Article

# Can atmospheric pollution be considered a co-factor in extremely high level of SARS-CoV-2 lethality in Northern Italy?

Authors:
• Rheumatology unit university of siena italy
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## Abstract

This paper investigates the correlation between the high level of Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) lethality and the atmospheric pollution in Northern Italy. Indeed, Lombardy and Emilia Romagna are Italian regions with both the highest level of virus lethality in the world and one of Europe's most polluted area. Based on this correlation, this paper analyzes the possible link between pollution and the development of acute respiratory distress syndrome and eventually death. We provide evidence that people living in an area with high levels of pollutant are more prone to develop chronic respiratory conditions and suitable to any infective agent. Moreover, a prolonged exposure to air pollution leads to a chronic inflammatory stimulus, even in young and healthy subjects. We conclude that the high level of pollution in Northern Italy should be considered an additional co-factor of the high level of lethality recorded in that area.

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... In late February 2020, the pandemic began its rapid community spreading in Europe, and the most harmful outbreaks first occurred in the middle of Po Plain, (Northern Italy), where, in the last week of March, apparent CFR reached 12% (Conticini et al., 2020), an alarming level if compared with the rest of Italy and the globally expected CFR. While the researchers were discussing about the CFR age-decomposition, other authors parallelly tried to find associations between the anisotropic progression of the pandemic and the different levels of exposure to pollutants experimented by human communities. ...
... In medical literature, pollution is a notorious factor of prolonged inflammation and impairment of the respiratory tract (Conticini et al., 2020). Long-term exposure to PM 2.5 e PM 10 is known to lead to immune system overactivation, (Conticini et al., 2020), therefore, an individual living in a geographical area with high pollution levels is more likely to develop chronic respiratory diseases. ...
... In medical literature, pollution is a notorious factor of prolonged inflammation and impairment of the respiratory tract (Conticini et al., 2020). Long-term exposure to PM 2.5 e PM 10 is known to lead to immune system overactivation, (Conticini et al., 2020), therefore, an individual living in a geographical area with high pollution levels is more likely to develop chronic respiratory diseases. Moreover, the long-term exposure to pollutants tends to maintain a high chronic inflammatory stimulus in the organism, also in young and healthy individuals. ...
Article
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The present work aims to give an overview on the international scientific papers related to the territorial spreading of SARS-CoV-2, with a specific focus upon applied quantitative geography and territorial analysis, to define a general structure for epidemiological geography research. The target publications were based on GIS spatial analysis, both in the sense of topological analysis and descriptive statistics or lato sensu geographical approaches. The first basic purpose was to organize and enhance the vast knowledge developments generated hitherto by the first pandemic that was studied “on-the-fly” all over the world. The consequent target was to investigate to what extent researchers in geography were able to draw scientifically consistent conclusions about the pandemic evolution, as well as whether wider generalizations could be reasonably claimed. This implied an analysis and a comparison of their findings. Finally, we tested what geographic approaches can say about the pandemic and whether a reliable spatial analysis routine for mapping infectious diseases could be extrapolated. We selected papers proposed for publication during 2020 and 209 articles complied with our parameters of query. The articles were divided in seven categories to enhance existing commonalities. In some cases, converging conclusions were extracted, and generalizations were derived. In other cases, contrasting or inconsistent findings were found, and possible explanations were provided. From the results of our survey, we extrapolated a routine for the production of epidemiological geography analyses, we highlighted the different steps of investigation that were attained, and we underlined the most critical nodes of the methodology. Our findings may help to point out what are the most critical conceptual challenges of epidemiological mapping, and where it might improve to engender informed conclusions and aware outcomes.
... nitrogen dioxide (NO 2 ), particulate matter (PM2.5 (< 2.5 μm) and PM10 (< 10 μm)) and ozone (O3) on the COVID-19 fatality rate (Ogen, 2020;Wu et al. 2020a;Wu et al. 2020b;Contini and Costabile, 2020;Boluwade, 2020). Conticini et al. (2020) provided evidence showing that those living in areas with high levels of pollutants are prone to chronic respiratory health conditions and eventual deaths. The authors concluded that a high level of air pollutants should be considered as an additional cofactor in the high level of COVID-19 lethality. ...
... This period was selected to capture COVID-19 deaths at the onset of the pandemic. Longterm exposure to air pollutants can lead to health complications such as chronic respiratory and inflammatory stimulus conditions (Conticini et al., 2020). Therefore, at the onset of the pandemic, this affected population segment will be most heavily impacted due to their pre-existing health conditions. ...
... There have been studies that have attempted to associate important deaths). Consistent exposure to any of these air pollutants has been shown to exacerbate chronic respiratory and inflammatory stimulus conditions (Conticini et al., 2020). Therefore, the following question then arises: If the analysis period was extended to at least 20-30 years preceding the pandemic, would a similar conclusion be reached about the contributions of these explanatory variables? ...
Article
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The COVID-19 caused by the severe acute respiratory syndrome coronavirus was reported in China in December 2019. The transmission and spread of this disease have been linked to poor air quality indicators such as tropospheric nitrogen dioxide (NO2) and dust surface mass concentration particulate matter (PM2.5) as possible contributors. The Arab League has 22 member countries and is home to almost 420 million people. The primary objective of this study is to assess the relationship between NO2, PM2.5 and vertical pressure velocity (hereafter: OMEGA) (extracted from the Modern-Era Retrospective analysis for Research and Applications, Version 2 (MERRA-2) database), socio-economic factors (the population and geographic area of each member country) and COVID-19 deaths using Bayesian model averaging. The total plausible models (25) were estimated. The results show that the posterior inclusion probability (PIP), which indicates the probability that a particular indicator is included in the best model, was 0.74, 0.74, 0.76, 0.34, and 0.46 for OMEGA, PM2.5, NO2, geographical area and population, respectively, meaning that these variables are important contributors in predicting COVID-19 fatalities in the Arab League states. This study shows that atmospheric satellite measurements from MERRA-2 datasets are capable of being used to quantify trace gases in pandemic studies. Keywords: COVID-19, PM2.5, Geospatial Mapping, Bayesian Model Averaging, Nitrogen Dioxide, Arab League States
... Based on this presupposition, it is possible that the air pollution exposure will alter the intensity of the COVID-19 symptoms or help explain the differential-spatial patterns of disease prevalence. Recent surveys have reported that people with severe COVID-19 may already have respiratory disease [15][16][17][18][19][20][21][22]. Recent studies on viral respiratory disease (such as influenza) have shown that an infectious virus can be emitted from infected peoples by speaking even breathing, without sneezing or coughing [23,24]. ...
... The chronic exposure to air pollutants such as PM2.5, SO2 and NO2 causes to reduce lung function, respiratory disease, and cardiovascular disease [22,50,51]. In addition to causing a persistent inflammatory reaction, air pollutants have been shown to increase risk of viruses targeting the respiratory tract, even in relatively young people [16,17]. PM2.5 penetrates into peripheral lung air spaces [52] and can through interaction with the renin-angiotensin system (RAS) facilitate the viral infection. ...
... In addition to the clear overlap between the COVID-19 -induced ARDS symptoms and prolonged air pollution exposure, there is evidence of an association between COVID-19 cases and ozone and nitrogen oxide concentrations [15]. Another study in northern Italy found that air pollutant concentrations may play a role in increasing COVID-19 mortality in that region [16]. Similar evidence in Italy suggests that PM may actually carry virus and thus directly contribute to its spread [64]. ...
Article
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Epidemiological studies have shown that respiratory viral infections have been associated with air pollutants exposure. So that, the increased incidence of SARS-CoV-2 infection and mortality from COVID-19 is related to exposure to urban air pollution. In addition, changes in meteorological parameters have been involved in air pollution and the incidence and development of COVID-19. Although, the molecular mechanisms by which exposure to air pollutants affects COVID-19 are still unknown and it is not yet clear how the virus is transmitted from one sick person to another and why it is so transmissible. Viruses can be probably transmitted through speech and exhalation aerosols. Findings show that SARS-CoV-2 aerosol transmission is possible. Spike (S) proteins of SARS CoV-2 determine tissue tropism using an angiotensin-converting enzyme receptor type2 (ACE-2) to bind to the cells. This mini-review briefly describes the COVID-19 biology and the viral transmission route, and explains the relationship between air pollution exposure and COVID-19, and helps us anticipate the potential role of urban air pollution in the spread of COVID-19.
... In particular, some of the acute health effects include chronic respiratory and cardiovascular diseases (Ghorani-Azam et al., 2016), respiratory infection (e.g. Conticini et al., 2020), and even cancer and death (IOM, 2011;Villeneuve et al., 2013). Polluted air can cause, for example, damage in epithelial cilia , which leads to a chronic inflammatory stimulus (Conticini et al., 2020). ...
... Conticini et al., 2020), and even cancer and death (IOM, 2011;Villeneuve et al., 2013). Polluted air can cause, for example, damage in epithelial cilia , which leads to a chronic inflammatory stimulus (Conticini et al., 2020). It has also been shown that the SARS-CoV-2 can stay viable and infectious on aerosol particles that are smaller than 5 µm in diameter for more than 3 h (van Doremalen et al., 2020). ...
... Xu et al., 2016;Horne et al., 2018;Xie et al., 2019;Phosri et al., 2019). Conticini et al. (2020) concluded that weakened lung defence mechanisms due to continuous exposure to air pollution could partly explain the higher morbidity and mortality 4656 R. S. Sokhi et al.: Advances in air quality research caused by SARS-CoV-2 in areas of poor air quality in Italy. Zhu et al. (2020) used the data of daily confirmed COVID-19 cases, air pollution, and meteorology from 120 cities in China to study the association between the concentrations of ambient air pollutants (PM 2.5 , PM 10 , SO 2 , CO, NO 2 , and O 3 ), and COVID-19 cases. ...
Article
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This review provides a community's perspective on air quality research focusing mainly on developments over the past decade. The article provides perspectives on current and future challenges as well as research needs for selected key topics. While this paper is not an exhaustive review of all research areas in the field of air quality, we have selected key topics that we feel are important from air quality research and policy perspectives. After providing a short historical overview, this review focuses on improvements in characterizing sources and emissions of air pollution, new air quality observations and instrumentation, advances in air quality prediction and forecasting, understanding interactions of air quality with meteorology and climate, exposure and health assessment, and air quality management and policy. In conducting the review, specific objectives were (i) to address current developments that push the boundaries of air quality research forward, (ii) to highlight the emerging prominent gaps of knowledge in air quality research, and (iii) to make recommendations to guide the direction for future research within the wider community. This review also identifies areas of particular importance for air quality policy. The original concept of this review was borne at the International Conference on Air Quality 2020 (held online due to the COVID 19 restrictions during 18–26 May 2020), but the article incorporates a wider landscape of research literature within the field of air quality science. On air pollution emissions the review highlights, in particular, the need to reduce uncertainties in emissions from diffuse sources, particulate matter chemical components, shipping emissions, and the importance of considering both indoor and outdoor sources. There is a growing need to have integrated air pollution and related observations from both ground-based and remote sensing instruments, including in particular those on satellites. The research should also capitalize on the growing area of low-cost sensors, while ensuring a quality of the measurements which are regulated by guidelines. Connecting various physical scales in air quality modelling is still a continual issue, with cities being affected by air pollution gradients at local scales and by long-range transport. At the same time, one should allow for the impacts from climate change on a longer timescale. Earth system modelling offers considerable potential by providing a consistent framework for treating scales and processes, especially where there are significant feedbacks, such as those related to aerosols, chemistry, and meteorology. Assessment of exposure to air pollution should consider the impacts of both indoor and outdoor emissions, as well as application of more sophisticated, dynamic modelling approaches to predict concentrations of air pollutants in both environments. With particulate matter being one of the most important pollutants for health, research is indicating the urgent need to understand, in particular, the role of particle number and chemical components in terms of health impact, which in turn requires improved emission inventories and models for predicting high-resolution distributions of these metrics over cities. The review also examines how air pollution management needs to adapt to the above-mentioned new challenges and briefly considers the implications from the COVID-19 pandemic for air quality. Finally, we provide recommendations for air quality research and support for policy.
