In December 2019, a novel β-coronavirus, now designated SARS-CoV2 (severe acute respiratory syndrome coronavirus 2), was identified as the cause of an outbreak of acute respiratory illness in Wuhan City, China. SARS-CoV2 causes severe respiratory disease, termed coronavirus disease 2019 (COVID-19), which represents its most frequent lethal complication. Since its outbreak, SARS-CoV2 has spread to 196 countries and has been declared a pandemic by the World Health Organization (WHO) on March 11, 2020. It has caused over 2 million confirmed infections with over 130,000 deaths worldwide (as of April 15, 2020), of which two-thirds have occurred in Europe.
To date, no specific antiviral treatment for SARS-CoV2 exists, but a number of investigational agents are currently being explored including remdesivir, lopinavir-ritonavir, a combined protease inhibitor, chloroquine/hydroxychloroquine, colchicine, and tocilizumab, an IL-6 inhibitor. The worldwide case fatality rate of 3.4% of COVID-19 now exceeds that from seasonal influenza. Death results from acute respiratory distress syndrome (ARDS), acute respiratory failure, coagulopathy, septic shock, and metabolic acidosis. Cardiovascular complications of COVID-19 comprise arrhythmias, acute cardiac injury, and shock, and have been reported in 7–17% of hospitalized patients. In Italy, the estimated case fatality rate was 7.2%, while it was 0.9% in South Korea and 2.3% in China. Case fatality is highest in those aged > 80 years (14.8% in China, 20.2% in Italy) and in patients with pre-existing conditions including cardiovascular disease, diabetes mellitus, chronic respiratory disease, hypertension, and cancer. Among all comorbidities, cardiovascular disease in the elderly was most consistently associated with adverse outcomes, as a case fatality rate of 10.5% has been reported in this high-risk population.