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Air pollution and COVID-19
- 1. AIR POLLUTION AND COVID-19 Kripa Thapa Magar MPH 1st Year, CDPH, IOM 1
- 2. Outline of the Presentation • COVID-19 Introduction • Effect of the COVID-19 prohibitory orders/lockdown on ambient air quality • Air pollution and COVID-19 association 2
- 3. COVID-19: At a glance • Caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) • First identified in Wuhan, China on 31st December 2019 • First case in Nepal on January 23, 2020 (Magh 10th, 2076) • WHO declared COVID-19 a PH Emergency of International Concern on 30th January 2020 and a Global Pandemic on 11th March 2020 • Variant of concern: Alpha (UK) , Beta (South Africa), Gamma (Brazil), Delta (India) and Omicron (South Africa) 3
- 5. Recent Updates of COVID-19 cases Nepal Globally 273,900,334 confirmed cases and 5,351,812 deaths 5
- 6. COVID-19 Lockdown Impact on Air Quality First corona virus lockdown in Wuhan on 23rd January 2020 until June Something good that came out of COVID-19 6
- 7. • Research done on 597 major cities worldwide between January 1, 2020, and July 5, 2020 found that NO2 air quality index value falls more precipitously (23–37%) relative to the pre-lockdown period, followed by PM10 (14–20%), SO2 (2–20%), PM2.5 (7–16%), and CO (7–11%), but the O3 increases 10–27% (Liu et al., 2021). • Decline in the population-weighted concentration of ground-level nitrogen dioxide (NO2: 60%), and fine particulate matter (PM2.5: 31%), with marginal increases in ozone (O3: 4%) in 34 countries during lockdown dates up until 15 May was observed (Venter et al., 2020). • A study done in Portugal revealed that traffic related NO2 and SO2 decreased by 15-71% & 35% respectively during lockdown period, whereas ozone concentrations slightly increases (Slezakova & Pereira, 2021). 7
- 8. Fig: The global trend of air pollution (PM2.5) Notes: The solid red line indicates the date of Wuhan lockdown (January 23, 2020), and the black dash line indicates the date that this novel corona virus received an official name from WHO (February 11, 2020) (Liu et al., 2021). 8
- 9. COVID-19 containment measures resulted in up to 50% reduction in the AQI over South Asian megacities (M. Mishra & Kul Shrestha, 2021) 9
- 10. Figure: A before/after comparison of the NO2 tropospheric column over the four Hindu Kush Himalaya (HKH) cities for January 2020 and April 2020; Clockwise from top left: (a) Delhi, India b) Dhaka, Bangladesh c) Kathmandu, Nepal, and d) Lahore, Pakistan (Sudip Pradhan & Utsav Maden, n.d.). 10
- 11. The Centre for Research on Energy and Clean Air reported that quarantines and travel bans to contain coronavirus resulted in a 25 per cent reduction of carbon emission in China (Sakshi Mishra, 2020). Fig: A map shows the sharp decline in emissions over China between early January and late February as parts of the country went on lockdown in an attempt to contain the COVID-19 coronavirus. (Image credit: NASA Earth Observatory) 11
- 12. 12
- 13. • The expected premature deaths due to improved air quality decline by around 99,270 to 146,649 among 76 countries and regions (Liu et al., 2021). 13
- 14. Lockdown in Nepal • First lockdown: Chaitra 11, 2076 to Shrawan 6, 2077 (for 4 months) • Second lockdown: Baisakh 16, 2078 to Bhadra 16, 2078 (for 4 months) 14
- 15. Everest from Kathmandu Valley: A Rare Sight Mt Everest (arrow) hidden behind Mt Kang Nachugo and Mt Chobutse from Chobar in Kathmandu on 10 May (Awale, n.d.). Locals believe that this is the first time in about 40-50 years that Everest was visible from the valley (World, n.d.). Photo: Abhushan Gautam 15