... Chronic exposure to air pollution, in its turn, may increase vulnerability of individuals to respiratory infections like COVID-19, since many diseases have environmental pollution as an aggravating factor [12,13]. Exposure to air pollution constitutes a chronic inflammatory stimulus, even for young and healthy individuals, contributing to the increase in hospitalisation rates and mortality [14]. Individuals under chronic exposure to nitrogen dioxide (NO 2 ) and particulate matter (PM) typically show an overexpression of coronaviruses receptor on epithelial cell surfaces of the respiratory tract [15], facilitating the occurrence of infection. ...
... Recent studies reported correlations between mortality by COVID-19 and air pollution in many countries and regions, e.g. North Italy [14,22], England [23], United States [24] and Lima, in Peru [25]. The relationship between air quality and COVID-19 cases is debatable. ...
... Air quality and the possible interactions between air pollution and the increasing risk of COVID-19 health impacts have garnered a lot of attention during the pandemic (Conticinia et al., 2020;Travaglio et al., 2020;Ogen, 2020). Because air quality is worse in cities, it is difficult to know if or to what degree the high rates and severity of infections are due to things like high density living during a pandemic that can be spread through the air or if it is also due to higher levels of aerosols in that air. ...
... Studies need to correct for spatial spillover (Cole et al., 2020) and confounding factors like social deprivation, population density, ethnic composition, age, etc., but the connection is compelling. Conticinia et al. (2020) emphasize that prolonged exposure to air pollution leads to a chronic inflammatory stimulus and that northern Italy, with one of the highest death rates of the virus, also has some of the highest levels of air pollution in Europe (ESA, 2020) (Fig. 2.6.8). ...
Chapter
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Infectious and chronic diseases are issues of concern for public health on a global, regional, and local level. Key to managing these diseases and reducing their impact is having timely, evidence-based knowledge. Earth Observation (EO) provides data at multiple spatial scales and is becoming a vital tool in helping us understand, track, and predict these diseases, allowing public health to proactively plan and implement informed interventions. This chapter offers a preliminary appraisal of geospatial EO data in support of public health and safety measures undertaken during the COVID-19 pandemic.
... The relationship between air quality and COVID-19 was first described by Conticini et al. (2020) in Northern Italy and, according to the authors, the high levels of air pollution in Lombardy and Emilia Romagna might explain why these regions registered the highest level of virus fatality in the world at the beginning of the pandemic. After this study, similar ones were conducted in different regions of the world (Table 1). ...
... It also reveals that, in São Paulo state (Brazil), the fatality rate is a better variable to explore its association with air pollutants' exposure than mortality rate and that PM 2.5 is the best pollutant for such model. The study relevance is highlighted by the use of statistical models, which support the first descriptive associations on the theme (such as that by Conticini et al. in 2020), by using a longer time series to demonstrate the long-term exposure and by the studied area, which has consolidated among the regions with the highest incidence of COVID-19 in the world. Despite this, some limitations should be mentioned. ...
Article
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Since air pollution compromise the respiratory system and COVID-19 disease is caused by a respiratory virus, it is expected that air pollution plays an important role in the current COVID-19 pandemic. Exploratory studies have observed positive associations between air pollution and COVID-19 cases, deaths, fatality, and mortality rate. However, no study focused on Brazil, one of the most affected countries by the pandemic. Thus, this study aimed to understand how long-term exposure to PM10, PM2.5, and NO2 contributed to COVID-19 fatality and mortality rates in São Paulo state in 2020. Air quality data between 2015 and 2019 in 64 monitoring stations within 36 municipalities were considered. The COVID-19 fatality was calculated considering cases and deaths from the government’s official data and the mortality rate was calculated considering the 2020 population. Linear regression models were well-fitted for PM2.5 concentration and fatality (R² = 0.416; p = 0.003), NO2 concentration and fatality (R² = 0.232; p = 0.005), and NO2 concentration and mortality (R² = 0.273; p = 0.002). This study corroborates other authors’ findings and enriches the discussion for having considered a longer time series to represent long-term exposure to the pollutants and for having considered one of the regions with the highest incidence of COVID-19 in the world. Thus, it reinforces measures to reduce the concentration of air pollutants which are essential for public health and will increase the chance to survive in future respiratory disease epidemics.
... Les aérosols jouent un rôle majeur dans les processus physico-chimiques de l'atmosphère qui régissent le climat par diffusion ou absorption directe du rayonnement solaire, ou par des effets indirects tels que la nucléation et les précipitations des gouttelettes de nuages (Slingo 1990;Ramanathan et al. 2001;Mallet et al. 2003;Lewis et al. 2004;Mulcahy et al. 2008;Wang et al. 2014;Mallet et al. 2016;Sroka and Emanuel 2021). D'autre part, les aérosols sont importants pour la biosphère à travers le transport de minéraux dans les régions privées de nutriments, pour la santé publique avec la capacité de transporter des virus (Conticini et al. 2020;Piazzola et al. 2021), et d'autres domaines tel que le transport et la défense où ces particules peuvent affecter la profondeur optique atmosphérique, et donc la visibilité et l'éfficacité des systèmes d'assistance optroniques. De grandes incertitudes sur l'impact de ces particules persistent (Boucher et al. 2013;Zhang et al. 2016;Brooks and Thornton 2018). ...
... Aerosols play a major role in the physicochemical processes of the atmosphere that govern the climate through direct scattering or absorbing of solar radiation, or through indirect effects such as cloud droplet nucleation and precipitation (Slingo 1990;Ramanathan et al. 2001;Mallet et al. 2003;Lewis et al. 2004;Mulcahy et al. 2008;Wang xvii et al. 2014;Mallet et al. 2016;Sroka and Emanuel 2021). Aerosols are also important for Earth's life cycle by transporting minerals in nutrient-deprived areas, for public health with the capacity to transport viruses (Conticini et al. 2020;Piazzola et al. 2021), and can significantly affect visibility by significantly increasing atmospheric optical depth. Large uncertainties on the impact of these particles such as on radiative forcing remain (Boucher et al. 2013;Zhang et al. 2016;Brooks and Thornton 2018). ...
Thesis
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Sea spray droplets are aqueous phase aerosols generated from the water surface. In the open ocean, they are generated as a result of wind-forced wave breaking and surface-tearing mechanisms. To this day, knowledge of sea spray particles larger than 20 µm radius is sparse. The present thesis aims to improve knowledge of the sea spray generation flux, as well as transport and impacts on the properties of the marine atmospheric boundary layer (MABL). To this end, the effects of wind–wave interactions on the surface sea spray generation flux are investigated during the MATE2019 experiment, conducted at the large wave–wind facility in Luminy (Marseille, France). Scaling analysis shows that the sea spray generation is best correlated with the wave-slope variance for thelarger spume droplets generated by surface tearing. For the smaller jet droplets generated by bubble bursting, the highest correlation is found with a nondimensional number combining the wave-slope variance, the wave age, and a windsea Reynolds number. This resulted in the formulation of two wave-state-dependent sea spray generation functions, each valid for wind speeds 12–20 m s-1 and radii 3–35 µm. Upscaled to the field, the laboratory-derived generation functions are parameterized in the MACMod and MESO-NH numerical models, and validated using field data collected during the thesis in the Bay of Biscay for this purpose. Best model performance is found with the laboratory generation functions. Such results are encouraging for the study of sea spray impacts on the properties of the MABL.
... Additionally, SO 2 exposure can make people more susceptible to viral infections of the respiratory tract (Cole et al., 2020). This is due to persistent inflammatory activity in the respiratory system via interleukin-8, interleukin-17, and tumor necrosis factor-α, both in vitro and in vivo (Conticini et al., 2020). This mechanism may explain why individuals exposed to higher SO 2 levels had a higher incidence of COVID-19 in our study. ...
Article
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Air pollution and meteorological factors can exacerbate susceptibility to respiratory viral infections. To establish appropriate prevention and intervention strategies, it is important to determine whether these factors affect the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Therefore, this study examined the effects of sunshine, temperature, wind, and air pollutants including sulfur dioxide (SO2), carbon monoxide (CO), ozone (O3), nitrogen dioxide (NO2), particulate matter ≤2.5 μm (PM2.5), and particulate matter ≤10 μm (PM10) on the age-standardized incidence ratio of coronavirus disease (COVID-19) in South Korea between January 2020 and April 2020. Propensity score weighting was used to randomly select observations into groups according to whether the case was cluster-related, to reduce selection bias. Multivariable logistic regression analyses were used to identify factors associated with COVID-19 incidence. Age 60 years or over (odds ratio [OR], 1.29; 95% CI, 1.24–1.35), exposure to ambient air pollutants, especially SO2 (OR, 5.19; 95% CI, 1.13–23.9) and CO (OR, 1.17; 95% CI, 1.07–1.27), and non-cluster infection (OR, 1.28; 95% CI, 1.24–1.32) were associated with SARS-CoV-2 infection. To manage and control COVID-19 effectively, further studies are warranted to confirm these findings and to develop appropriate guidelines to minimize SARS-CoV-2 transmission.
... Studies conducted on COVID-19 [2,[5][6][7][8] showed that exposure to air pollution could cause severe cardiovascular and respiratory problems. Therefore, there could be a potential relationship between air quality and COVID-19 [9][10][11][12]. ...
Article
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The first case of COVID-19 in Iran was reported on 19 February 2020, 1 month before the Nowruz holidays coincided with the global pandemic, leading to quarantine and lockdown. Many studies have shown that environmental pollutants were drastically reduced with the spread of this disease and the decline in industrial activities. Among these pollutants, nitrogen dioxide (NO2) and carbon monoxide (CO) are widely caused by anthropogenic and industrial activities. In this study, the changes in these pollutants in Iran and its four metropolises (i.e., Tehran, Mashhad, Isfahan, and Tabriz) in three periods from 11 March to 8 April 2019, 2020, and 2021 were investigated. To this end, timeseries of the Sentinel-5P TROPOMI and in situ data within the Google Earth Engine (GEE) cloud-based platform were employed. It was observed that the results of the NO2 derived from Sentinel-5P were in agreement with the in situ data acquired from ground-based stations (average correlation coefficient = 0.7). Moreover, the results showed that the concentration of NO2 and CO pollutants in 2020 (the first year of the COVID-19 pandemic) was 5% lower than in 2019, indicating the observance of quarantine rules, as well as people’s initial fear of the coronavirus. Contrarily, these pollutants in 2021 (the second year of the COVID-19 pandemic) were higher than those in 2020 by 5%, which could have been due to high vehicle traffic and a lack of serious policy- and law-making by the government to ban urban and interurban traffic. These findings are essential criteria that might be used to guide future manufacturing logistics, traffic planning and management, and environmental sustainability policies and plans. Furthermore, using the COVID-19 scenario and free satellite-derived data, it is now possible to investigate how harmful gas emissions influence air quality. These findings may also be helpful in making future strategic decisions on how to cope with the virus spread and lessen its negative social and economic consequences.
... In addition, British researchers have recently shown the link between ultrafine particles found in the human brain and Alzheimer's disease (Maher et al. 2016). Even more, in the context of the current health crisis, researchers have shown that exposure to air pollution is a comorbid factor of SARS-COV-2 (Coccia 2020;Conticini et al. 2020;Ogen 2020;Wu et al. 2020). ...
Article
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Indoor air quality has become a major concern in recent years due to the adverse effects of poor air quality, caused by the presence of several sources of pollutants, on the building occupants’ health. Particle resuspension has been identified as a major indoor particle matter (PM) source in indoor environments. The present work investigated the human walking-induced PM resuspension in a full-scale laboratory experimental chamber. The PM mass concentration was monitored using a Miniwras Grimm counter. The floor of the test chamber was covered with a tufted synthetic carpet and uniformly loaded with neutralized alumina dust. Using the mass-based balance equation and the well-mixed condition hypothesis, resuspension rates were estimated after 10 min of walking activity. Results show that human walking significantly increases the indoor PM10, PM2.5, PM1, and PM0.1 concentrations. The average estimated PM10, PM2.5, PM1, and PM0.1 resuspension rates were (2.5 ± 0.6) × 10⁻¹ h⁻¹, (1.9 ± 0.5) × 10⁻² h⁻¹, (6.5 ± 0.3) × 10⁻³ h⁻¹, and (4.3 ± 0.3) × 10⁻³ h⁻¹, respectively.
