Why ignoring Life Expectancy Lost brings us to the Brink of an Abyss?
Because our emotions don’t meet the facts on the Coronavirus pandemic.
It is currently hard to estimate the world’s life expectancy lost from the Coronavirus pandemic, but it is low compared to our length of life.
A couple of minutes for those countries who contained it well, till some weeks for those who will or cannot suppress the virus, have an aged population, and cannot treat their patients.
Currently China stays at roughly 5 minutes, and the US at about 4 hours life expectancy lost due to the Coronavirus pandemic.
Therefore why is it then that we believe the end of the world is near, when actually the facts tell us otherwise? Because we don’t sit down and take our thinking process seriously. Because we are blown away by the media’s emotional storm like some autumn leaves in the wind.
This article is about correcting that fatal mistake that stalls the world. This article is about getting the facts right. This article is about a quantitative analysis, its conclusions, and a philosophical discourse. This article is not capable of competing with the boulevard press. This article is not something you can glance over in a few minutes, it rather is one step in a lifetime journey of seeing life and death as it really is. This article is about the long needed attempt to escape the wrong Coronavirus movie we are all sitting in.
It contains two parts and I chose some images for you to easier navigate the article:
- A quantitative analysis containing an introduction, the construction of five key parameters used, the subsequent three life expectancy calculations (starting at the rose image), and a conclusion
- A philosophical discourse (starting at the volcano image) where we look at issues like figures without a reference point, the other side of the balance, and our difficulties of coping with death. Finally (starting at the Athens image) we will round it up.
Obviously you also could jump over chapters to omit some. This article does not require you to read all chapters, they all can stand on their own. I do not want to discourage you from this, but please keep in mind that if you do not sincerely believe the results of the calculations, there is no other way around than to dig into them. And please keep also in mind that to start the philosophical discourse obviously the numbers, the dimension of the results of the life expectancy calculation have to be sunk into your mind first.
Introduction
A single tragic death brought to our living rooms via the media can arouse in us emotions that are completely out of any relation to the underlying base rates. It is essential that we do this analysis slowly, thoroughly, and not emotionally. If we step back, think intentionally, with great effort, and with the real numbers, we can reduce the fast taken, but wrong conclusions in our head and gain decisive insights. This is what we want to do here, a quantitative analysis that is based on facts, on statistics, on mathematics, on logic and not on emotions. (Source: “Thinking Fast and Slow” written by Daniel Kahnemann, ISBN-13: 978–0141033570)
I do not want to take my juggling with the numbers too serious either, as it will be wrong if we expect an exact outcome. But to get an idea, a dimension, an association, the examples of how to calculate, of how to find a model to assess the seriousness of this crisis can be very useful.
Yes, our society calls it unethical to calculate a statistic on a population as individuals are dying. And the killer-argument always follows: It could be me or one of my loved ones. Yes, our society also calls it unethical to put a counterweight to life expectancy lost. We are used to value lives at the highest price possible, but there is a downside to calling it unethical, we could lose the perspective on the seriousness of a healthcare crisis that stops the world.
In the following you will find three calculations of life expectancy lost, but let’s first dig into the five key parameters used. I built the construction of the five key parameters in a manner so that you yourself can follow every single step taken, and you yourself can verify all sources that were used. I built the calculations transparently for you to comprehend and retrace all of them. If something does not seem plausible to you, please adapt or correct it as needed.
Five key parameters
The first key parameter is “actual Coronavirus related deaths”. For this parameter we take the official numbers and ignore an eventual underreporting, meaning that corona-deaths exist without entering the official statistics, meaning the dead were not tested and therefore unknown to be corona related. Additionally we ignore that all people that died “with” the Coronavirus maybe did not die “because” of the Coronavirus. We will consider that later on in the third key parameter.
The second key parameter is “examples for Coronavirus related deaths”. Here again we ignore that all people who died “with” the Coronavirus maybe did not die “because” of the Coronavirus. We will also consider that later on in the third key parameter.
This parameter contains some estimations of how an uncontained case scenario could look like. Obviously I did some math on it, I made my own estimation, but as the mathematical problem depends on exponential functions, on the age distribution within a population, on medical preconditions, and even more factors we have to be cautious about the assumptions behind. The capability of the healthcare system, whether most can get intensive care, or nearly none due to an overload in the hospitals will be considered in the fifth key parameter.