- 16. Figure: PM mass concentration (percentage change) for 2017-19 (averaged), and 2020 from April to August (A. Mishra et al., 2021) 16
- 17. Figure: concentration of PM2.5 and PM10 (mcg/m3) in different cities of Nepal, before, during and after lockdown was lifted (Baral & Thapa, 2021). 17
- 18. COVID-19 and Air Pollution: A Dangerous Association? Air Pollutants Role in Transmission of COVID-19 • Air quality index was significantly correlated with COVID-19 incidence in both Wuhan and Xiaogan. COVID-19 incidence was prominently correlated with PM2.5 and NO2 in both cities (Li et al., 2020). • Evidence from 219 Chinese cities suggests that the corona virus further spreads by 5–7% as the AQI increases by 10 units (Zhang et al., 2020). 18
- 19. Setti et al. suggest that PM could act as a carrier for droplet nuclei, boosting the spread of the virus (Setti et al., 2020). Figure: Scheme of possible enhancement of viral transmission through stabilized human exhalation on PM 19
- 20. • Coccia et al. demonstrated that the accelerated transmission dynamics of COVID-19 resulted mainly from transmission by contaminated air to man, besides the transmission from man to man (Coccia, 2020). • The highest incidences of COVID-19 occurred in cities located in Northern Italy. The lowest incidences were observed in Southern Italy. 39 out of 41 Northern Italian Provinces resulted in the category with highest PM10 levels, while 62 out of 66 Southern Provinces presented low PM10 concentrations (Setti et al., 2020). • A 10-μg/m3 increase in PM2.5, PM10, NO2, and O3 was associated with a 2.24%, 1.76%, 6.94%, and 4.76% increase in the daily counts of confirmed cases, respectively (Zhu et al., 2020). 20
- 21. Air Pollutants Role in the Susceptibility & Severity of COVID-19 • Study conducted in Northern Italy suggest that an increase in one unit of PM2.5 (mcg/m3) is associated with a 9% increase in COVID-19 related mortality (Coker et al., 2020). • In the US, a study shows that an increase of 1 mcg/m3 in PM2.5 is associated with a 15% increase in the COVID-19 mortality rate (Wu et al., 2020). • Study conducted in UK found that 0.5% increase in COVID-19 mortality risk for every 1 mcg/m3 increase in NO2 (Konstantinoudis et al., 2021). 21
- 22. • Out of the 4443 fatality cases, 3487 (78%) were in five regions (have the highest NO2) out of 66 administrative regions of Italy, Spain, France and Germany (Ogen, 2020). • In England, a study suggests that individuals exposed to chronic high levels of air pollution may be more susceptible to SARS-CoV-2 infection as a result of compromised immune defence responses due to pollution (Travaglio et al., 2020). 22
- 23. PM Exposure Effects of PM on COVID-19 have been associated with: o Inflammatory effects and immune dysregulation; o Oxidative stress and cytotoxicity of polycyclic aromatic hydrocarbons (PAHs); o Dysfunctional surfactants; o Ace-2; and o Metabolic pathways (Zhao et al., 2021). 23
- 24. NO2 Exposure Effects of NO2 levels on COVID-19 have been associated with (1) Inflammatory effects and immune dysregulation; (2) Increasing pulmonary epithelial permeability; (3) Metabolic pathways; and (4) Monocyte enrichment (Zhao et al., 2021). 24