... Unfortunately, data on health conditions at the municipality/local-labour-market-level are not available.15 Several studies have shown long-term exposure to particulate matters such as PM10 and PM2.5 to increase health risks (WHO, 2017), whileWu et al. (2020),Becchetti et al. (2020) andConticini et al. (2020) have found a positive link between PM10 and COVID-19-induced mortality. Since data availability on air pollution is an issue, we use provincial-level data on the number of days in a year in which the level of PM10 is above the legal limit of 50 mg/m 3 and match it to local labor markets.16 ...
Article
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Governments around the world have adopted unprecedented policies to deal with COVID‐19. This paper zooms in on business shutdowns and investigates their effectiveness in reducing mortality. We leverage highly granular death registry data for almost 5000 Italian municipalities in a diff‐in‐diff approach that allows us to mitigate endogeneity concerns credibly. Our results, which are robust to controlling for a host of co‐factors, offer strong evidence that business shutdowns effectively curb mortality. We calculate that they may have reduced the death toll from the first wave of COVID‐19 in Italy by about 40%. Our findings also highlight that timeliness is key – by acting 1 week earlier, their effectiveness could have been increased by an additional 5%. Finally, shutdowns should be targeted. Closing service activities with a high degree of interpersonal contact saves the most lives. Shutting down production activities, while substantially reducing mobility, only has mild effects on mortality.
... During the COVID-19 pandemic it has been observed that patients that become infected with SARS-CoV-2 often experience serious complications, including multiorgan failure, septic shock, pulmonary edema, severe pneumonia and respiratory stress, in many cases with fatal consequences [10]. Some authors consider that air pollution could contribute to the severity [7] and mortality [12] of COVID-19. However, the COVID-19 mortality rate (CM) during the first wave varied in different countries and depended, among other things, on the response capacity of countries [28]. ...
Article
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Background The objective of this study was to identify which air pollutants, atmospheric variables and health determinants could influence COVID-19 mortality in Spain. This study used information from 41 of the 52 provinces in Spain (from Feb. 1, 2021 - May 31, 2021). Generalized Linear Models (GLM) with Poisson link were carried out for the provinces, using the Rate of Mortality due to COVID-19 (CM) per 1,000,000 inhabitants as dependent variables, and average daily concentrations of PM10 and NO2 as independent variables. Meteorological variables included maximum daily temperature (Tmax) and average daily absolute humidity (HA). The GLM model controlled for trend, seasonalities and the autoregressive character of the series. Days with lags were established. The relative risk (RR) was calculated by increases of 10 g/m3 in PM10 and NO2 and by 1 ºC in the case of Tmax and 1 g/m3 in the case of HA. Later, a linear regression was carried out that included the social determinants of health. Results Statistically significant associations were found between PM10, NO2 and the CM. These associations had a positive value. In the case of temperature and humidity, the associations had a negative value. PM10 being the variable that showed greater association, with the CM followed of NO2 in the majority of provinces. Anyone of the health determinants considered, could explain the differential geographic behavior. Conclusions The role of PM10 is worth highlighting, as the chemical air pollutant for which there was a greater number of provinces in which it was associated with CM. The role of the meteorological variables- temperature and HA- was much less compared to that of the air pollutants. None of the social determinants we proposed could explain the heterogeneous geographical distribution identified in this study.
... Among the existing problems, it is known that pollution is a major source of health problems [3,12]. Moreover, there seems to be a worrying correlation between air pollution and the dissemination of respiratory infections [11,26,40,59]. More specifically, it appears that more pollution entails a higher risk of a respiratory illness, so minimizing exposure to air pollution (e.g., by reducing the time invested in parking) may help to reduce the spread of these diseases. ...
Article
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Air pollution due to the presence of small particles and gases in the atmosphere is a major cause of health problems. In urban areas, where most of the population is concentrated, traffic is a major source of air pollutants (such as nitrogen oxides or $$\hbox {NO}_x$$ NO x and carbon monoxide or CO). Therefore, for smart cities, carrying out an adequate traffic monitoring is a key issue, since it can help citizens to make better decisions and public administrations to define appropriate policies. Thus, citizens could use these data to make appropriate mobility decisions. In the same way, a city council can exploit the collected data for traffic management and for the establishment of suitable traffic policies throughout the city, such as restricting the traffic flow in certain areas. For this purpose, a suitable modelling approach that provides the estimated/predicted values of pollutants at each location is needed. In this paper, an approach followed to model traffic flow and air pollution dispersion in the city of Zaragoza (Spain) is described. Our goal is to estimate the air quality in different areas of the city, to raise awareness and help citizens to make better decisions; for this purpose, traffic data play an important role. In more detail, the proposal presented includes a traffic modelling approach to estimate and predict the amount of traffic at each road segment and hour, by combining historical measurements of real traffic of vehicles and the use of the SUMO traffic simulator on real city roadmaps, along with the application of a trajectory generation strategy that complements the functionalities of SUMO (for example, SUMO’s calibrators). Furthermore, a pollution modelling approach is also provided, to estimate the impact of traffic flows in terms of pollutants in the atmosphere: an R package called Vehicular Emissions INventories (VEIN) is used to estimate the amount of $$\hbox {NO}_x$$ NO x generated by the traffic flows by taking into account the vehicular fleet composition (i.e., the types of vehicles, their size and the type of fuel they use) of the studied area. Finally, considering this estimation of $$\hbox {NO}_x$$ NO x , a service capable of offering maps with the prediction of the dispersion of these atmospheric pollutants in the air has been established, which uses the Graz Lagrangian Model (GRAL) and takes into account the meteorological conditions and morphology of the city. The results obtained in the experimental evaluation of the proposal indicate a good accuracy in the modelling of traffic flows, whereas the comparison of the prediction of air pollutants with real measurements shows a general underestimation, due to some limitations of the input data considered. In any case, the results indicate that this first approach can be used for forecasting the air pollution within the city.
... Apart from focusing only on the flow dynamics, the effects of various external factors affecting the transmission of respiratory droplets have also been explored broadly. The effects of atmospheric pollution [36], the viability of the 2 m of physical distancing norm [16,22,37], flow dynamics of a turbulent dry cough jet/ puff having contagious pathogen [21], drying time of the respiratory droplets [19,38], the effect of evaporation time of droplets on infection transmission [39][40][41], and the effect of relative humidity and breakup of cough droplets on transmission intensity [16,22] have also been explored widely. Also, recently, the role of the size of water droplets [42] and the effect of evaporation of the water droplets [43] on the survival of the airborne viruses has been discussed. ...
Article
Hypothesis The formation of virus-laden colloidal respiratory microdroplets – the sneeze or cough virulets and their evaporation driven miniaturization in the open air are found to have a significant impact on the community transmission of COVID–19 pandemic. Simulation Details We simulate the motions and trajectories of virulets by employing laminar fluid flow coupled with droplet tracing physics. A force field analysis has been included considering the gravity, drag, and inertial forces to unleash some of the finer features of virulet trajectories leading to the droplet and airborne transmissions of the virus. Furthermore, an analytical model corroborates temperature (T) and relative humidity (RH) controlled droplet miniaturization. Results The study elucidates that the tiny (1-50 µm) and intermediate (60-100 µm) size ranged virulets tend to form bioaerosol and facilitate an airborne transmission while the virulets of larger dimensions (300 to 500 µm) are more prone to gravity dominated droplet transmission. Subsequently, the mapping between the T and RH guided miniaturization of virulets with the COVID–19 cases for six different cities across the globe justifies the significant contribution of miniaturization-based bioaerosol formation for community transmission of the pandemic.
... Second, given that the fatality rates for males are two to three times higher than for females (Porcheddu et al., 2020), that the fatality rate is positively correlated with a larger presence of elderly people (Knittel and Ozaltun, 2020), that nursing homes and hospitals were the locations of the first outbreaks of the pandemic (Barnett and Grabowski, 2020), and that pollution can be an important co-determinant of COVID-19-related fatalities in northern Italy 8 (Coker et al., 2020;Conticini et al., 2020;Dettori et al., 2021), we also control for five measures of vulnerability to the pandemic: the share of male population at the municipality level (share males), the share of population older than 75 years old at the municipality level (share over75), the share of individuals older than 65 years old cohabiting with younger individuals at the municipality level (share cohab over65), the number of hospital beds per inhabitant at the province level (hospital beds pc), and the PM10, defined as the average values of µg/m 3 at the province level (pm10). ...
... UV index, wind speed, pressure, and precipitation also may have an impact on virus transmission (Manik et al., 2022b). Several studies emphasise the correlation between air pollution and COVID-19 transmission (Lembo et al., 2021;Conticini et al., 2020;Al Huraimel et al., 2020). A significant correlation was found between different air pollutant agents and greenhouse gas elements with the cumulative positive number of cases and deaths (Lembo et al., 2021). ...
Article
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Corona Virus Disease 2019 (COVID-19) started in Wuhan province of China in November 2019 and within a short time, it was declared as a worldwide pandemic by World Health Organisation due to the very fast worldwide spread of the virus. There are a few studies that look for the correlation with infected individuals and different environmental parameters using early data of COVID-19 but there is no study so far that deals with the variation of effective reproduction number and environmental factors. Effective reproduction number is the driving parameter of the spread of a pandemic and it is important to study the effect of various environmental factors on effective reproduction number to understand the effect of those factors on the spread of the virus. We have used time-dependent models to investigate the variation of different time-dependent driving parameters of COVID-19 like effective reproduction number and contact rate using data from India as a test case. India is a large population country that is highly affected due to the COVID-19 pandemic and has a wide span of different temperature and humidity regions and is ideal for such study. We have studied the impact of temperature and humidity on the spread of the virus of different Indian states using time-dependent epidemiological models SIRD, and SEIRD for a long time scale. We have used a linear regression method to look for any dependency between the effective reproduction number with the relative humidity, absolute humidity, and temperature. The effective reproduction number shows a negative correlation with both relative and absolute humidity for most of the Indian states, which are statistically significant. This implies that relative and absolute humidity may have an important role in the variation of effective reproduction number. Most of the states (six out of ten) show a positive correlation while two (out of ten) show a negative correlation between effective reproduction number and average air temperature for both SIRD and SEIRD models.
... While the novel corona virus has had catastrophic socioeconomic consequences globally, researchers have theorized that air pollution in highly urbanized areas may have been a cofactor in the development of disease during the pandemic [52,53]. Delnevo et al. ...
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Air pollutants, NO, NO2, and O3, were examined from April to June 2020 and compared to a 10-year (2010–2019) climatology of these pollutants for two monitoring sites in Toronto, Ontario, Canada, coinciding with local lockdown measures during the first wave of the COVID-19 pandemic. NO and NO2 values were lower than any of the preceding 10 years at the two Toronto sites for both weekdays and weekends. Ozone concentrations did not have a corresponding decrease and in fact increased for weekdays, similar to other parts of the world. The well-documented ozone weekend effect was considerably muted during the morning rush hour throughout this pandemic period. A Fisher exact test on hourly averaged data revealed statistically significant record hourly minimums for NO and NO2, but this was not found for ozone, consistent with the aggregate ranking results. These findings are likely the result of considerably reduced vehicular traffic during this time and ozone chemistry in a NOx-saturated (VOC limited) environment. This has important implications for ozone abatement strategies.
