pooled (true) and “hearsay” COVID deaths (TCD[+&?]) and the calculated number of Collateral Covid Deaths (CCD) in the indicated years of pandemic. The lines (right axis) are indicating the corresponding P-Scores (P-) and the proportion of CCDs of the XCDs .

Figure 9A. Origin & Components of Excess Covid Associated Mortality – Using CDC method. The bars (left axis) represent the reported (R) and projected (P) counts of the population, the calculated excess COVID associated mortality (XCM); the total reported count of pooled (true) and “hearsay” COVID deaths (TCD[+&?]) and the calculated number of Collateral Covid Deaths (CCD) in the indicated years of pandemic. The lines (right axis) are indicating the corresponding P-Scores (P-) and the proportion of CCDs of the XCDs .

Figure 9B. Origin & Components of Excess Covid Associated Mortality – Using the Evidence Based Method. This chart is identical to the FIGURE 9A, except that only true, test confirmed COVID deaths were included into the count of TCD [C+] and the “hearsay-based” causes (not supported by positive viral test, [C?]) were added to the CCD instead.

Figure 9B. Origin & Components of Excess Covid Associated Mortality – Using the Evidence Based Method. This chart is identical to the FIGURE 9A, except that only true, test confirmed COVID deaths were included into the count of TCD [C+] and the “hearsay-based” causes (not supported by positive viral test, [C?]) were added to the CCD instead.

4. 

Effects on the Economy of the USA (short- and long-term)

It is generally believed, that the COVID pandemic is solely responsible for (or at least major contributor to) the significantly increased expenses for the taxpayers, racketing healthcare costs, galloping inflation, uncontrolled increase of national debt (incl. generous printing of new money). However even if these statements are not entirely false, they are not entirely true either. More likely the virus served as a catalyst that amplified some of the already existing negative trends (weaknesses) of the recent political / social / economical structure of the USA. (Table IV).

Correct interpretation of economic meta-data is almost a “mission impossible” for a non-expert average American meanwhile the official interpretation is sometimes unreliable. Consequently subjective and extreme interpretations exist. Keeping in mind this difficulties we estimate the real costs of pandemic to be around 5 T$ total (corresponding to the extra budget deficit) and having two components: a) ‘virus-induced’ extra healthcare costs, 2.7 T$ and b) ‘men-made’ extra costs, 2.3 T$.

Table 4. Caption.

Table 4. Caption.

5. 

Effects on the ‘Perception’ of the Constitutional Structure and Laws of the USA

The American’s Constitutional rights having been violated, by the numerous restrains under the pandemic. However it was widely accepted as necessary under emergency conditions i.e. when the life and wellbeing of larger number of persons was seriously threatened by any natural or manmade condition(s). But a dilemma is existing – still not satisfactorily resolved – whether the emergency situation occurred as the result of a) the random and mindless accidental events in the Nature (like mutation) or b) the conscious but malicious intelligence of other arrogant and greedy Humans? What caused the emergency conditions: the virus (?), the sensation driven media (?) or both?

The answer might be found in the unusual nature of the COVID infection and the weaknesses deeply rooted in the human psychology.

• COVID is a syndemic [19].

It is a synergistic epidemics, where the occurrence and interaction of multiple diseases or health conditions exacerbate their individual impact, leading to complex health challenges and increased vulnerability in populations. It is well recognized that age and preexisting comorbidities acting synergistically when COVID becomes the UCOD. There is no one documented case of death caused by COVID of a previously healthy, young individual.

b.

Heterodoxy of COVID-19 [20].

COVID affects different people very differently: infected persons experience the disease very differently and this leads to serious disagreements regarding the dangerousness of the pandemic and what do we need to do to protect us. As the result we could see serious disagreements – up to the degree of animosity - develop between persons or groups of the society, involving even the most respected scientists (experts).

Stanford Professor J. P. A. Ioannidis broth to the scientific attention - already in 2020 [21] -

the importance of to differentiate promptly the true epidemic from an epidemic of false claims and potentially harmful actions. He particularly mentioned * fake news and censorship of critical scientific papers, * exaggerated pandemic estimates, * exaggerated Case Fatality Rate (CFR), * exaggerated exponential community spread, * extreme (aggressive) ‘protective’ measures, * harm from nonevidence-based judgements. Ioannidis issued warning for the potentially unwanted consequences of these false and inadequate claims, like * misallocation of resources, * economic and social disruption, * claims for ‘ones-in-a-century pandemic.

c.

COVID induced ‘nocebo’ effects [22].

In addition to well-known placebo effects, so-called “nocebo” effects also exist. Due to the placebo effect, a person recovers from an illness because they expect to recover. When a person suffers from a nocebo effect, on the contrary, they get ill just because they expect to become ill. When people expected to be infected with the “deadly China virus” every sneeze became the alarming sign of COVID infection even for otherwise cautious doctors. Not surprisingly COVID became the first and best choice when somebody died and the physicians were expected to state the UCOD on the death certificate. These nocebo generated “hearsay” COVID deaths occurred mostly in cases when the objective laboratory confirmation (specific COVID viral test) was missing of some reason.

d.

COVID is politically polarizing [23,24,25].

The pandemic reignited the century old inherent political antagonism that was comfortably dormant in USA after the Cold War. Tons of publications blames the social conditions for the occurrence and deadliness of the pandemic. This is very unusual and surprising, because major catastrophes used to unite a nation: people first has to survive together, they can fight with each other later. (Just remember the effect of “September 11” on the American people).

Discussion

Conclusions & Summary

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the value of “longevity” is increasing and it is already high in the USA;

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The costs of longevity is extremely high in USA compared to well-developed west-European countries;

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The COVID pandemic threatened the largest and most profitable market of the American health-care industry by accelerating the natural death process of elderly and seriously sick persons;

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The state enforced defense policy was life-saving for the medical-pharmaceutical industry;

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The benefit-cost ration of the pandemic rules is not uplifting, especially not when, it seems to be, that as much persons died due to the dramatic changes in life style (lockdown, isolation, et cet.) than as the result of the direct COVID disease.

Abbreviations

References

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9. The author’s terminology.
10. The author’s terminology.
11. Like the market value of Leonardo da Vinci-s Mona Lisa, hanged in the Louvre Museum forever. Living long or forever is one of the wildest phantasies of the Homo sapiens. Just to mention some variations in the subject: “aqua vitae”, “fountain of youth”, “philosopher’s stone”, “and elixir of life”. The religious concept of “afterlife” is probably one of the most powerful ideas of living-for-ever.
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18. Publications often not distinguish CCM from TCM as a separate category of XCM and ignoring the ‘man-made’ (human) contributions to the consequences of the pandemic.
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26. AMA Code of Medical Ethics - https://code-medical-ethics.ama-assn.org/.