- 25. References 1. Archived: WHO Timeline - COVID-19. (n.d.). Retrieved 18 December 2021, from https://www.who.int/news/item/27-04-2020-who-timeline---covid- 19 2. Awale, S. (n.d.). Nepal lockdown proves air quality can be improved. Retrieved 18 December 2021, from https://www.nepalitimes.com/banner/nepal-lockdown-proves-air-quality-can-be-improved/ 3. Baral, B., & Thapa, K. (2021). Effect of COVID-19 Lockdown on Ambient Air Quality In Major Cities of Nepal. In Journal of Health and Pollution (Vol. 11). https://doi.org/10.5696/2156-9614-11.29.210211 4. Coccia, M. (2020). Diffusion of COVID-19 Outbreaks: The Interaction between Air Pollution-to-Human and Human-to-Human Transmission Dynamics in Hinterland Regions with Cold Weather and Low Average Wind Speed (SSRN Scholarly Paper ID 3567841). Social Science Research Network. https://doi.org/10.2139/ssrn.3567841 5. Coker, E. S., Cavalli, L., Fabrizi, E., Guastella, G., Lippo, E., Parisi, M. L., Pontarollo, N., Rizzati, M., Varacca, A., & Vergalli, S. (2020). The Effects of Air Pollution on COVID-19 Related Mortality in Northern Italy. Environmental and Resource Economics, 76(4), 611–634. https://doi.org/10.1007/s10640- 020-00486-1 6. Konstantinoudis, G., Padellini, T., Bennett, J., Davies, B., Ezzati, M., & Blangiardo, M. (2021). Long-term exposure to air-pollution and COVID-19 mortality in England: A hierarchical spatial analysis. Environment International, 146, 106316. https://doi.org/10.1016/j.envint.2020.106316 7. Li, H., Xu, X.-L., Dai, D.-W., Huang, Z.-Y., Ma, Z., & Guan, Y.-J. (2020). Air pollution and temperature are associated with increased COVID-19 incidence: A time series study. International Journal of Infectious Diseases: IJID: Official Publication of the International Society for Infectious Diseases, 97, 278–282. https://doi.org/10.1016/j.ijid.2020.05.076 8. Liu, F., Wang, M., & Zheng, M. (2021). Effects of COVID-19 lockdown on global air quality and health. Science of The Total Environment, 755, 142533. https://doi.org/10.1016/j.scitotenv.2020.142533 9. Mishra, A., Pant, B. P., Shakya, S., Tiwari, P., Pandit, D., & Poudyal, K. N. (2021). Impact of COVID-19 lockdown on particulate matter (PM2.5) concentration in Kathmandu, Nepal. International Journal of Environmental Studies, 0(0), 1–9. https://doi.org/10.1080/00207233.2021.1974757 10. Mishra, M., & Kulshrestha, U. C. (2021). A Brief Review on Changes in Air Pollution Scenario over South Asia during COVID-19 Lockdown. Aerosol and Air Quality Research, 21(4), 200541. https://doi.org/10.4209/aaqr.200541 25
- 26. 11. Ogen, Y. (2020). Assessing nitrogen dioxide (NO2) levels as a contributing factor to coronavirus (COVID-19) fatality. Science of The Total Environment, 726, 138605. https://doi.org/10.1016/j.scitotenv.2020.138605 12. Sakshi Mishra. (2020). Origin and Impact of Covid 19. https://www.slideshare.net/sakshioo1/origin-and-impact-of-covid-19?qid=b9c1986a-5eca- 4729-919e-e8cfc183864d&v=&b=&from_search=3 13. Setti, L., Passarini, F., Gennaro, G. D., Barbieri, P., Perrone, M. G., Piazzalunga, A., Borelli, M., Palmisani, J., Gilio, A. D., Piscitelli, P., & Miani, A. (2020). The Potential role of Particulate Matter in the Spreading of COVID-19 in Northern Italy: First Evidence-based Research Hypotheses (p. 2020.04.11.20061713). https://doi.org/10.1101/2020.04.11.20061713 14. Siciliano, B., Dantas, G., da Silva, C. M., & Arbilla, G. (2020). Increased ozone levels during the COVID-19 lockdown: Analysis for the city of Rio de Janeiro, Brazil. The Science of the Total Environment, 737, 139765. https://doi.org/10.1016/j.scitotenv.2020.139765 15. Slezakova, K., & Pereira, M. C. (2021). 