... All this has sparked great interest in the scientific community, where numerous studies are being carried out in this area. The role of air quality in the spread of coronavirus has been analysed in different territories: Brazil (Nakada and Urban, 2020), India (Beig et al., 2020;Shehzad et al., 2020;Singh et al., 2020), Italy (Cazzolla-Gatti et al., 2020;Conticini et al., 2020) and China (He et al., 2020;Huang and Sun, 2020;Pei et al., 2020;Wang et al., 2020a;Wu et al., 2021;Yao et al., 2021;Zhao et al., 2020). The influence of meteorological factors on the evolution of the disease has also been studied, focusing on the United States (Dogan et al., 2020;Gupta et al., 2020) or the Eastern Mediterranean (Hochman et al., 2021), with one study even covering a total of 166 countries to draw more precise conclusions . ...
Article
The rapid transmission of COVID-19 has meant that all economic and human efforts have been focused on confronting it, ignoring environmental aspects whose consequences are causing adverse situations all over the planet. The saturation of the sanitary system and confinement measures have multiplied the waste generated, which implies the need to adapt environmental policies to this new situation caused by the pandemic. It is a review article whose objective was to identify the environmental policies that would facilitate an adequate treatment of the waste generated by the pandemic. It was proposed to analyse the current lines of research developed on this paradigm, applying the text mining methodology. A systematic review of 111 studies published in environmental journals indexed in the Web of Science was carried out. The results identified three areas of interest: knowledge of transmission routes, management of the massive generation of plastics and appropriate treatment of solid waste in extreme situations. Leaders are called upon to implement the contingency plans to sustainably alleviate the enormous waste burden caused by society’s adaptation to the restrictions imposed by the pandemic. Specifically, innovation aimed at achieving the reuse of medical products, the promotion of the circular economy and educational campaigns to promote clean environments should be encouraged.
... Most studies are of the ecological type that correlate short and long term exposure to averaged air pollution measurements reported in jurisdictions ranging from metropolitan areas to districts and provinces within specific countries and even comparing results from countries. As examples of ecological type of studies, we have major urban areas in China (Zheng et al. (2021)), county-level study covering the USA (Wu et al. (2020)), Italy (Conticini et al. (2020); Coccia (2021a); Fattorini and Regoli (2020)), Poland (Semczuk-Kaczmarek et al. (2021)), 33 European countries (Lembo et al. (2021)), and OCDE countries (Barnett-Itzhaki and Levi (2021)). Evidently, country-wide studies offer a very coarse and limited capacity for the control of confounders. ...
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... Then, given that the COVID-19 fatality rate is positively correlated with a higher presence of elderly people (Knittel & Ozaltun, 2020), that nursing homes and hospitals were the first epicentres of the pandemic (Alacevich et al., 2020;Barnett & Grabowski, 2020), and that pollution can be an important co-determinant of COVID-19-related fatalities 9 (Becchetti et al., 2020;Cartenì et al., 2020;Coker et al., 2020;Conticini et al., 2020;Wu et al., 2020), we also control for three measures of vulnerability to the pandemic at the LLM level: the population share older than 75 10 years old (share_over75), the number of hospital beds per 1 000 inhabitants (hospital_beds), and the PM10, defined as the average values of μg/m 3 (pm10). ...
Article
Within the much broader framework of global interest, the dilemma concerning the real impact of mode of transport on the spread of COVID-19 has been a priority for transport stakeholders and policy-makers. How dangerous is it to move around a certain territory? Does the danger depend on the mode of transport? By considering a novel and detailed dataset at the level of local labour markets, we analysed the spatial association between the pre-pandemic propensity to use public transport and excess mortality in Italy attributable to the initial spread of COVID-19. We found that places characterised by larger commuting flows exhibit higher excess mortality during the first wave of the pandemic, but observed no significant spatial association between excess mortality and transit usage. Our results were obtained by considering a wide range of heterogeneity in the estimation of quantile regressions across a variety of specifications. Although we do not provide a definitive answer concerning the risk associated with transit use, our analysis suggests that mobility, not modal choice, should be considered a main driver of the initial contagion.
... It has emphasized that improving air quality will play an important role in overcoming the epidemic and mitigating the disease (Conticini et al. 2020). In this context, during the Covid-19 epidemic disease, it has great importance to clarify how much the air pollutant parameters, PM10 (particulate matter 10), PM2.5 (particulate matter 2.5), SO 2 (sulfur dioxide), NO X (nitrogen oxide), NO 2 (nitrogen dioxide), CO (carbon monoxide), and O 3 (ozone) that increase the severity of the disease in humans, affect the number of patients. ...
Article
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The dilemma between health concerns and the economy is apparent in the context of strategic decision making during the pandemic. In particular, estimating the patient numbers and achieving an informed management of the dilemma are crucial in terms of the strategic decisions to be taken. The Covid-19 pandemic presents an important case in this context. Sustaining the efforts to cope with and to put an end to this pandemic requires investigation of the spread and infection mechanisms of the disease, and the factors which facilitate its spread. Covid-19 symptoms culminating in respiratory failure are known to cause death. Since air quality is one of the most significant factors in the progression of lung and respiratory diseases, it is aimed to estimate the number of Covid-19 patients corresponding to the pollutant parameters (PM10, PM2.5, SO2, NOX, NO2, CO, O3) after determining the relationship between air pollutant parameters and Covid-19 patient numbers in Turkey. For this purpose, artificial neural network was used to estimate the number of Covid-19 patients corresponding to air pollutant parameters in Turkey. To obtain highest accuracy levels in terms of network architecture structure, various network structures were tested. The optimal performance level was developed with 15 neurons combined with one hidden layer, which achieved a network performance level as high as 0.97342. It was concluded that Covid-19 disease is affected from air pollutant parameters and the number of patients can be estimated depending on these parameters by this study. Since it is known that the struggle against the pandemic should be handled in all aspects, the result of the study will contribute to the establishment of environmental decisions and precautions.
... Air pollution is a general term that can include fine particulate matter-often categorized by diameter size as less than 2.5 µM (PM 2.5 ) or less than 10 µM (PM 10 )-as well as nitrogen oxide (NO X ), ozone (O 3 ), polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs), sulfur oxides (SO X ), and other contaminants. Epidemiological studies have established broad links between air pollutants and COVID-19 infections and deaths, particularly for PM and NO X [6••, [35][36][37][38][39]. Mechanistically, air pollution may alter COVID-19 susceptibility partially through epigenetic modification of immune system pathways. ...
Article
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Purpose of Review Several environmental contaminants have been implicated as contributors to COVID-19 susceptibility and severity. Immunomodulation and epigenetic regulation have been hypothesized as mediators of this relationship, but the precise underlying molecular mechanisms are not well-characterized. This review examines the evidence for epigenetic modification at the intersection of COVID-19 and environmental chemical exposures. Recent Findings Numerous environmental contaminants including air pollutants, toxic metal(loid)s, per- and polyfluorinated substances, and endocrine disrupting chemicals are hypothesized to increase susceptibility to the SARS-CoV-2 virus and the risk of severe COVID-19, but few studies currently exist. Drawing on evidence that many environmental chemicals alter the epigenetic regulation of key immunity genes and pathways, we discuss how exposures likely perturb host antiviral responses. Specific mechanisms vary by contaminant but include general immunomodulation as well as regulation of viral entry and recognition, inflammation, and immunologic memory pathways, among others. Summary Associations between environmental contaminants and COVID-19 are likely mediated, in part, by epigenetic regulation of key immune pathways involved in the host response to SARS-CoV-2.
... The different susceptibility of people of different sexes and ages might be related to their physiological characteristics and lifestyle. Elder individuals with weak immune systems and chronic underlying diseases might be more sensitive to air-pollution exposure [49,50]. ...
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Previous studies found that exposure to ambient nitrogen dioxide (NO2) was associated with an increased risk of incident stroke, but few studies have been conducted for relatively low NO2 pollution areas. In this study, the short-term effects of NO2 on the risk of incident stroke in a relatively low-pollution area, Enshi city of Hubei Province, China, were investigated through time-series analysis. Daily air-pollution data, meteorological data, and stroke incidence data of residents in Enshi city from 1 January 2015 to 31 December 2018 were collected. A time-series analysis using a generalised additive model (GAM) based on Poisson distribution was applied to explore the short-term effects of low-level NO2 exposure on the risk of incident stroke and stroke subtypes, as well as possible age, sex, and seasonal differences behind the effects. In the GAM model, potential confounding factors, such as public holidays, day of the week, long-term trends, and meteorological factors (temperature and relative humidity), were controlled. A total of 9122 stroke incident cases were included during the study period. We found that NO2 had statistically significant effects on the incidence of stroke and ischemic stroke, estimated by excess risk (ER) of 0.37% (95% CI: 0.04–0.70%) and 0.58% (95% CI: 0.18–0.98%), respectively. For the cumulative lag effects, the NO2 still had a statistically significant effect on incident ischemic stroke, estimated by ER of 0.61% (95% CI: 0.01–1.21%). The two-pollutant model showed that the effects of NO2 on incident total stroke were still statistically significant after adjusting for other air pollutants (PM2.5, PM10, SO2, CO, and O3). In addition, the effects of NO2 exposure on incident stroke were statistically significant in elderly (ER = 0.75%; 95% CI: 0.11–1.40%), males (ER = 0.47%; 95% CI: 0.05–0.89%) and cold season (ER = 0.83%; 95% CI: 0.15–1.51%) subgroups. Our study showed that, as commonly observed in high-pollution areas, short-term exposure to low-level NO2 was associated with an increased risk of incident stroke, including ischemic stroke. Males and elderly people were more vulnerable to the effects of NO2, and the adverse effects might be promoted in the cold season.
... The evidence for the association between air pollution and COVID-19 severity is getting stronger, suggesting that the potential chronic exposure to air pollution might increase the susceptibility to COVID-19; nevertheless, the potential association between PM 10 exposure and SARS-CoV-2 spreading remains unclear (Bontempi, 2020;Cao et al., 2021;Conticini et al., 2020;Copat et al., 2020;Veronesi et al., 2022;Zheng et al., 2021). ...
Article
Particulate matter (PM) may play a role in differential distribution and transmission rates of SARS-CoV-2. For public health surveillance, identification of factors affecting the transmission dynamics concerning the endemic (persistent sporadic) and epidemic (rapidly clustered) component of infection can help to implement intervention strategies to reduce the disease burden. The aim of this study is to assess the effect of long-term residential exposure to outdoor PM ≤ 10 μm (PM10) concentrations on SARS-CoV-2 incidence and on its spreading dynamics in Marche region (Central Italy) during the first wave of the COVID-19 pandemic (February to May 2020), using the endemic-epidemic spatio-temporal regression model for individual-level data. Environmental and climatic factors were estimated at 10 km² grid cells. 10-years average exposure to PM10 was associated with an increased risk of new endemic (Rate Ratio for 10 μg/m³ increase 1.14, 95%CI 1.04–1.24) and epidemic (Rate Ratio 1.15, 95%CI 1.08–1.22) infection. Male gender, older age, living in Nursing Homes and Long-Term Care Facilities residence and socio-economic deprivation index increased Rate Ratio (RR) in epidemic component. Lockdown increased the risk of becoming positive to SARS-CoV-2 as concerning endemic component while it reduced virus spreading in epidemic one. Increased temperature was associated with a reduction of endemic and epidemic infection. Results showed an increment of RR for exposure to increased levels of PM10 both in endemic and epidemic components. Targeted interventions are necessary to improve air quality in most polluted areas, where deprived populations are more likely to live, to minimize the burden of endemic and epidemic COVID-19 disease and to reduce unequal distribution of health risk.
... People living in disadvantaged areas (e.g., areas with low socio-economic status, with poor access to sanitation and hand washing facilities and those who were marginalized were) were at higher risk of COVID-19 when compared to those living in more affluent areas (Fatima et al., 2021;Macharia et al., 2020). On the other hand, densely populated cities, especially in resource-poor countries, were at high risk of COVID-19 (Conticini et al., 2020;Cordes & Castro, 2020;Fattorini & Regoli, 2020;Karmakar et al., 2021;Zhu et al., 2020). ...
