A study recently published by the Journal of the American Medical Association indicates that there were two leading causes of death during the COVID-19 pandemic, but neither of them was COVID-19. Rather, they were heart disease and cancer.

The research paper showed the major causes of death in the United States from March 2020 to October 2021. According to the article, 20.1 percent of deaths were due to heart disease, and 17.5 percent were caused by cancer. The third leading cause of death during this time was COVID-19, accounting for 12.2 percent of all deaths.

Cardiovascular disease had always been a leading cause of death, yet the number of heart disease-related deaths during the pandemic has seen an unusual change.

According to the National Center for Health Statistics (NCHS), the number (pdf) of heart disease deaths before 2020 in the United States had been steadily decreasing on an annual basis. This is likely due to an increase in people’s awareness of heart disease, and technological advancements in the medical field, both of which have likely contributed to more preventive measures being taken against heart disease and an enhanced response mechanism to sudden heart attacks.

However, the number of heart disease deaths started to rise again in 2020. For every 100,000 people, 161.5 died of heart disease in 2019. In 2020, this number increased to 168.2.

COVID-19 Infections Are Related to the Increased Mortality Rate in Heart Disease Patients

The number of heart disease complications in critically ill COVID-19 patients are much larger than average.

A 2020 article published in the British Medical Journal analyzed 5,019 COVID-19 critically ill patients in the intensive care units of 68 hospitals across the United States, and found that 14 percent of them had cardiac arrest, and only 12 percent of those survived the cardiac arrest after receiving CPR.

The number of cardiac arrest cases outside of the hospital also saw a significant increase. Many who contracted COVID-19 and experienced cardiac arrest at home passed away before the ambulance arrived. Data provided by the Houston Fire Department, for example, showed just this. Forensic data confirm that the increase in such deaths is directly linked to SARS-CoV-2 infection.

Similar situations have also occurred in other countries and regions.

An Italian study published in The New England Journal of Medicine found that after the COVID-19 pandemic started in Europe in 2020, the number of out-of-hospital cardiac arrest cases increased significantly, by 58 percent compared to 2019. In addition, the number of COVID-19 infections was found to be directly positively correlated to the number of out-of-hospital cardiac arrest cases. Also, 77 percent of all patients who died from out-of-hospital cardiac arrest were suspected of or confirmed having contracted the SARS-CoV-2 virus.

A 2020 large-scale cohort study from Paris published in The Lancet Public Health showed that since March 2020, when the pandemic started spreading rapidly, the number people who died of an out-of-hospital cardiac arrest in Paris had increased dramatically, essentially doubling the number before the pandemic (looking at the same weeks in 2019).

COVID-19 is widely regarded as a virus that affects the respiratory tract, so why have so many patients passed away due to heart disease? The reasons are as follows:

• The SARS-COV-2 virus can directly damage cardiac cells, causing damage to cardiac vessels and carditis;
  The impact of lung infection on blood circulation burdens the heart;
• The virus can cause an aggressive inflammatory response known as a “cytokine storm.” And inflammatory factors can severely impact the cardiovascular system and vital organs;
• The pandemic has altered people’s lifestyles. Being forced to stay at home and the lack of exercise both could cause a decline in their general health, which made them more prone to heart disease.

An article published in the Indian Heart Journal listed several leading causes of sudden cardiac death due to COVID-19 infection. The leading causes were acute myocarditis and pericarditis; followed by acute coronary syndrome and hypoxia; there were also coagulopathy, systemic inflammatory responses, and arrhythmia.

Myocarditis and Pericarditis Cases Increased Significantly After Administration of COVID-19 Vaccines

In addition to COVID-19 infections, the administration of COVID-19 vaccines has also increased the risk of heart disease. A study published in the Journal of the American Medical Association (JAMA) in August 2021, by using data collected from more than 40 American medical institutions, shows that the number of myocarditis and pericarditis cases increased sharply after around 2 million people received the COVID-19 vaccines in the United States.

The median onset of myocarditis is around 3.5 days after vaccination, and there is a strong correlation between the time of onset and the time of vaccination. Among the myocarditis patients, 80 percent developed the symptoms after the second dose, 75 percent were male, and their median age was 36 years old.

The median onset of pericarditis in patients is 20 days after receiving the COVID-19 vaccines; and in 60 percent of the cases, the onset of symptoms took place after the second dose. Among these patients, 73 percent were male, and their median age was 59 years old.

As a result, three countries in Europe suspended the use of the Moderna vaccines for young men at that time.

Is the Second Leading Cause of Death Possibly Related to the COVID-19 Pandemic?

The second leading cause of death during the first year of the pandemic was cancer. This, however, differs from heart disease, as the number of cancer patients did not have any abnormal fluctuations in terms of data trends during the pandemic.

Nevertheless, COVID-19 infections did have an impact on cancer patients during this time period.

