European Heart Journal | 2021
Is COVID-19 the deadliest event of the last century?
Abstract
Cicero’s quote poignantly embodies history as a life. Despite the passing of more than 2000 years, this statement is still relevant today. Indeed, according to people born in the second half of the 20th century, the most grievous cause of loss of lives was Second World War (World War II, WWII), with 75 million deaths between 1939 and 1945 (Figure 1). But this global war was not the worst cause of fatalities of the last century (Table 1). Before WWII, in 1918, the Spanish flu due to the H1N1 virus was the deadliest pandemic in human history. Its death toll is typically estimated to be between 50 and 100 million during only 12 months, divided in four main waves. It is true that there have been other pandemics since 1918, but none of them as disastrous as the Spanish flu. From these pandemics the world learned several lessons and measures to deal with them, including social distancing, wearing masks, avoiding public gatherings, caring for health care professionals, quarantine, and isolation. Luckily, after WWII, there were no more global conflicts, and this time lapse could be due to the awareness of state leaders of the necessity of avoiding a world conflict, especially after the advent of nuclear weapons. Evidently, a current war would express a human madness of even greater magnitude than the ones from the past. Until 2019, it was thought that the lessons of the H1N1 pandemic had provided us appropriate knowledge for the management of new pandemics, just like what happened in 2003 with severe acute respiratory syndrome (SARS). Yet, 2020 clearly invalidated this theory. On 31 December 2019, the Wuhan Municipal Health Commission in Wuhan City, Hubei Province, China, reported a cluster of pneumonia cases (including seven severe cases) of unknown aetiology, with a common reported link to Wuhan Huanan Seafood Wholesale Market, a wholesale fish and live animal market (Figure 2): it was the beginning of a new pandemic. The International Committee on Taxonomy of Viruses announced severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) to be the name of the new virus on 11 February 2020 and, on the same date, the World Health Organization (WHO) announced that the disease caused by the novel coronavirus would be named COVID-19 (COronaVIrus Disease 19). It took 3 months, more than 148 000 total cases of COVID-19 and more than 4000 deaths before WHO explicitly stated that COVID-19 should be characterized as a pandemic. From March 2020, governments have decided independently for the use of patient isolation, social distancing, face masks, and local/ regional/national lockdowns in order to contain and mitigate the diffusion of SARS-COV2. In April 2020, the New England Journal of Medicine highlighted the risk of transmission with aerosols and fomites, and WHO provided clear recommendations for masks in healthcare and community settings. Nevertheless, in 12 months of pandemic due to SARS-COV2, the world counts more than 100 million cases and almost 3 million deaths. It would seem that the most frequent cause of deaths since December 2019 is COVID-19, given its high contagiousness and capability to cause severe disease, especially in the elderly and the frail. Despite the dreadfulness of infectious diseases, other factors also continue to heavily impact on the global burden of disease. For instance, environmental changes and social conditions have increased the prevalence of what once were relatively obscure ailments, e.g. myocardial infarction and lung cancer, and according to the latest data from WHO, cardiovascular disease (CVD) is still the first cause of death globally, taking an estimated 18 million lives every year: more than any war or pandemic!