Article
Many studies have associated the dynamics of diseases’ prevalence with differences in social, economic and demographic status, but it is not yet clear if the same variables explain the spatial distribution of COVID-19 infections in parts of sub-Saharan Africa. This study assessed the spatial spread of COVID-19 infections in relation to socio-demographic risk factors in a typical administrative state – a relatively typical ethnocentric community – in Southwestern Nigeria. Data used were socio-demographics, income variables, COVID-19 status and travel history of 40,300 households. Data were analysed for frequency, prevalence and spatial distributions. The results revealed that COVID-19 cases were heterogeneously distributed within the state. The number of cases was relatively higher in the north and south-eastern parts of the State than in other areas. Male respondents had a higher prevalence (3.7%) of COVID-19 cases compared to their female (2.4%) counterparts. Transmission was most dominant among respondents aged above 70 years old (3.5%), widowed (3.3%) and those who lived in households with between 6 and 10 (4.9%) members. Transmission was also relatively high among those with travel history within the State (9.1%), those that aquired tertiary education (3.8%) and selfemployed (3.0%). The study associated imbalanced socio-economic distributions to a diverse range of COVID-19 transmission in the area and therefore advocated for improved policy on residents’ education and sustainable living.
... People living in disadvantaged areas (e.g., areas with low socio-economic status, with poor access to sanitation and hand washing facilities and those who were marginalized were) were at higher risk of COVID-19 when compared to those living in more affluent areas (Fatima et al., 2021;Macharia et al., 2020). On the other hand, densely populated cities, especially in resource-poor countries, were at high risk of COVID-19 (Conticini et al., 2020;Cordes & Castro, 2020;Fattorini & Regoli, 2020;Karmakar et al., 2021;Zhu et al., 2020). ...
Article
Full-text available
Many studies have associated the dynamics of diseases’ prevalence with differences in social, economic and demographic status, but it is not yet clear if the same variables explain the spatial distribution of COVID -19 infections in parts of sub-Saharan Africa. This study assessed the spatial spread of COVID-19 infections in relation to socio-demographic risk factors in a typical administrative state – a relatively typical ethnocentric community – in Southwestern Nigeria. Data used were socio-demographics, income variables, COVID-19 status and travel history of 40,300 households. Data were analysed for frequency, prevalence and spatial distributions. The results revealed that COVID-19 cases were heterogeneously distributed within the state.©The number of cases was relatively higher in the north and south-eastern parts of the State than in other areas. Male respondents had a higher prevalence (3.7%) of COVID-19 cases compared to their female (2.4%) counterparts. Transmission was most dominant among respondents aged above 70 years old (3.5%), widowed (3.3%) and those who lived in households with between 6 and 10 (4.9%) members. Transmission was also relatively high among those with travel history within the State (9.1%), attained tertiary education (3.8%) and self-employed (3.0%). The study associated imbalanced socio-economic distributions to a diverse range of COVID-19 transmission in the area and therefore advocated for improved policy on residents’ education and sustainable living.
... Long-term exposure to air pollution has been hypothesized to worsen COVID-19 outcomes because the pollution may be suppressing the early immune responses to infection (Conticini et al. 2020;Hu et al. 2021). Many studies have shown the relation between long-term exposure to air pollution and COVID19 mortality (Cole et al. 2020;Liang et al. 2020). ...
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Foundry workers face a number of occupational health hazards, which may lead to an increased risk of respiratory disease, cancer, and anxiety level and are associated with endocrine, hematologic, renal, and neurological problems in humans. This study aims to evaluated thyroid functions, glutathione level, and the risk of infection with SARS-CoV-2 after vaccinated (two doses of the BNT162b2 mRNA COVID-19 vaccine) foundry workers in Jordan. We examined the efficacy BNT162b2 vaccine by calculating the rate of mortality and the degree of severity from mild to severe respiratory infections in 105 adult males foundry workers occupationally exposed to metals and Pb who had been received two doses, 21 days apart, of the BNT162b2 vaccine. Seventy-five male subjects not exposed to the Pb and who received two shots of the BNT162b2 vaccine (Pfizer–BioNTech) served as the control group. In foundry workers who were infected with COVID-19, the mortality rate (0%) was similar as in the control group (0%), and increased transmission of infection with SARS-CoV-2; the non-hospitalized infections increased nearly 3.4-times and hospitalized infections increased 4.29-times among people exposed to lead and metal contamination compared to the healthy persons control group. Also, among the foundry workers, the blood lead, FT3, and FT4 levels were significantly higher (p < 0.0001) and the levels of glutathione and TSH were significantly decreased (p < 0.0001) compared with the control group. In conclusion, long-term exposure to Pb is associated with a risk of infection with COVID-19 despite the 2 doses of the BNT162b2 vaccine (Pfizer–BioNTech). Also, exposure to Pb is associated with hyperthyroidism and a reduction in glutathione.
... In the 2003 study of SARS, ecologic analysis conducted among 5 regions in China with 100 or more SARS cases showed that case fatality rate increased with the increment of air pollution index (Cui, Zhang, Froines, et al. , 2003). The higher the concentration of fine particulate matter (PM2.5), the higher the death rate (Conticini, Frediani, & Caro, 2020). As researchers, Xiao Wu, Rachel C. Nethery and colleagues (2020) from the Harvard T.H. Chan School of Public Health point out: ...
Article
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Most likely, COVID-19 disease will become endemic because the SARS-CoV-2 virus will continuously mutate. To reduce future infections, the focus of interventions should 1) reduce virus exposure, 2) vaccinate to activate the immune system, and 3) enhance the innate immune system competence. Public Health policies need to focus on intervention strategies and positive health behaviors that optimize the immune system capacity to respond; since, comorbidity such as obesity, diabetes, cardiovascular disease and other chronic diseases are the significant risk factors that contribute to COVID-19 deaths. The focus needs to be on incorporate behavioral medicine prescriptions supporting a healthy lifestyle into treatment plans, such as increasing vitamin D, eating organic locally grown vegetable and fruits foods, exercise and stress management.
... In Italia, si è ben presto affacciata l'ipotesi di una relazione tra la diffusione del morbo e l'inquinamento atmosferico 2 poiché le regioni maggiormente colpite sono le regioni del Nord, in particolare la Lombardia, ma in generale la pianura padana tutta, definita una delle aree geografiche più inquinate d'Europa (Fares et al. 2020). Uno studio di Conticini et al. (2020) sottolinea come un'esposizione prolungata all'inquinamento atmosferico conduca a uno stimolo infiammatorio cronico non solamente gli anziani spesso affetti da pluripatologie, ma anche soggetti giovani e sani. Ciò potrebbe rappresentare, quindi, una concausa dell'elevata incidenza di mortalità se nello stesso ambiente viene a svilupparsi un agente virale molto contagioso come SARS-CoV-2. ...
Article
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An economic-financial crisis like the one that has arisen from the epidemiological emergency from Covid-19 means that every undertaking must consider themselves 'in potential crisis'.
... pollution may increase the risk of hospitalization among individuals infected by COVID-19 and subsequently leading to death (Bowe et al., 2021;Wu et al., 2020a). Several pathways explained the connection between hospitalization and death due to COVID-19 with long-term exposure to air pollution (Conticini et al., 2020). The increased risks of diabetes and atherosclerosis are associated with long-term exposure to air pollution . ...
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Exposure to air pollution can exacerbate the severe COVID-19 conditions, subsequently causing an increase in the death rate. In this study, we investigated the association between long-term exposure to air pollution and risks of COVID-19 hospitalization and mortality in Arak, Iran. Air pollution data was obtained from air quality monitoring stations located in Arak, including particulate matter (PM), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3) and carbon monoxide (CO). Daily numbers of Covid-19 cases including hospital admissions (hospitalization) and deaths (mortality) were obtained from a national data registry recorded by Arak University of Medical Sciences. A Poisson regression model with natural spline functions was applied to set the effects of air pollution on COVID-19 hospitalization and mortality. The percent change of COVID-19 hospitalization per 10 μg/m³ increase in PM2.5 and PM10 were 8.5% (95% CI 7.6 to 11.5) and 4.8% (95% CI 3 to 6.5), respectively. An increase of 10 μg/m³ in PM2.5 resulting in 5.6% (95% CI: 3.1–8.3%) increase in COVID-19 mortality. The percent change of hospitalization (7.7%, 95% CI 2.2 to 13.3) and mortality (4.5%, 95% CI 0.3 to 9.5) were positively significant per one ppb increment in SO2, while NO2, O3 and CO were inversely associated with hospitalization and mortality. Our findings strongly suggesting that a small increase in long-term exposure to PM2.5, PM10 and SO2 elevating risks of hospitalization and mortality related to COVID-19.
Article
The scare of the ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), does not seem to fade away, while there is a constant emergence of novel deadly variants including Alpha, Beta, Gamma, Delta and Omicron. Until now, it has claimed approximately 276,436,619 infections, and the number of deaths surpluses to 5,374,744 all over the world. While saving the life has been a priority during the ongoing SARS-CoV-2 pandemic, the post-infection healing and getting back to normalcy has been undermined. Improving general health conditions and immunity with nutritional adequacy is currently of precedence for the government as well as frontline health workers to prevent and assuage infections. Exploring the role of probiotics and prebiotics in managing the after-effects of a viral outbreak could be of great significance, considering the emergence of new variants every now and then. To enhance human immunity, the recent evidence on the connection between gut microbiota and the broad spectrum of the clinical COVID-19 disease is the reason to look at the benefits of probiotics in improving health conditions. This review aims to sketch out the prospective role of probiotics and prebiotics in improving the standard of health in common people.
Article
There is a need to improve the understanding of air quality parameters and meteorological conditions on the transmission of SARS-CoV-2 in different regions of the world. In this preliminary study, we explore the relationship between short-term air quality (nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and particulate matter (PM2.5, PM10)) exposure, temperature, humidity, and wind speed on SARS-CoV-2 transmission in 41 cities of Turkey with reported weekly cases from February 8 to April 2, 2021. Both linear and non-linear relationships were explored. The nonlinear association between weekly confirmed cases and short-term exposure to predictor factors was investigated using a generalized additive model (GAM). The preliminary results indicate that there was a significant association between humidity and weekly confirmed COVID-19 cases. The cooler temperatures had a positive correlation with the occurrence of new confirmed cases. The low PM2.5 concentrations had a negative correlation with the number of new cases, while reducing SO2 concentrations may help decrease the number of new cases. This is the first study investigating the relationship between measured air pollutants, meteorological factors, and the number of weekly confirmed COVID-19 cases across Turkey. There are several limitations of the presented study, however, the preliminary results show that there is a need to understand the impacts of regional air quality parameters and meteorological factors on the transmission of the virus.
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Efforts to prevent the spread of the COVID-19 pandemic have had profound positive and negative impacts on social and environmental indicators worldwide. For the first time, a scenario of a partial economic shutdown could be measured, and large tech companies published wide-coverage mobility reports to quantify the impacts on social change with anonymised location data. During the COVID-19 pandemic, the UK government has employed some of the strictest lockdown periods in the world, causing an immediate halt to travel and business activities. From these repeated lockdown periods we have gained a snapshot of life without excessive human-made pollution, this has allowed us to interrogate the interaction between meteorology and air quality with minimal anthropogenic input. Our findings show a warmer 2020 increased the UK’s Ozone levels by 9%; while reductions in human-mobility reduced UK-wide Nitrogen Dioxide levels by 25% in 2020, which have remained low during the first months of 2021 despite curtailing/ending of restrictions; and a decrease in Particulate Matter created by meteorological and human drivers. Regionally, London records the highest NO2 and O3 changes, -31% and 35%, respectively, linked to mobility reductions and meteorology.
