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 of conceptualizing the reasons for a so 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, of whom a lot of them are distinctive features of the population in northern Italy, have been summarized in "unmodifiable", "partially modifiable", and "modifiable", for the sake of clarity. Up-to-date scientific evidence in this field was described in the form of a narrative and easy-to-read review.
The Deadly Quartet (Covid-19, old age, lung disease, and heart failure) explain why coronavirus-related mortality in northern Italy was so high