Air pollution contributes to Covid-19, hospitalizations and deaths. Among the contributing factors to what some have called the syndrome, let us then include polluted air and its systemic inflammatory effects which obviously predispose one to infection and to suffer the consequences of exposure to dust and nitrogen oxides. These are the first results of the Epikovair research initiative conducted by the Higher Institute of Health with the best Italian environmental epidemiologists coordinated by Ivano Iavaraone, in collaboration with ISPRA, SNPA and the Rias project.
In particular, the two scientific articles that concluded this two-year effort were co-ordinated by Andrea Ranzi (Arpa Emilia Romagna) for findings on incidence and by Massimo Stafoggia (Dep Lazio) for hospitalization and mortality (here The article occurred e here Mortality article).
There is already a fair amount of literature on the link between pollution and Covid-19, which in the early stages of the pandemic also sparked controversy regarding hypotheses that considered air pollutants as potential virus vectors. Instead, these results focus on the most reasonable guess of effect reinforcement of exposure to pollutants and left us with a very robust and reliable characterization from a statistical point of view, having been able to draw on the rich epidemic database generated by the International Space Station and on key environmental, demographic, socioeconomic and health data from other agencies and, in terms of individual mobility, to Enel X. These data made it possible to generate a map of PM10, PM 2.5 and NO2 concentrations on a 1 km x 1 km scale and a population-weighted average relative exposure.
The most suggestive finding is that in the 16 months encompassing the first three pandemic waves (February 2020-June 2021), past exposure to air pollution that exceeds the precautionary thresholds set by the World Health Organization in 2021 will be responsible for about 10,000 deaths. 124,346 in that period, 8% of the total, and a much larger share of infection cases than the total of 4 million cases in the cited period.
More specifically, the study on the incidence of Covid-19 cases estimated an effect equal to 3% for a 10 μg/m3 increase of PM 2.5 and PM10, and equal to 9% for a 10 μg/m3 increase of NO2. Additional analyzes highlighted a larger effect with respect to age and a clearer role for NOx, confirming other findings that prompted the WHO to focus special attention on this pollutant. The primary results, which indicated effects much higher than these, were reduced after controlling for a very large set of potential confounding variables related to mobility, demographic and regional characteristics of the 7903 Italian municipalities, economic and social profile, health care and locality. Mobility.
Analysis of deaths due to Covid-19 in relation to levels of chronic exposure to pollution revealed more significant effects in the first wave than in the other two waves, by 7%, 3% and 6% respectively for each 10 μg increase in PM2.5, PM10 and NO2. The effects on hospitalizations are similar, which – as for deaths – sees an almost linear relationship with increased exposure to air pollution.
Epicovir is therefore making a signal of concern for air quality also in terms of infectious risks, which add to the already heavy health accounts of dust and nitrogen dioxide, responsible for about 50,000 deaths in Italy and 400,000 in Europe. In the presentation of the results held on June 20 at the Istituto Superiore di Sanità, President Silvio Brusaferro stressed the importance of this study, also reflecting on the need for increasingly integrated approaches in the study of epidemiology. Italian Association of Epidemiologists President Carla Ancona concluded by noting the congruence of these findings with the ongoing revision of the European Air Quality Directive, which has seen Italy’s most polluted regions resist the new limits proposed by the European Commission. Union, because it is difficult to achieve in the most important areas (we talked about it here).
Certainly this makes us believe that in a state of complete lockdown, with engines shut down and offices empty, air quality especially in the Po Valley has kept secondary particulate levels almost unchanged due to ammonia contamination of livestock farms, as noted a few days ago by Another conference on agriculture and pollution. We need to work on several fronts simultaneously to reduce the health burden of bad air.
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