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This article presents outcomes from a Workshop entitled “Bioarchaeology: Taking Stock and Moving Forward,” which was held at Arizona State University (ASU) on March 6–8, 2020. Funded by the National Science Foundation (NSF), the School of Human Evolution and Social Change (ASU), and the Center for Bioarchaeological Research (CBR, ASU), the Workshop's overall goal was to explore reasons why research proposals submitted by bioarchaeologists, both graduate students and established scholars, fared disproportionately poorly within recent NSF Anthropology Program competitions and to offer advice for increasing success. Therefore, this Workshop comprised 43 international scholars and four advanced graduate students with a history of successful grant acquisition, primarily from the United States. Ultimately, we focused on two related aims: (1) best practices for improving research designs and training and (2) evaluating topics of contemporary significance that reverberate through history and beyond as promising trajectories for bioarchaeological research. Among the former were contextual grounding, research question/hypothesis generation, statistical procedures appropriate for small samples and mixed qualitative/quantitative data, the salience of Bayesian methods, and training program content. Topical foci included ethics, social inequality, identity (including intersectionality), climate change, migration, violence, epidemic disease, adaptability/plasticity, the osteological paradox, and the developmental origins of health and disease. Given the profound changes required globally to address decolonization in the 21st century, this concern also entered many formal and informal discussions.
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The SARS-CoV-2 pandemia had stimulated the numerous publications emergence on the α1-proteinase inhibitor (α1-PI, α1-antitrypsin), primarily when it was found that high mortality in some regions corresponded to the regions with deficient α1-PI alleles. By analogy with the last century's data, when the root cause of the α1-antitrypsin, genetic deficiency leading to the elastase activation in pulmonary emphysema, was proven. It is evident that proteolysis hyperactivation in COVID-19 may be associated with α1-PI impaired functions. The purpose of this review is to systematize scientific data, critical directions for translational studies on the role of α1-PI in SARS-CoV-2-induced proteolysis hyperactivation as a diagnostic marker and a target in therapy. This review describes the proteinase-dependent stages of a viral infection: the reception and virus penetration into the cell, the plasma aldosterone-angiotensin-renin, kinins, blood clotting systems imbalance. The ACE2, TMPRSS, ADAM17, furin, cathepsins, trypsin- and elastase-like serine proteinases role in the virus tropism, proteolytic cascades activation in blood, and the COVID-19-dependent complications is presented. The analysis of scientific reports on the α1-PI implementation in the SARS-CoV-2-induced inflammation, the links with the infection severity, and comorbidities were carried out. Particular attention is paid to the acquired α1-PI deficiency in assessing the patients with the proteolysis overactivation and chronic non-inflammatory diseases that are accompanied by the risk factors for the comorbidities progression, and the long-term consequences of COVID-19 initiation. Analyzed data on the search and proteases inhibitory drugs usage in the bronchopulmonary cardiovascular pathologies therapy are essential. It becomes evident the antiviral, anti-inflammatory, anticoagulant, anti-apoptotic effect of α1-PI. The prominent data and prospects for its application as a targeted drug in the SARS-CoV-2 acquired pneumonia and related disorders are presented.
Several epidemiologic and toxicological studies have commonly viewed ambient fine particulate matter (PM2.5), defined as particles having an aerodynamic diameter of less than 2.5 µm, as a significant potential danger to human health. PM2.5 is mostly absorbed through the respiratory system, where it can infiltrate the lung alveoli and reach the bloodstream. In the respiratory system, reactive oxygen or nitrogen species (ROS, RNS) and oxidative stress stimulate the generation of mediators of pulmonary inflammation and begin or promote numerous illnesses. According to the most recent data, fine particulate matter, or PM2.5, is responsible for nearly 4 million deaths globally from cardiopulmonary illnesses such as heart disease, respiratory infections, chronic lung disease, cancers, preterm births, and other illnesses. There has been increased worry in recent years about the negative impacts of this worldwide danger. The causal associations between PM2.5 and human health, the toxic effects and potential mechanisms of PM2.5, and molecular pathways have been described in this review.
The COVID-19 epidemic has emerged as one of the biggest challenges, and the world is focused on preventing and controlling COVID-19. Although there is still insufficient understanding of how environmental conditions may impact the COVID-19 pandemic, airborne transmission is regarded as an important environmental factor that influences the spread of COVID-19. The natural ventilation potential (NVP) is critical for airborne infection control in the micro-built environment, where infectious and susceptible people share air spaces. Taking Wuhan as the research area, we evaluated the NVP in residential areas to combat COVID-19 during the outbreak. We determined four fundamental residential area layouts (point layout, parallel layout, center-around layout, and mixed layout) based on the semantic similarity model for point of interest (POI) picking. Our analyses indicated that the center-around and point layout had a higher NVP, while the mixed and parallel layouts had a lower NVP in winter and spring. Further analysis showed that the proportion of the worst NVP has been rising, while the proportion of the poor NVP remains very high in Wuhan. This study suggested the need to efficiently improve the residential area layout in Wuhan for better urban ventilation to combat COVID-19 without losing other benefits.
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Respiratory infectious diseases (e.g., COVID-19) have brought huge damages to human society, and the accurate prediction of their transmission trends is essential for both the health system and policymakers. Most related studies focus on epidemic trend forecasting at the macroscopic level, which ignores the microscopic social interactions among individuals. Meanwhile, current microscopic models are still not able to sufficiently decipher the individual-based spreading process and lack valid quantitative tests. To tackle these problems, we propose an exposure-risk-based model at the microscopic level, including 4 modules: individual movement, virion-laden droplet movement, individual exposure risk estimation, and prediction of transmission trends. Firstly, the front two modules reproduce the movements of individuals and the droplets of infectors’ expiratory activities, respectively. Then, the outputs are fed to the third module to estimate the personal exposure risk. Finally, the number of new cases is predicted in the final module. By predicting the new COVID-19 cases in the United States, the performances of our model and 4 other existing macroscopic or microscopic models are compared. Specifically, the mean absolute error, root mean square error, and mean absolute percentage error provided by the proposed model are respectively 2,454.70, 3,170.51, and 3.38% smaller than the minimum results of comparison models. The quantitative results reveal that our model can accurately predict the transmission trends from a microscopic perspective, and it can benefit the further investigation of many microscopic disease transmission factors (e.g., non-walkable areas and facility layouts).
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Louisiana (LA) ranks fifth in the United States in cancer mortality rate. LA's infamous “cancer alley” is a well evidenced region near the southeast part of the Mississippi river surrounding the petrochemical hub of the state. LA has also experienced a high COVID‐19 death rate and incidences compared to other states during the recent pandemic. In this study we analyzed publicly available datasets related to health and socio‐economic parameters in LA to determine the factors triggering high incidences and deaths caused by COVID‐19. Correlation analysis was performed to find the impact of different parameters on the outcome of COVID‐19. Our analysis showed higher COVID‐19 incidences in the parishes which are in and around the “cancer alley” with a correlation of r = 0.9. Interestingly, results also indicated a strong correlation (r = 0.9) between the death rates caused by asbestos toxicity to COVID‐19 caused death rate. Furthermore, we found that office‐administration related employment has a positive correlation to COVID‐19 incidences in the “cancer alley.” However, we also found both white and black races are equally affected by the COVID‐19 pandemic in the “cancer alley” region. In conclusion, our analysis strongly suggests that inhabiting “cancer alley” could significantly enhance the chances of getting affected by SARS‐CoV‐2 virus compared to other regions in LA.
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El objetivo de este estudio fue determinar la asociación espacial entre casos de COVID-19 y la concentración de material particulado (PM10 y PM2.5) y estimar el impacto de la densidad poblacional, el índice verde, y el número de centros de salud en Bogotá (Colombia). Se emplearon los índices global (IM) y local (LISA) de Moran para determinar la asociación espacial y se aplicó el método SHAP para estimar el impacto. Los resultados revelaron una autocorrelación espacial positiva moderada (IM=0.303) para el PM10 y débil (IM=0.159) para el PM2.5. Según el LISA, las asociaciones alto–alto de PM y el número de casos COVID-19 se presentaron en el suroccidente de la ciudad de Bogotá y las bajo–bajo en el nororiente. Las variables que más impactaron fueron, en orden, densidad poblacional, números de centros de salud y CPM10. Se concluye que existe una autocorrelación espacial entre PM10 y PM2.5 y el número de casos COVID-19, especialmente con el PM10.
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The COVID-19 pandemic has posed an unprecedented challenge to public health across the world and has further exposed health disparities and the vulnerability of marginal groups. Since the pandemic has exhibited marked regional differences, it is necessary to better understand the levels of vulnerability to the disease at local levels and provide policymakers with additional tools that will allow them to develop finely targeted policies. In this study, we develop for the State of Alabama (USA) a composite vulnerability index at county level that can be used as a tool that will help in the management of the pandemic. Twenty-four indicators were assigned to the following three categories: exposure, sensitivity, and adaptive capacity. The resulting subindices were aggregated into a composite index that depicts the vulnerability to COVID-19. A multivariate analysis was used to assign factor loadings and weights to indicators, and the results were mapped using Geographic Information Systems. The vulnerability index captured health disparities very well. Many of the most vulnerable counties were found in the Alabama Black Belt region. A deconstruction of the overall index and subindices allowed the development of individual county profiles and the detection of local strengths and weaknesses. We expect the model developed in this study to be an efficient planning tool for decision-makers.
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COVID-19, one of the greatest health challenges of the present century, has infected millions of people and caused more than 6 million deaths worldwide. The causative agent of this disease is the new virus SARS-CoV-2; which continues to spread globally and sometimes with new and more complex aspects than before. The present study is an observational study aimed to investigate the role of AQI; PM2.5 and its relationship with the incidence of suspected cases (SC) and positive cases (PC) of COVID-19 at different levels of the air quality index (AQI) in Tehran, the capital of Iran in the period from Feb 20th, 2020 to Feb 22nd, 2021. Data on AQI were collected online from the air monitoring website of Air Quality Control Company under the supervision of Tehran Municipality. The data on suspected and positive cases were obtained from the Iranian Ministry of Health. The results and statistical analysis (Pearson correlation test) showed that with the increase of AQI level, the number of suspected cases (SC) and positive cases (PC), also increased (P-value<0.01). The average daily number of suspected and positive COVID-19 cases referred to medical centers, at different levels of the AQI was as follows: level II: yellow, moderate (SC: Nave = 466; PC: Nave = 223), level III: orange, unhealthy for sensitive groups (SC: Nave = 564; PC: Nave = 275), and Level IV: red, unhealthy (SC: Nave = 558; PC: Nave = 294). The results of the GEE for seasonal comparison (winter as reference season), showed that there is an epidemiological pattern in autumn with colder weather compared to other seasons in both suspected (Cl: %95, B = 408.94) and positive (Cl: %95, B = 83.42) cases of COVID-19. The results of this study will serve policymakers as an informative tool for guidance on the importance of the role of air pollution in viral epidemics.
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Since late 2019 many people all over the world have become infected and have died due to coronavirus. There have been many general studies about the spread of the virus. In this study, new and accumulated confirmed cases (NCC and ACC), new and accumulated recovered cases (NRC and ARC), and new and accumulated deaths (ND and AD) were evaluated by geographical properties, meteorological parameters and air particulate matters between 3 April 2020 and 11 June 2020 within 15 provinces in Iran. Meteorological parameters, air particulate matters and COVID-19 data were collected from Iran Meteorological Organization, the Environmental Protection Agency and Aftabnews website, respectively. The results of the study show that provinces in dry lands (i.e., Kerman and South Khorasan) not only had low admission of NCC, ACC, ARC and AD but also presented lower rates of NCC, ACC and AD per 105 population. Air temperature showed positive and significant correlation with the number of COVID-19 cases. This is because of hot outdoor air especially in costal and equatorial regions that forces people to stay in closed environments with no ventilation and with closed-cycle air conditioners. Maximum air pressure was found to be the most frequent (66%) and significant parameter correlating with health outcomes associated with COVID-19. The most engaged province in this study was Khuzestan, while provinces in dry lands (i.e., Kerman and South Khorasan) showed low number of health endpoints associated with COVID-19. The highest rate of accumulated and new recovered cases per 105 population were also found in Khuzestan and Kerman provinces. North Khorasan also showed the worst rate of N&ARC/105 population. Therefore, air temperature, dry lands and population were the most important factors for the control of coronavirus spread.
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Respiratory infectious diseases (e.g., COVID-19) have brought huge damages to human society, and the accurate prediction of their transmission trends is essential for both the health system and policymakers. Most related studies focus on epidemic trend forecasting at the macroscopic level, which ignores the microscopic social interactions among individuals. Meanwhile, current microscopic models are still not able to sufficiently decipher the individual-based spreading process and lack valid quantitative tests. To tackle these problems, we propose an exposure-risk-based model at the microscopic level, including 4 modules: individual movement, virion-laden droplet movement, individual exposure risk estimation, and prediction of transmission trends. Firstly, the front two modules reproduce the movements of individuals and the droplets of infectors’ expiratory activities, respectively. Then, the outputs are fed to the third module to estimate the personal exposure risk. Finally, the number of new cases is predicted in the final module. By predicting the new COVID- 19 cases in the United States, the performances of our model and 4 other existing macroscopic or microscopic models are compared. Specifically, the mean absolute error, root mean square error, and mean absolute percentage error provided by the proposed model are respectively 2454.70, 3170.51, and 3.38% smaller than the minimum results of comparison models. The quantitative results reveal that our model can accurately predict the transmission trends from a microscopic perspective, and it can benefit the further investigation of many microscopic disease transmission factors (e.g., non-walkable areas and facility layouts).
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Efforts to prevent the spread of the coronavirus disease 2019 (COVID‐19) pandemic have had profound positive and negative impacts on social and environmental indicators worldwide. For the first time, a scenario of a partial economic shutdown could be measured, and large tech companies published wide‐coverage mobility reports to quantify the impacts on social change with anonymized location data. During the COVID‐19 pandemic, the UK government has employed some of the strictest lockdown periods in the world, causing an immediate halt to travel and business activities. From these repeated lockdown periods, we have gained a snapshot of life without excessive human‐made pollution; this has allowed us to interrogate the interaction between meteorology and air quality with minimal anthropogenic input. Our findings show a warmer 2020 increased the UK's ozone levels by 9%, while reductions in human‐mobility reduced UK‐wide nitrogen dioxide levels by 25% in 2020, which have remained low during the first months of 2021 despite curtailing/ending of restrictions; and a decrease in particulate matter created by meteorological and human drivers. Regionally, London records the highest NO2 and O3 changes, −31% and 35%, respectively, linked to mobility reductions and meteorology. First lockdown observed the highest nitrogen dioxide reduction. Nitrogen dioxide and particulate matter reductions linked to reduced mobility. London records highest nitrogen dioxide and ozone changes.
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As a result of extreme modifications in human activity during the COVID-19 pandemic, the status of air quality has recently been improved. This bibliometric study was conducted on a global scale to quantify the impact of the COVID-19 pandemic on air pollution, identify the emerging challenges, and discuss the future perspectives during the course of the ongoing COVID-19 pandemic. For this, we have estimated the scientific production trends between 2020 and 2021 and investigated the contributions of countries, institutions, authors, and most prominent journals metrics network analysis on the topic of COVID-19 combined with air pollution research spanning the period between January 01, 2020, and June 21, 2021. The search strategy retrieved a wide range of 2003 studies published in scientific journals from the Web of Sciences Core Collection (WoSCC). The findings indicated that (1) publications on COVID-19 pandemic and air pollution were 990 (research articles) in 2021 with 1870 citations; however, the year 2020 witnessed only 830 research articles with a large number 16,600 of citations. (2) China ranked first in the number of publications (n = 365; 18.22% of the global output) and was the main country in international cooperation network, followed by the USA (n = 278; 13.87% of the global output) and India (n = 216; 10.78 of the total articles). (3) By exploring the co-occurrence and links strengths of keywords "COVID-19" (1075; 1092), "air pollution" (286; 771), "SARS-COV-2" (252; 1986). (4) The lessons deduced from the COVID-19 pandemic provide defined measures to reduce air pollution globally. The outcomes of the present study also provide useful guidelines for future research programs and constitute a baseline for researchers in the domain of environmental and health sciences to estimate the potential impact of the COVID-19 pandemic on air pollution.
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Background: In December 2019, coronavirus disease 2019 (COVID-19) emerged in Wuhan and rapidly spread throughout China. Methods: Demographic and clinical data of all confirmed cases with COVID-19 on admission at Tongji Hospital from January 10 to February 12, 2020, were collected and analyzed. The data of laboratory examinations, including peripheral lymphocyte subsets, were analyzed and compared between severe and non-severe patients. Results: Of the 452 patients with COVID-19 recruited, 286 were diagnosed as severe infection. The median age was 58 years and 235 were male. The most common symptoms were fever, shortness of breath, expectoration, fatigue, dry cough and myalgia. Severe cases tend to have lower lymphocytes counts, higher leukocytes counts and neutrophil-lymphocyte-ratio (NLR), as well as lower percentages of monocytes, eosinophils, and basophils. Most of severe cases demonstrated elevated levels of infection-related biomarkers and inflammatory cytokines. The number of T cells significantly decreased, and more hampered in severe cases. Both helper T cells and suppressor T cells in patients with COVID-19 were below normal levels, and lower level of helper T cells in severe group. The percentage of naïve helper T cells increased and memory helper T cells decreased in severe cases. Patients with COVID-19 also have lower level of regulatory T cells, and more obviously damaged in severe cases. Conclusions: The novel coronavirus might mainly act on lymphocytes, especially T lymphocytes. Surveillance of NLR and lymphocyte subsets is helpful in the early screening of critical illness, diagnosis and treatment of COVID-19.
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Mucociliary epithelium lining the upper and lower respiratory tract constitutes the first line of defense of the airway and lungs against inhaled pollutants and pathogens. The concerted beating of multiciliated cells drives mucociliary clearance. Abnormalities in both the structure and function of airway cilia have been implicated in obstructive lung diseases. Emerging evidence reveals a close correlation between lung diseases and environmental stimuli such as sulfur dioxide and tobacco particles. However, the underlying mechanism remains to be described. In this review, we emphasize the importance of airway cilia in mucociliary clearance and discuss how environmental pollutants affect the structure and function of airway cilia, thus shedding light on the function of airway cilia in preventing obstructive lung diseases and revealing the negative effects of environmental pollutants on human health.
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Exposure to particulate matter ≤2.5 µm in diameter (PM2.5) profoundly affects human health. However, the role of PM2.5 on lung injury and cytokine levels in mice is currently unknown. The aim was to examine the effect of PM2.5 pollution on lung injury in mice fed at an underground parking lot. A total of 20 female Kunming mice were randomly divided into control and polluted groups, with 10 rats in each group. The control group was kept in the laboratory, while the pollution group was fed in an underground parking lot. The concentrations of pollutants were measured using ambient air quality monitoring instruments. After 3 months of treatment, the lungs were collected and examined using electron microscopy, and the morphological structures were assessed using hematoxylin and eosin staining. The polarization of macrophages was evaluated by immunofluorescence. The concentration of interleukin (IL)-4, tumor necrosis factor (TNF)-α and transforming growth factor (TGF)-β1 in peripheral sera were assessed by ELISA. The mRNA and protein levels of IL-4, TNF-α, and TGF-β1 in lung tissues were assessed by reverse transcription-quantitative polymerase chain reaction and western blot analyses, respectively. In the polluted group, the levels of CO, NOx and PM2.5 were significantly higher compared with the control group. Compared with the controls, intracellular edema, an increased number of microvilli and lamellar bodies, smaller lamellar bodies in type II alveolar epithelial cells, and abundant particles induced by PM2.5 in macrophages were observed in the polluted group. The lung ultrastructure changed in the polluted group, revealing exhaust-induced lung injury: The tissues were damaged, and the number of inflammatory cells, neutrophils, polylymphocytes and eosinophils increased in the polluted group compared with the control group. The authors also observed that the number of M1 and M2 macrophages markedly increased after the exhaust treatment. The levels of IL-4, TNF-α and TGF-β1 in the sera and tissues were significantly increased in the polluted group. PM2.5 pollutants in underground garages can lead to lung injury and have a significant impact on the level of inflammatory cytokines in mice. Therefore, the authors suggest that PM2.5 can activate the inflammatory reaction and induce immune dysfunction, leading to ultrastructural damage.
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The effect of particulate matter (PM) on health increases with exposure duration but the change from short to longer term is not well studied. We examined the exposure to PM smaller 10 μm (PM10) from short to longer duration and their associations with levels of inflammatory markers in the population-based CoLaus cohort in Lausanne, Switzerland. Baseline and follow-up CoLaus data were used to study the associations between PM10 exposure and inflammatory markers, including the high-sensitivity C-reactive protein (CRP), as well as interleukin 1-beta (IL-1β), interleukin 6 (IL-6), and tumor-necrosis-factor alpha (TNF-α) using mixed models. Exposure was determined for each participant’s home address from hourly air quality simulations at a 5-m resolution. Short-term exposure intervals were 1 day, 1 week, and 1 month prior to the hospital visit (blood withdrawal); long-term exposure intervals were 3 and 6 months prior to the visit. In most time windows, IL-6, IL-1β, and TNF-α were positively associated with PM10. No significant associations were identified for CRP. Adjusted associations with long-term exposures were stronger and more significant than those for short-term exposures. In stratified models, gender, age, smoking status, and hypertension only led to small modifications in effect estimates, though a few of the estimates for IL-6 and TNF-α became non-significant. In this general adult cohort exposed to relatively low average PM10 levels, clear associations with markers of systemic inflammation were observed. Longer duration of elevated exposure was associated with an exacerbated inflammatory response. This may partially explain the elevated disease risk observed with chronic PM10 exposure. It also suggests that reducing prolonged episodes of high PM exposure may be a strategy to reduce inflammatory risk.
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Previous studies have shown that exposure to particulate matter (PM) increased variety of health problems, particularly cardiovascular diseases leading to premature mortality. The cardiac effects of particulate matter containing PM10 include increased infarct size, decreased heart function, and increased arrhythmias in experimental ischemia-reperfusion models in rats. The aim of this study was to evaluate the effects of particles with an aerodynamic diameter smaller than 10 μm (PM10) on isolated-rat heart and also to determine the efficacy of gallic acid (GA) as a preventive agent in oxidative damage. The healthy rats were divided into 8 equal groups which served as, control, GA, PM10 (0.5, 2.5, and 5 mg/kg), and PM10+GA groups. PM10 administered into the lungs via the trachea in two stages with 48-h interval. After all experiments, the electrocardiogram was recorded. Then, the hemodynamic parameters and ventricular arrhythmias in rat isolated-hearts were assessed using Langendorff apparatus and according to the Lambeth conventions. In addition, the inflammation and oxidative stress factors in cardiac tissues were evaluated in all groups. The obtained results showed that the exposure to PM caused to decrease in cardiac hemodynamic and electrocardiogram parameters. Also, in PM10 rat groups, the IL-6, TNF-α, and oxidative stress parameters were increased. Gallic acid preserved the value of cardiac parameters and inflammation in rat hearts. In summary, we added a novel therapeutic effect of gallic acid for cardiac dysfunction induced by particulate matter. These findings could be related to antioxidant and antiinflammation properties and the obtained results suggest that natural antioxidant like gallic acid could be a therapeutic agent in prevention and management of health issues in the polluted areas of the world.
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Increased proinflammatory interleukin-6 (IL-6) levels are associated with acquired long QT-syndrome (LQTS) in patients with systemic inflammation, leading to higher risks for life-threatening polymorphic ventricular tachycardia such as Torsades de Pointes. However, the functional and molecular mechanisms of this association are not known. In most cases of acquired LQTS, the target ion channel is the human ether-á-go-go-related gene (hERG) encoding the rapid component of the delayed rectifier K current, IKr, which plays a critical role in cardiac repolarization. Here, we tested the hypothesis that IL-6 may cause QT prolongation by suppressing IKr. Electrophysiological and biochemical assays were used to assess the impact of IL-6 on the functional expression of IKr in HEK293 cells and adult guinea-pig ventricular myocytes (AGPVM). In HEK293 cells, IL-6 alone or in combination with the soluble IL-6 receptor (IL-6R), produced a significant depression of IKr peak and tail current densities. Block of IL-6R or Janus kinase (JAK) reversed the inhibitory effects of IL-6 on IKr. In AGPVM, IL-6 prolonged action potential duration (APD) which was further prolonged in the presence of IL-6R. Similar to heterologous cells, IL-6 reduced endogenous guinea pig ERG channel mRNA and protein expression. The data are first to demonstrate that IL-6 inhibition of IKr and the resulting prolongation of APD is mediated via IL-6R and JAK pathway activation and forms the basis for the observed clinical QT interval prolongation. These novel findings may guide the development of targeted anti-arrhythmic therapeutic interventions in patients with LQTS and inflammatory disorders.
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Acute respiratory distress syndrome (ARDS) is the most advanced form of acute lung injury (ALI). This is characterized by bilateral pulmonary infiltrates and severe hypoxemia. According to Berlin definition of ARDS, this is defined based on the timings, radiographic changes, edema formation, and severity on the PaO2/FiO2 ratio. During ARDS, the loss of integrity of the epithelium causes the septic shock. The degree of epithelial injury is the major prognostic marker of ARDS. In addition to this, inflammatory cell migration, fibro-proliferation, and activation of apoptosis also play an important role in the pathophysiology of ARDS. The alveolar epithelial cell is the prime target during injury where this cell either undergo apoptosis or epithelial–mesenchymal transition (EMT). Injury to the AECs triggers the changes in the DNA fragmentation and activation of certain apoptotic markers such as caspases at the same time some cells undergo biochemical changes and loses its epithelial morphology as well epithelial biomarkers and gain mesenchymal biomarkers and morphology. In both the cases, the fibrinolytic system plays an important role in maintaining the integrity of the disease process efficiently. This review highlights the research evidence of apoptosis and EMT in lung development, injury and its prognosis in ARDS thereby to develop an effective strategy for the treatment of ARDS.
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Background Experimental and controlled human exposure studies have demonstrated additive effects of ambient particulate matter and ozone on health. A few epidemiological studies have suggested that ambient particulate matter components are important for the combined effects of ambient particulate matter and ozone on health. However, few studies have examined whether ozone changes the effects of ambient particulate matter on pro-inflammatory cytokine production. In this study, the influence of ozone on pro-inflammatory cytokine production in response to ambient particulate matter was evaluated. Results Ambient particulate matter smaller than 1 μm was collected and the suspension of this particulate matter was bubbled through 0.12 ppm and 0.24 ppm ozone. THP1 cells were stimulated by the solution containing the particulate matter with and without bubbling through ozone at 1 μg/mL. The interleukin-8 concentrations in the supernatants of THP1 cells stimulated by collected particulate matter dissolved in solution were 108.3 ± 24.7 pg/mL without ozone exposure, 165.0 ± 26.1 pg/mL for 0.12 ppm ozone bubbling for 1 min, 175.1 ± 33.1 pg/mL for 0.12 ppm for 5 min, 183.3 ± 17.8 pg/mL for 0.12 ppm for 15 min, 167.8 ± 35.9 pg/mL for 0.24 ppm for 1 min, 209.2 ± 8.4 pg/mL for 0.24 ppm for 5 min, and 209.3 ± 14.3 pg/mL for 0.24 ppm for 15 min. Ozone significantly increased interleukin-8 concentrations compared to those for particulate matter dissolved in solution without ozone exposure and the solvent only (8.2 ± 0.9 pg/mL) in an ozone concentration-dependent manner. Collected particulate matter in solutions with or without bubbling through ozone had no effect on interleukin-6 production. The antioxidant N-acetyl-L-cysteine significantly inhibited the increases in interleukin-8 induced by solutions with particulate matter, regardless of ozone exposure. The reactive oxygen species concentration in solutions with collected particulate matter was not associated with ozone bubbling. Conclusion Ozone may augment the production of interleukin-8 in response to ambient particulate matter by a mechanism unrelated to reactive oxygen species. These results support the epidemiological evidence for combined effects of ambient particulate matter and ozone on human health.
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Systemic inflammation is an integral part of chronic obstructive pulmonary disease (COPD), and air pollution is associated with cardiorespiratory mortality, yet the interrelationships are not fully defined. We examined associations between nitrogen dioxide (NO2) exposure (as a marker of traffic-related air pollution) and pro-inflammatory cytokines, and investigated effect modification and mediation by post-bronchodilator airflow obstruction (post-BD-AO) and cardiovascular risk. Data from middle-aged participants in the Tasmanian Longitudinal Health Study (TAHS, n = 1389) were analyzed by multivariable logistic regression, using serum interleukin (IL)-6, IL-8 and tumor necrosis factor-α (TNF-α) as the outcome. Mean annual NO2 exposure was estimated at residential addresses using a validated satellite-based land-use regression model. Post-BD-AO was defined by post-BD forced expiratory ratio (FEV1/FVC) < lower limit of normal, and cardiovascular risk by a history of either cerebrovascular or ischaemic heart disease. We found a positive association with increasing serum IL-6 concentration (geometric mean 1.20 (95% CI: 1.1 to 1.3, p = 0.001) per quartile increase in NO2). This was predominantly a direct relationship, with little evidence for either effect modification or mediation via post-BD-AO, or for the small subgroup who reported cardiovascular events. However, there was some evidence consistent with serum IL-6 being on the causal pathway between NO2 and cardiovascular risk. These findings raise the possibility that the interplay between air pollution and systemic inflammation may differ between post-BD airflow obstruction and cardiovascular diseases.
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Background Patients with severe traumatic brain injury (TBI) are at risk of the development of acute respiratory distress syndrome (ARDS). TBI and ARDS pathophysiologic mechanisms are known to independently involve significant inflammatory responses. The literature on the association between plasma inflammatory cytokines and ARDS in patients with TBI is sparse. Methods The study was a secondary analysis of the safety of a randomized trial of erythropoietin and transfusion threshold in patients with severe TBI. Inflammatory markers within the first 24 hours after injury were compared in patients who developed ARDS and patients without ARDS, using Cox proportional hazards models. ResultsThere were 200 patients enrolled in the study. The majority of plasma and cerebrospinal fluid (CSF) cytokine levels were obtained within 6 hours. Plasma proinflammatory markers IL-6 and IL-8 and anti-inflammatory marker IL-10 were associated with the development of ARDS (adjusted hazard ratio (HR) = 1.55, confidence interval (CI) = 1.14, 2.11, P = 0.005 for IL-6; adjusted HR = 1.32, CI = 1.10, 1.59, P = 0.003 for IL-8). Conclusion Plasma markers of IL-6, IL-8, and IL-10 are associated with ARDS in patients with severe TBI. Trial registrationNCT00313716 registered 4/2006
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Despite the ongoing spread of MERS, there is limited knowledge of the factors affecting its severity and outcomes. We analyzed clinical data and specimens from fourteen MERS patients treated in a hospital who collectively represent a wide spectrum of disease severity, ranging from mild febrile illness to fatal pneumonia, and classified the patients into four groups based on severity and mortality. Comparative and kinetic analyses revealed that high viral loads, weak antibody responses, and lymphopenia accompanying thrombocytopenia were associated with disease mortality, whereas persistent and gradual increases in lymphocyte responses might be required for effective immunity against MERS-CoV infection. Leukocytosis, primarily due to increased neutrophils and monocytes, was generally observed in more severe and fatal cases. The blood levels of cytokines such as IL-10, IL-15, TGF-β, and EGF were either positively or negatively correlated with disease mortality. Robust induction of various chemokines with differential kinetics was more prominent in patients that recovered from pneumonia than in patients with mild febrile illness or deceased patients. The correlation of the virological and immunological responses with disease severity and mortality, as well as their responses to current antiviral therapy, may have prognostic significance during the early phase of MERS.
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Exposure to fine particles may trigger pulmonary inflammation/systemic inflammation. The objective of this study was to investigate the association between daily individual exposure to air pollutants and airway inflammation and disease activity in childhood-onset systemic lupus erythematosus (cSLE) patients. A longitudinal panel study was carried out in 108 consecutive appointments with cSLE patients without respiratory diseases. Over four consecutive weeks, daily individual measures of nitrogen dioxide (NO2), fine particulate matter (PM2.5), ambient temperature, and humidity were obtained. This cycle was repeated every 2.5 months along 1 year, and cytokines of exhaled breath condensate-EBC [interleukins (IL) 6, 8, 17 and tumoral necrose factor-α (TNF-α)], fractional exhaled NO (FeNO), and disease activity parameters were collected weekly. Specific generalized estimation equation models were used to assess the impact of these pollutants on the risk of Systemic Lupus Erythematous Disease Activity Index 2000 (SLEDAI-2K) ≥ 8, EBC cytokines, and FeNO, considering the fixed effects for repetitive measurements. The models were adjusted for inflammatory indicators, body mass index, infections, medication, and weather variables. An IQR increase in PM2.5 4-day moving average (18.12 μg/m³) was associated with an increase of 0.05 pg/ml (95% CI 0.01; 0.09, p = 0.03) and 0.04 pg/ml (95% CI 0.02; 0.06, p = 0.01) in IL-17 and TNF-α EBC levels, respectively. Additionally, a short-term effect on FeNO was observed: the PM2.5 3-day moving average was associated with a 0.75 ppb increase (95% CI 0.38; 1.29, p = 0.03) in FeNO. Also, an increase of 1.47 (95% CI 1.10; 1.84) in the risk of SLEDAI-2K ≥ 8 was associated with PM2.5 7-day moving average. Exposure to inhalable fine particles increases airway inflammation/pulmonary and then systemic inflammation in cSLE patients.
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Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect almost any organ in the human body. Despite significant advancements in our understanding of SLE over the recent years, its exact mode of onset and disease progression remains elusive. Low concordance rates among monozygotic twins with SLE (as low as 24%), clustering of disease prevalence around polluted regions and an urban – rural difference in prevalence all highlight the importance of environmental influences in SLE. Experimental data strongly suggests a complex interaction between the exposome (or environmental influences) and genome (genetic material) to produce epigenetic changes (epigenome) that can alter the expression of genetic material and lead to development of disease in the susceptible individual. In this review, we focus on the available literature to explore the role of environmental factors in SLE disease onset and progression and to better understand the role of exposome- epigenome – genome interactions in this dreaded disease.
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Background: Long-term exposure to ambient air pollution can lead to adverse health effects in children; however, underlying biological mechanisms are not fully understood. Objectives: We evaluated the effect of air pollution exposure during different time periods on mRNA expression as well as circulating levels of inflammatory cytokines in children. Methods: We measured a panel of 10 inflammatory markers in peripheral blood samples from 670 8-y-old children in the Barn/Child, Allergy, Milieu, Stockholm, Epidemiology (BAMSE) birth cohort. Outdoor concentrations of nitrogen dioxide (NO2) and particulate matter (PM) with aerodynamic diameter <10 μm (PM10) from road traffic were estimated for residential, daycare, and school addresses using dispersion modeling. Time-weighted average exposures during infancy and at biosampling were linked to serum cytokine levels using linear regression analysis. Furthermore, gene expression data from 16-year-olds in BAMSE (n=238) were used to evaluate links between air pollution exposure and expression of genes coding for the studied inflammatory markers. Results: A 10 μg/m(3) increase of NO2 exposure during infancy was associated with a 13.6% (95% confidence interval (CI): 0.8; 28.1%) increase in interleukin-6 (IL-6) levels, as well as with a 27.8% (95% CI: 4.6, 56.2%) increase in IL-10 levels, the latter limited to children with asthma. However, no clear associations were observed for current exposure. Results were similar using PM10, which showed a high correlation with NO2. The functional analysis identified several differentially expressed genes in response to air pollution exposure during infancy, including IL10 , IL13 , and TNF . