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Healthcare Development, Relaxed Natural Selection, and COVID-19 Infection Rates: An Evolutionary Population-Level

Wenpeng You1,2, Brendon Coventry3, Arthur Saniotis1

  • 1School of Biomedicine The University of Adelaide Adelaide South Australia Australia.

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|March 12, 2026
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Summary
This summary is machine-generated.

Higher healthcare development, measured by the Biological State Index (Ibs), correlates with increased COVID-19 infection rates globally. This suggests modern healthcare may alter pathogen-host dynamics, emphasizing evolutionary insights for pandemic preparedness.

Keywords:
Biological State IndexCOVID‐19 infection rateevolutionary medicinehealthcare developmentrelaxed natural selection

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Area of Science:

  • Evolutionary biology and public health
  • Infectious disease dynamics
  • Global health disparities

Background:

  • Evolutionary principles offer insights into pandemic dynamics but are overlooked in COVID-19 responses.
  • Modern societal factors like relaxed natural selection and increased mobility enhance human vulnerability to infectious diseases.
  • Healthcare development may influence disease transmission patterns.

Purpose of the Study:

  • To investigate the relationship between healthcare development, quantified by the Biological State Index (Ibs), and cumulative COVID-19 infection rates.
  • To explore how healthcare advancement correlates with infection prevalence across diverse global settings.

Main Methods:

  • Analysis of data from 189 countries, correlating the Biological State Index (Ibs) with COVID-19 infection rates (cumulative population percentage).
  • Employed Pearson's r and Spearman rho correlation, partial correlations (adjusting for aging, economic affluence, urbanization, vaccination), and multiple linear regressions.
  • Stratified analyses by income level, development status, and WHO regions to identify group-specific patterns.

Main Results:

  • A strong positive association was found between higher Biological State Index (Ibs) values and higher COVID-19 infection rates globally (Pearson's r = 0.734, p < 0.001).
  • This association remained significant after adjusting for demographic and economic variables; economic affluence and aging were independent predictors.
  • Correlations were consistently stronger in developing and low- to middle-income countries compared to high-income nations.

Conclusions:

  • Advancements in healthcare systems are linked to higher reported COVID-19 infection rates, potentially due to increased susceptibility, detection, and exposure.
  • Findings underscore the need to integrate evolutionary perspectives into pandemic preparedness, acknowledging how healthcare changes pathogen-host dynamics.
  • Modern healthcare's impact on infection patterns requires further study within an evolutionary framework.