COVID-19 at 1 Year
Authors: Mitchell S.V. Elkind, Robert A. Harrington, Donald M. Lloyd-Jones
Journal: Circulation (2021)

As we write these words, the United States is climbing the steep grade of the third wave of the coronavirus pandemic, and a bleak winter with tens, if not hundreds, of thousands of deaths awaits us.As you read these words, it has been a year since coronavirus disease 2019 (COVID-19) first reached US shores.Within that year, remarkably, vaccines have been rolled out, and the beginning of the end of the pandemic is in sight.Over the past months, we have learned a tremendous amount, which we distill into 3 main lessons.First, Mother Nature, in the form of COVID-19, has presented a breadth of medical mysteries, perhaps foreshadowing future challenges that we can only imagine.Second, the scientific enterprise, including projects supported by the American Heart Association (AHA), is alive and more robust than ever.And third, despite the strength of the response of the research community, translation of the knowledge gained into effective treatment and public health requires more than scientific evidence; the mitigation of mortality from COVID-19 and the ultimate end of the pandemic require education, trust, and political leadership.We need better coordination between clinical medicine and public health.Back in February 2020, as reports of the illness caused by severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) began to filter to the United States, cardiovascular clinicians and scientists learned that the virus caused not only respiratory illness but also, in some cases, a diffuse syndrome that affects the heart, nervous system, gastrointestinal tract, kidneys, and other organs throughout the body. 1 Probably attributable in part to the presence of its receptor, angiotensin-converting enzyme 2, on the surface of cells that participate in vascular function, SARS-CoV-2 was discovered to induce endothelial activation, leading to the release of inflammatory and prothrombotic factors, including von Willebrand factor, promoting microvascular and macrovascular thrombosis and diffuse tissue injury. 2 In other words, in some respects, COVID-19 is inherently a vascular disorder.COVID-19 was also discovered to induce severe inflammation and immune activation through the release of cytokines and other inflammatory mediators.A multi-inflammatory syndrome of childhood was reported in a small number of children, and a presumably related syndrome was also noted in adults.In addition to respiratory failure, patients presented with myocardial infarction, heart failure, myocarditis, strokes, kidney failure, diarrhea, and other manifestations of a systemic illness. 1 As with syphilis in the 19th century, COVID-19 appears to be a "great imitator" because it mimics so many other conditions.Similar to pandemic influenza in the past century, COVID-19 may also lead to lingering aftereffects, the so-called long-haul COVID syndrome, which remains poorly understood.All these mysteries of the virus, however, were not entirely without precedent.SARS-CoV-2 is only one of a family of coronaviruses, including Middle East Respiratory Syndrome (MERS) virus found in camels, that causes seasonal outbreaks of even more COVID-19 at 1 YearAmerican Heart Association Presidents Reflect on the Pandemic