2020 COVID-19 lockdown and the impacts on air quality with emphasis on urban, suburban and rural zones. Scientific Reports, 11(1), 21336. https://doi.org/10.1038/s41598-021-99491-7 16. Sudip Pradhan, B. B., & Utsav Maden. (n.d.). Monitoring air quality from space during the COVID-19 pandemic. ICIMOD. Retrieved 19 December 2021, from https://www.icimod.org/article/monitoring-air-quality-from-space-during-the-covid-19-pandemic/ 17. Travaglio, M., Yu, Y., Popovic, R., Selley, L., Leal, N. S., & Martins, L. M. (2020). Links between air pollution and COVID-19 in England (p. 2020.04.16.20067405). https://doi.org/10.1101/2020.04.16.20067405 18. Venter, Z. S., Aunan, K., Chowdhury, S., & Lelieveld, J. (2020). COVID-19 lockdowns cause global air pollution declines. Proceedings of the National Academy of Sciences, 117(32), 18984–18990. https://doi.org/10.1073/pnas.2006853117 19. World, R. (n.d.). Mount Everest visible from Kathmandu for the first time in decades, see exclusive pictures. Republic World. Retrieved 18 December 2021, from https://www.republicworld.com/india-news/general-news/majestic-mount-everest-visible-from-kathmandu-amid- lockdown.html 20. Wu, X., Nethery, R. C., Sabath, B. M., Braun, D., & Dominici, F. (2020). Exposure to air pollution and COVID-19 mortality in the United States: A nationwide cross-sectional study. MedRxiv, 2020.04.05.20054502. https://doi.org/10.1101/2020.04.05.20054502 21. Zhang, Z., Xue, T., & Jin, X. (2020). Effects of meteorological conditions and air pollution on COVID-19 transmission: Evidence from 219 Chinese cities. The Science of the Total Environment, 741, 140244. https://doi.org/10.1016/j.scitotenv.2020.140244 22. Zhao, C., Fang, X., Feng, Y., Fang, X., He, J., & Pan, H. (2021). Emerging role of air pollution and meteorological parameters in COVID-19. Journal of Evidence-Based Medicine, 14(2), 123–138. https://doi.org/10.1111/jebm.12430 23. Zhu, Y., Xie, J., Huang, F., & Cao, L. (2020). Association between short-term exposure to air pollution and COVID-19 infection: Evidence from China. Science of The Total Environment, 727, 138704. https://doi.org/10.1016/j.scitotenv.2020.138704 26
- 27. THANK YOU 27
Editor's Notes
- Why ozone concentration increases? A detailed analysis of NMHC/NOx ratios and trajectories of air masses in the city of Rio de Janeiro, showed that the relatively high ozone concentrations were a consequence of higher ratios (due to a sharper decrease in NOx than for hydrocarbons) and also to the possible increase in the reactivity of the VOC mixture (Siciliano et al., 2020).
- The paper examines a novel COVID19 government response tracker dataset, combining the daily air pollution data and weather data across 597 major cities worldwide between January 1, 2020, and July 5, 2020 Figure shows the daily changes in PM2.5 individual AQI (converted from corresponding concentrations based on the US EPA standard) of study area cities during the sample period and at the same time frame in 2019, which suggests that cities experienced a similar air pollution level before the date of Wuhan lockdown (the first city in the world to impose city lockdown policy) when the COVID-19 had not spread worldwide, and few cities were put under strict lockdown compared with the same period last year. However, the difference significantly increased, especially after March 2020, when more cities were locked down, indicating an air quality improvement occurred after city lockdowns.