This is because a COVID-19 infection can cause chronic inflammation, and the inflammatory factors can directly or indirectly inhibit the functions of immune cells. The spike proteins of the SARS-CoV-2 virus can also inhibit mitochondrial functions and suppress the cells’ DNA repair mechanisms. The aforementioned effects can all cause the degeneration of the immune cell functions, further aggravating the cancer patients’ conditions and causing their tumors to worsen and spread.

Also, the prolonged lockdowns during the pandemic could lead to or increase the levels of anxiety and depression, which could both inhibit the immune cells’ ability to surveil and suppress tumors.

In addition, since hospitalization rates rose sharply due to the COVID-19 pandemic, many cancer screening, surgery, and chemotherapy appointments have been postponed. A review in The Lancet Public Health comprehensively discussed the consequences of postponing cancer-related appointments. Early screening and diagnosis of cancers (such as colon, breast, prostate, and cervical cancers, as well as melanoma) have a large impact on patient survival. For instance, for each 4-week delay in treatment for colon cancer, the risk of death increases by 6 percent; while a similar delay in adjuvant chemotherapy for colorectal cancer increases the risk of death by 13 percent.

As of May 9, 2021, Australia had attributed the deaths of 7,509 cancer patients to the pandemic.

A Way to Reduce Mortality Rates of Heart Disease and Cancer

How can one reduce the risk of heart disease and cancer?

Since the onset of the pandemic, people have been under a lot of pressure, stress, and anxiety, which affects their immunity. Furthermore, being prone to anxiety puts one at further risk for heart disease.

In the movie Kung Fu Panda, the term “inner peace” is repeatedly mentioned. Recently, more and more studies have found that “inner peace” is closely related to one’s health.

In 2016, researchers from the University of Connecticut and University of Oregon jointly published a study in the journal Health Psychology to explore the association between a state of spiritual peace and the survival rate of patients with congestive heart failure (CHF).

Congestive heart failure is a very common chronic disease in the United States, affecting more than 5 million people. Factors such as smoking, poor diets, alcohol consumption, depression, and a lack of social support are all associated with the increased risk of death in patients with congestive heart failure.

The study followed 191 patients with congestive heart failure for five years. One of the items assessed the subjects’ state of spiritual peace and harmony, asking them to rate their own state and frequency of spiritual peace from “never or almost never to some days” to “most days or many times a day.”

The results showed that a state of spiritual peace could be an important predictor of mortality. During the five-year follow up, people who felt peace of mind regularly had a very low or close to zero risk of death, while those who experienced little or no peace of mind had a 25 percent mortality rate.

Even after taking other factors into consideration, spiritual peace still played a role in reducing mortality rate.

A state of spiritual peace also has a positive effect on cancer patients. Another study has discovered that life meaning and peace was negatively associated with anxiety, and positively associated with physical well-being.  For cancer survivors that suffer from a high level of anxiety, their physical health would improve significantly when they had a higher level of inner peace and meaning of life.

However, for people who don’t feel anxious, their health is usually already much better than people who suffer from anxiety. Therefore, after becoming even more calm, their physical condition doesn’t show any obvious changes.

A lot of people might ask, “How can I have spiritual peace?”

If we pay more attention to our spiritual pursuits, and less to our materialistic pursuits, and remind ourselves to remain calm when facing conflicts, then it will be easier for us to obtain inner peace. For materialistic people who can’t let go of their emotions and love to pick a fight in the face of conflicts, it will be quite difficult to reach inner peace.

There is another term to describe a state of spiritual peace, namely spirituality, and this is usually used to represent a divine feeling or a “holy” state of mind. In medical research, spirituality is more commonly used to describe inner peace and a feeling of meaningfulness in life. This is a state of mind that takes spiritual cultivation, and it requires continuous restraint and effort to achieve.

So our attitude decides our fate. Reducing the number of fights with others and achieving more inner peace, our hearts will be thankful to us, and we will be rewarded with a longer, healthier life.

References

Leading Causes of Death in the US During the COVID-19 Pandemic, March 2020 to October 2021 | Population Health | JAMA Internal Medicine

State Declines in Heart Disease Mortality in the United States, 2000–2019 | NCHS Data Brief | CDC

Mortality in the United States, 2020

In-hospital cardiac arrest in critically ill patients with covid-19: multicenter cohort study | The BMJ

A Spike in People Dying at Home Suggests Coronavirus Deaths in Houston May Be Higher Than Reported — ProPublica

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204428/?report=reader#!po=50.0000

Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study – The Lancet Public Health

COVID-19 and sudden cardiac death: A new potential risk – PMC

Myocarditis and Pericarditis After Vaccination for COVID-19 | Cardiology | JAMA

Impact of the COVID-19 pandemic on cancer incidence and mortality – The Lancet Public Health

Cancer incidence and mortality in Australia from 2020 to 2044 and an exploratory analysis of the potential effect of treatment d

Spiritual Peace Predicts 5-Year Mortality in Congestive Heart Failure Patients – PMC

Spiritual peace and life meaning may buffer the effect of anxiety on physical well-being in newly diagnosed cancer survivors