The Deadly Quartet (Covid-19, Old Age, Lung Disease, and Heart Failure) Explains Why Coronavirus-Related Mortality in Northern Italy Was So High

Curr Cardiol Rev. 2021;17(1):74-77. doi: 10.2174/1573403X16666200731162614.

Abstract

Since its outbreak in China at the end of 2019, the new coronavirus disease (COVID-19) was characterized by both easy spreading and high mortality. The latter proved to be way more elevated in the North of Italy -with a peak of 18.4% in region Lombardia and even 31% in the city of Bergamo and surrounding county- than in the rest of the world. In an attempt to conceptualize the reasons for such a dramatic situation, four key elements have been identified: COVID-19 itself, old age, lung disease, and heart failure. Their harmful combination has been named "The deadly quartet". The underlying risk factors, among which a lot of them are distinctive features of the population in northern Italy, have been summarized as "unmodifiable", "partially modifiable", and "modifiable", for the sake of clarity. Up-to-date scientific evidence in this field has been described in the form of a narrative and easy-to-read review.

Keywords: COVID-19; Italy; coronavirus; heart; lung; mortality.

Publication types

  • Review

MeSH terms

  • Age Factors
  • Aged
  • COVID-19 / epidemiology
  • COVID-19 / mortality*
  • Disease Outbreaks
  • Heart Failure / epidemiology
  • Heart Failure / mortality*
  • Heart Failure / virology
  • Humans
  • Italy / epidemiology
  • Lung Diseases / epidemiology
  • Lung Diseases / mortality*
  • Lung Diseases / virology
  • Risk Factors
  • SARS-CoV-2