I do not urge you to commit to that logic, but you can get a hint on what I am aiming at. As for the actual death rate even WHO admits to have only a vague clue about, I assume in the examples a 0,6% death-rate on the whole population, or 2.000.000 deaths for the US and 50.000.000 deaths worldwide. My stance is that I take the official, known percentages of Coronavirus deaths for those countries that pretty much have recovered, and discount them for the whole of the corona infections, known and unknown, and reduce a herd-immunity factor. China, South Korea and the “Diamond Princess” seem to be giving us a usable hint (Source: worldometers).
China has as of 04/20/2020 4.642 deaths on a total of 84.149 confirmed cases which leads to around 5,5% death rate of known cases (Source: who). Around 86% of all cases were not discovered, which suggests an actual death rate of less than one percent (Source: wikipedia). Another factor to consider is that usually not the whole of a population gets infected and the so-called herd-immunity is protecting some part of the population from getting the virus. This would be another factor to reduce the percentage. Therefore it is reasonable to assume less than one percent for the death-rate for the whole population.
South Korea has as of 04/20/2020 230 deaths on a total of 10.635 confirmed cases which leads to around 2% death rate of known cases (Source: who). Now if we multiply it with an estimated 70% of the population which would need to get sick to assure herd-immunity, we arrive at 1,4%. (Source: independent.co.uk wikipedia) After that we can reduce it by half to assume the reduction of the case fatality rate to the infection fatality rate, and we arrive at a roughly estimated 0,7% death rate on the population as a whole. The reduction to half is now without any basis except the fact that not all cases possibly could have been discovered.
Another example is the “Diamond Princess”, where out of 3700 passengers 12 or 0,3% died (Source: wikipedia).
The University of Oxford’s Centre for Evidence-Based Medicine estimates that the infection fatality rate for the pandemic as a whole is between 0.1 per cent and 0.39 per cent. (Source: cebm from wikipedia) Here we also would need to apply a herd-immunity factor to come to a death rate on the population as a whole.
You already can see that we are not getting the numbers right, my calculations are pretty vague, and even the estimations from top institutes have quite a spread. So let’s go with 0,6% and wait till more reliable estimations are available. You are free to change the numbers, if you know any better, and do your own math.
The third key parameter is “how many with Coronavirus actually died on Coronavirus”. The big argument I believe to be is that we actually do not know whether a death case should be attributed to the Coronavirus or to the pre-existing medical conditions also called comorbidities. Did someone die of the virus or of a cardiovascular disease just to name an example? Obviously both factors have to meet to make a death more likely, but what cause is really the guilty one, what cause is to blame? The one that came first, or the one that arrived later in plus. And it even would be necessary to decide on a comorbidity rate, like for example a 50–50, or 70–30, or 90–10. Both drivers could partially be guilty, and as the statistics show, in most cases only a combination of causes leads to death. Are the people dying “on” the virus, or “with” the virus? The following table shows the chance of dying with the Coronavirus with some pre-existing conditions:
An investigation on death cases with positive COVID-19-diagnosis in Italy (as of 17th of March 2020) resulted, that only 0,8% of those people did not have any pre-existing medical conditions, while 25.1% had one, and 25,6% two. Three or more were reported in 48,5% of all cases.(Source: Report-in-Italia from wikipedia)
The room for interpretation is huge. We could interpret nearly all deaths having had the Coronavirus in the body, as Coronavirus deaths, or, according to the above table, only 2,5% (coming from the 0,9% when scaled to 100%), or one out of forty, as nearly all had quite serious pre-existing conditions. It seems fair to treat only those cases, where the Coronavirus also would have led to death, no matter the pre-existing conditions, as Coronavirus deaths. But what the number now is we do not know as we do not have a statistic on that.
It will be higher than a low percentage, but certainly less than 100%. Here we have very high uncertainties, but let’s simply go with 50%, like in a compromise where we do not actually know who is right. Additionally I do not want to use theoretic medical definitions. I prefer to have a philosophical definition. Someone who is old and has an illness cannot blame the small hill he had to climb, the month of the year, or the early morning hour to have died.
The fourth key parameter is “remaining life expectancy”. COVID-19 mostly affects the elderly with pre-existing medical conditions. The following table shows the chance of dying with the Coronavirus within some age groups:
As of 9th of April 2020 where after WHO 95% of all in Europe reported deaths were older than 60 years. More than 50 % of those were more than 80 years old (Source: WHO from wikipedia).
If we now assume the average death age after that statistic to be 80 years, this is what the data approximately suggests, the remaining life span would be around nine years for the US (Source: ssa.gov) and also for the UK (Source: ons.gov.uk). If we reduce those nine years for a guessed third for pre-existing medical conditions, we arrive at six years. You can change it to any number you think of to be more appropriate as I currently do not have a more trustworthy statistic available.
The fifth key parameter is “intensive care”, how well hospitals can handle the arriving cases, how many intensive care beds are available and can be operated. This is a factor which seems to be completely missing and unknown. An estimation can be done when looking at Italy, where intensive capacities were exceeded. But how valid are conclusions thereof? Should we compare those mortality rates to those of China? If we let the virus spread freely, how many of the hospitals are overwhelmed? And what is the effect thereof? If we just take low cost social distancing measures, what will be the effect on the total numbers, on the hospitals? A very difficult issue we only will consider after the calculations were done.
Not that I did not read some estimates about it, and even could cite the references, but I believe that they themselves have no real clue about it, and we also openly should admit that neither have we unless we get to see some trustworthy statistics, in minimum something we can build an estimate on.
Three life expectancy calculations
The (1.), (2.), (3.), etc. denote the used key parameters. The calculations are depicting a one time only effect, and not something that regularly would be repeated.
(Source: Population: wikipedia-China, wikipedia-/United_States wikipedia-World_population Corona virus related deaths: covid19.who.int)
The first life expectancy calculation is about China and the US: This is as of 04/28/2020 and with the real numbers that actually occurred. It calculates the life expectancy lost for China and the US due to the Coronavirus.
In the following you can find a table with more selected countries and the world average at the bottom. Please note that the above figures are from WHO and the below from worldometers which differ substantially (Source: worldometers.info from 04/23/2020).
The second life expectancy calculation is about the US and the world example. The calculations are based on a no-containment example where the fifth key parameter “intensive care” still would need to be applied.
The third life expectancy calculation is about a typical seasonal flu, a reality check, and a serious previous pandemic, the Spanish flu.
The typical seasonal flu can be found in the following. For the parameters I used the upper estimates for the typical death rate (Source: wikipedia), and for the comorbidity factor and the remaining life expectancy I used the exact same factors as for the Coronavirus pandemic, as it seems that those viruses affect mostly the elderly population in a similar manner.
And now let’s do a reality check. When I googled “Coronavirus life expectancy lost” I did not find many results. But one I picked out where a so-called expert said that he expects the average life expectancy to fall by “one or two years” (Source: nltimes.nl) This is what now happens, experts assume, politicians assume, the media assumes, people assume — and the world panics. Let’s have a reality check. This calculation just serves as the absolute worst case bottom line.
If all the world’s people over 65 would die with the Coronavirus, 50% comorbidities taken into account, and with an estimated full life span remaining of roughly 12 years, then the life expectancy lost on the world population would be half a year. (Source: wikipedia) This number would differ from country to country due to the different age structures. For countries with a younger population, the factor would be lower, and for countries with an older population higher.
Another check whether we got the math right: If the whole world population would die on corona, and would have a remaining life expectancy of 12 years, obviously the life expectancy would go down by 12 years. If 50% comorbidities are taken into consideration, by 6 years. And if now only less than 10% would die, roughly half a year. Obviously this is a theoretical one time eradication of all older than 65 and its mathematical effects thereof. If constantly, over many years all older than 65 would die, life expectancy would go much more down.
The Spanish flu, also known as the 1918 flu pandemic, was an unusually deadly influenza pandemic. Lasting almost 36 months from January 1918 to December 1920, it infected 500 million people — about a third of the world’s population at the time. The death toll is estimated to have been anywhere from 17 million to 50 million, and possibly as high as 100 million, making it one of the deadliest pandemics in human history (Source: wikipedia).
As for the parameters we again have to make some crude assumptions. As child mortality was very high at the time, as the pandemic itself had a big influence on life expectancy itself, and as two world wars were raging, the usage of detailed sources seems to be futile. We have to base the analysis on estimations, on best guesses.
Therefore I assume the death age to have been around 30 (Source: wikipedia), where we can estimate a remaining life expectancy of around 40 years. Today the remaining life expectancy at 30 would be around 50 years and therefore it seems to be fair to discount that value (Source: ssa.gov). As the death age was quite young it is unlikely that many deaths were due to pre-existing medical conditions. Therefore I suggest setting the comorbidity factor to 90% meaning that 90% really died on the Spanish flu and not on other causes (Source: wikipedia).
Here again, we do get a number, a dimension we can continue to work with.
Conclusion
The typical seasonal flu costs us around one to two hours on average.
As it follows, China lost around 5 minutes and the US around 4 hours of life expectancy till today.
The no-containment examples for the US and the whole world show a life expectancy loss of roughly 7 days. These examples do not necessarily need to be the best or worst case examples. They could considerably be better or worse depending on the actual handling of the pandemic, and the actual outcome thereof, but those estimations still can give us a hint on the dimension we are talking about today, based on the knowledge we have today.
If we compare those 7 days loss of life expectancy to a worldwide life expectancy at birth of 73 years (Source: wikipedia), then we arrive at a loss of around 0,025%, or a hypothetical one dying at birth out of around 4000.
The fifth key parameter, the capability of the hospitals handling the number of patients at once was not taken into account. We could now increase the roughly one week to one month or more of life expectancy lost. But on the other hand could also decrease it because of social distancing and other measures taken down to a single day or even less, as it is very unlikely that simply nothing would be done.
In the most extreme example possible, just to mark the theoretical bottom line, where the whole of the world’s population aged over 65 would cease to exist, taking a 50% comorbidity into account, global life expectancy would shrink by half a year.
The in 1918 raging Spanish flu was around twice as severe and reduced life expectancy by around one full year.
We do not know where exactly we will land and lastly, here I would like to stop the mathematical analysis as it gets too blurred. The dimension remains, we still have a number in our head, but what it actually is, we should not get too overconfident with. Let us try to continue in a pure philosophical manner, in manners of thinking and arguing, in manners trying to make sense out of it.
It is not much of a difference, for a given issue, whether someone loses a day, a week or a month of life expectancy. Mentally we will handle it in a similar manner, as a dimension, as an emotion, as an association within our mind.
Disclaimer: The mathematical problem is exponential, which means that we need to think in a logarithmic way where for example if I quote “10”, I actually would mean “1”, “10”, or “100”, depending whether I over-, correctly-, or underestimated it. And all the numbers had to be interpreted or corrected by guessing, by some gut-feeling, and are based on WYSIATI “what you see is all there is”. There will be new statistics out soon, maybe there will be some vaccination out, the seasonal effect helps, or the virus could turn out to be a real killer virus.This analysis is a snapshot of today and is subject to change. It is very clear that even a WHO cannot state exact numbers at the moment, as even for them the possibility of erring is very high. Therefore I provide this analysis as “As-Is” without any responsibility for the content or for errors it might contain. I will not take any responsibility for any damages that might result from the interpretation of this analysis.
A philosophical discourse
The numbers of the life expectancy lost, actual and estimated, should now be mental associations, and it is not me, but you to decide what you do with them, and how to use them. It is not my brain, but your brain that now should be working. I cannot think in your brain, but you can think in mine. My intention was to provide you with a tool that can show you something to build your own evaluation on. Something that might help you to estimate for yourself the seriousness of the Coronavirus pandemic.
If I told you, that the radius of the sun is 109 times bigger than the radius of the earth, it inspires within you some thoughts, you get an idea which celestial object is bigger, you could imagine the one as a big gymnastic ball, the other one as a small pebble, and estimate how important earth would be within our solar system. We are comparing apples with pears, but nonetheless you would get an idea, you would get associations in your mind you can continue with.
Similarly it is with this life expectancy lost calculation because of COVID-19. It cannot be correct, the numbers are just estimates, we do not know the real infection rate, the real death rate, and we even do not know whether the deaths should be attributed to the virus, or to the medical preconditions of the patients. But nonetheless you get an idea, an idea how much worth it could be to prevent such a loss.
It all seems quite bad if we just see the figures without any reference point in front of our eyes (Source: Chapter “Anchors” from “Thinking Fast and Slow” by Daniel Kahnemann, ISBN-13: 978–0141033570). But when comparing the actual deaths to the whole population, the actually lost life years are not that high and the resulting loss of life expectancy seems to be very bearable for a society as a whole. There are of course individual lives, individual sufferings and tragedies associated we should not forget. But we also should not forget the individual losses of having to live such constrained and quarantined lives, maybe losing everything someone has, and maybe even to the limit where some people cannot support their lives anymore. Especially in developing countries many people rapidly could come close to the brink of an abyss.
Climbing Mount Everest has a death rate of 6.5% (Source: irishtimes.com). Means one out of fifteen will not make it may be losing fifty years. What is the life expectancy lost? Three years for all that (try to) climb the mountain for a few minutes on the top. Well the excitement seems to be more important than the loss. Not doing sufficient physical exercise, smoking, or being overweight takes years of life expectancy. That is why days, weeks or even months seem to be low if compared to our human lives and the things we handle day in, day out. Also we have to see how much time we waste while quarreling with our loved ones, how much time we waste on paying our mortgages, how much time we waste to hoard things we do not need. Do we really live life so fully that we cannot bear to lose an additional week? Let’s on the first hand not waste our lives, let’s on the first hand get the greater part of our short time span on this planet under control, and not be stingy about some additional minor losses.
The one side of the balance we have established with some life expectancy lost. But let’s have a look on the other side of the balance and what we could put on it.
First, we have to put things like world economic growth lost, personal income lost, social damage, unemployment, you name it. Also we have to think of other costs like worries, like lost adventures, missed family meetings, the nightmare people are going through and the like. It’s you who should now start having a pair of weighing scales in your head and to begin balancing them. Let’s neither oversimplify it nor make it unduly complicated. In minimum we should find the words, the issues that we would want to take into consideration. In maximum we would even want to put on those things numbers or even monetary values, like what the smashed economy will cost us.
The world’s social and economic life is coming to a halt. Entire nations impose on their people rigid and oppressive measures to reduce their social interactions. The freedom of the free choice of their whereabouts, the freedom of choosing with whom to interact, the freedom of living a human life as a social being is being curtailed in unprecedented manners. Basic human rights were undermined and discarded in a matter of weeks and days.
Whole nations, and even major parts of this planet are suspended in lockdown. It cannot be the interest of the young and healthy majority to see the elderly and with pre-existing illnesses burdened minority die in overfilled hospitals, not capable of applying state of the art medical procedures. But, it also cannot be the interest of the minority to put such a big demand, such big restrictions on the lives, on the freedom, on the human rights of the majority.
Second, what else we could do with our time and effort. If we invest in preventing COVID-19 deaths, alternatively, with the same effort, time and money, we also could invest into being more healthy, more sporty, to live longer because of exercising our bodies or providing our children healthier food. It is proven that people who exercise regularly will live longer. Would such an alternative campaign have even better effects on our life expectancy than to prevent COVID-19 deaths? Most likely it would, most likely it would by far.
The cure should not be more severe than the illness. A not unusual way to approach medical interventions or medications administered. We look at the package insert, what side effects a drug has, and if the side effects seem to be too severe, we usually won’t take it and hope the body itself will come out of the illness. Exactly in the same way we should put the life expectancy lost into relation with the other issues. Is it worth it? Should we still do it? Just take measures that are low cost? Just wash hands and keep distance, but let the economy run undisturbed? There is no right or wrong, it is just a decision, your and my decision on which side of the balance the weighing scale will go up, and on which side down.
The benefit of winning life expectancy would have to be put into relation to the cost of achieving those benefits, the cost of a worldwide social and economic lockdown with unforeseeable consequences. This is currently not being done. Fear and panic transmitted via mass media are suspending or even freezing our logical thinking processes. Fear and panic are influencing humanity in such a manner, that the measures taken might be worse than the pandemic itself.
Death is a natural process we have to come to terms with. We as individual humans, we as a society as a whole. If death, if the avoidance of death is becoming society’s number one purpose, if the avoidance of death is becoming society’s number one goal, life will not be worth living anymore. To extend life beyond our natural span is a good thing. Investing into medicine, into healthcare is a good thing, but only as long as the resulting suffering, as long as the resulting demand on the patient, on family, on friends, and on society as a whole is not outweighing the achieved benefits.
We, as a society, need to come to terms with death. We need to, in one way or another, put a price tag on life, and how much we are willing to pay for extending life. If the price tag is infinite, then we, just to save a few lives, just to extend lives for a few days, will even stop the world-economy. It seems that we are on the verge of a new humanist ideology which I prefer to call a religion. A religion that values homo sapiens lives over all, and finds every single day of human life lost as a tragedy. Maybe we now already develop a new humanist religion, a medical humanism, a religion where saving lives at any cost justifies oppressing the population and curtailing their lives (Source: Chapter “The Law of Religion” in the book “Sapiens” by Yuval Noah Harari, ISBN: 978–0771038983). We might already have entered the period of a new absolute regime, a dictatorship that exaggerates, not how to make the population more healthy and joyful, not how to fully live our lives, but just to avoid death at any cost, even taking any level of suffering of the patients into account. Medicine could become the most cruel mechanism we have developed on earth.
Death is a simple thing, nothing to be bothered about too much, and we cannot even avoid it for long. Every evening we train for death. Are we not “dying” when falling asleep, are we not “dead” when asleep? Physically we are still living, but mentally, we are unconscious of what is going on, except maybe for some dream phases. Dying is just falling asleep, without waking up again. Of course, we cannot be dead, because when we are dead, we are not anymore. We are just “not”, and this means being dead. But even “we are just not” already is wrong, because there is no “we” anymore. Were “we” not also “dead” before being born?
And if we compare our short lifespan to eternity, it really does not matter whether we die a few years early or late. Is it not of more importance, what we do in life, and not how long we do it in life? The ancients called it virtue and, although also this is artificially human-invented, I have quite some sympathy for that idea. What kind of life do we wish to see when we would get a chance to look back in thousands of years — on our own life? A good one, a bad one, or a long one? I guess all of us would want to see a good one, with an easy, uncomplicated end, short of suffering and anxiety. (Source: “On the Shortness of Life” by Seneca, ISBN: 978–0141018812)
And why is it so difficult for us humans to do the inevitable, do die? Many causes. For one, we do not see how small we are in comparison to eternity, we do not see ourselves as just a speck of dust within this vast universe. Nobody in this universe would recognize it when our whole solar system would cease to exist tomorrow morning. We do see ourselves as very important! We identify and have big attachments to our bodies, our minds, our belongings, and the people around us. We have big difficulties to depart with a peace of mind, with a smile on our face because of those attachments. When we came to this planet, we came with nothing, and all experiences we have and had in our lives were just a bonus, a boon, a gain. To unduly hang on to our lives is a disgrace, as it does not show our gratitude of having gotten a chance to live, having gotten a chance to fully experience and discover what a human life is all about.
We humans need personal and physical interactions to live satisfying lives. To rejoice in our environment, in our villages, in our towns, in our nations, in our world is a very basic human trait. We are not built for a life in isolation, we are not built for a life deprived of family, friends, or colleagues. We are not built to be stored away behind electronic devices.
Life is a trade off. Life is a compromise. Human life is being performed in a human society, and in such a society trade offs and compromises have to be taken to achieve a harmonious partnership. One for all, and all for one is indeed that what makes us human, is indeed the basis of how humanity might get a chance to survive.
The healthcare dilemma that we are facing is unprecedented in history. We are forced to make trade offs between life and death, between cost and treatment, between losing loved ones and watching their suffering. For the first time in history our medical possibilities exceed our abilities to actually apply them in reality. For the first time in history our medical advances are both a boon and a burden on human society.
Humanity is entering a new time age. A time where we do not only have to take care about birth to avoid overpopulation, but also where we have to take care of death to reduce the anxiety about the inevitable, to reduce the suffering of the involved, and to reduce the burden on those around. This only can be done free of a state of fear and panic, and can only be done through keeping the facts and the reality in perspective.
Humanity has to concentrate its efforts on living life to its fullest, and not on avoiding death at any cost. Those two things are not compatible with each other. Those who are full of fear and anxiety cannot walk life full stride. Humanity has to change its focus from “how to live longer” to “how to live better, how to live more joyful, more meaningful, more exuberant”!
Copyright © Harald Luckerbauer 2020