- It could be possible to look at the airborne route of transmission, and specifically to particulate matter, as a “highway” for the viral diffusion, in which the droplet nuclei emitted by the exhalations are stabilized in the air through the coalescence (merging) of aerosol with the PM at high concentrations in stability conditions (optimal conditions of temperature and humidity to stabilize the aerosols in airborne). In fact, the fate of a smalls droplet of a virus, under normal conditions of clean air and atmospheric turbulence, evaporates and /or disperses quickly in atmosphere. On the contrary in conditions of atmospheric stability and high concentrations of PM, viruses have a high probability of creating clusters with the particles and, by reducing their diffusion coefficient, enhancing their residence time and amount in atmosphere and promoting contagion.
- PM could increase the severity of COVID-19 through directly damaging the immune response of the lungs to infection or indirectly aggravating respiratory or cardiovascular diseases. Excessive inflammatory response results in a massive release of pro-inflammatory cytokines, also known as “cytokine storms,” which has a significant impact on COVID-19’s severity and mortality. Exposure to these pollutants induces the production of free radicals that induce damage the cells Third, surfactants decrease surface tension of lung air-fluid interface and prevent alveolar collapse at the end of expiration.87 Lack of surfactants can lead to ARDS.87 Experimental studies suggested that physical interaction between PM and surfactant can change the biomechanical function of surfactant.88 In mice, PM can cause alveolar collapse.89 On the one hand, PM could compromise the integrity of human respiratory barrier and weaken the host defense. Fourth, ACE2 plays a key role in viral entry into respiratory epithelial cells.91 In addition to its physiological function, ACE-2 could serve as a receptor for SARS-COV2. ACE-2 is overexpressed upon chronic exposure to NO2 and PM2.5 in mouse experiments. Fifth, eight metabolic pathways in glycerophospholipid, propanoate, sphingolipid, and glutathione metabolism have been associated with long-term exposure to PM2.5.80 These pathways are associated with oxidative stress, inflammation, immunity, and nucleic acid damage and repair (Zhao et al., 2021).
- Many studies have reported the effect of NO2 on immune inflammation. A prospective study in nonsmokers showed that higher exposure to NO2 was associated with IL-17.100 NO2 exposure can promote neutrophil and eosinophil recruitment, and a mixed Th2/Th17 response upon antigen challenge.101 Similarly, NO2 exposure can boost the production of IL-6 and NF-κB activation.102, 103 NO2 can function as an adjuvant and induce an antigen-specific Th2 immune response.104 Inhalation of 15 ppm NO2 for just 1 hour can induce MCP-1 within the lungs,105 indicating that NO2 can promote DC recruitment. After NO2 exposure, CD11c+ pulmonary cells secreted increased amount of IL-1α, IL-1β, IL-12p70, and IL-6, and increased Th2 cell activity.104 In addition, high-level NO2 exposure can induce endothelial dysfunction and oxidative stress disturbances.106 Thus, it is possible that NO2 exposure contributes to inflammation and immune disorders and exacerbate SARS-COV-2–induced lung damage. High concentrations of NO2 lead to bronchoconstriction and bronchial hyperreactivity and may also result in damage and inflammation of the airway epithelium. Studies have showed that NO2 exposure disrupts tight junctions in the lungs and increases epithelial permeability and human bronchial epithelial cell dysfunction.107, 108 In addition, NO2 exposure reduced the ability of alveolar macrophages to inactivate influenza virus.109 Nassan et al found significant associations between long-term exposure to NO2 and 15 blood metabolites using an untargeted metabolomic approach. Short-term exposure to NO2 was related to 100 unique metabolites and four perturbed metabolic pathways (glutathione, glycerophospholipid, beta-alanine, and taurine and hypotaurine metabolisms).80 Monocytes are key white blood cells of the innate immune system and play a central role in inflammasome activation and cardiovascular diseases. Exposure to NO2 was positively associated with monocyte levels and diastolic blood pressure after full adjustment.106 Thus NO2 may promote monocyte enrichment and DNA methylation in monocytes, which subsequently affects diastolic blood pressure and ultimately aggravates COVID-19 (Zhao et al., 2021).