D. Is There Synergism Between Concurrent Causes?

Synergism is a well-known and understood phenomenon.  It is the combination of two or more independent factors, such as toxins or chemicals, that cause an effect greater or lesser than the sum of the individual factors.  [https://www.ccohs.ca/oshanswers/chemicals/synergism.html] The following are a few examples:

1. Chemicals: Carbon tetrachloride, by itself, has a moderate toxicity to the liver. Drinking alcohol (ethanol) has an even lower toxicity.  But together there is a major increase in toxicity.   Many drugs cannot be taken with alcohol because of synergism. 

2. Diseases.  Numerous health studies have identified many disease pairs. [http://downloads.hindawi.com/journals/bmri/2016/9427231.pdf  Dorenkamp et al (2016) Research ArticleSynergistic Effects of Six Chronic Disease Pairs onDecreased Physical Activity: The SMILE Cohort Study, BioMedResearch International, doi 10.1155/2016/9427231]

  •   Respiratory Diseases (41%), Kidney Diseases (31%) together consequential effect is 70%

  •   Migraines (37%) and Inflammatory Joint Disease (40%) together effect is 64%

  •   Respiratory Disease (41%) and Inflammatory Join Disease (40%) together 57%

 3. Viruses in Plants. [Zhang et al (2001) Synergism between plant viruses: a mathematical analysis of the epidemiological implications, Plant Pathology, Vol 50 Issue 6 pgs. https://doi.org/10.1046/j.1365-3059.2001.00613.x]  Many virus pairs are discussed along with multiple references to individual studies. 

Is There Evidence of Synergism?  The influenza spread graph in Figure 6 shows that the top 6 states with the highest influenza presence had 61% of all CoVID-19 deaths.  The bottom 13 states exhibiting lowest influenza presence had 6.1 percent of the CoVID-19 deaths.  That’s a difference of 10 times.  Both groups had nearly the same population base (41 million to 43 million). 

Figure 6 is the Influenza Spread Rating for the United States from 2013 to 2020. The horizontal axis is the state number, including the District of Columbia and Puerto Rico. The vertical axis is the accumulated Flu Spread Rating. Data from the CDC.

The average of the virus spread rating in the top 6 states was 674 while the average of the bottom 13 states was 470.  That is a difference of 43%.   This percent does not match the observed 10 fold (1000%) increase in deaths.  Something is affecting the deaths rates in an unusual way.

One explanation is that COVID-19 was not in the 13 low influenza virus states.  But that is not the case.  Every state had COVID-19.  With an Ro  of 5.7 it would have spread like wildfire wherever it landed. 

The 2018 curve of US influenza deaths has a slope of 552 deaths/wk.   The slope of the influenza and CoVID-19 deaths combined was 1388 deaths/ wk.  Comparing the two slopes illustrates a 2.5 fold increase. These unusual results raise the possibility of synergism.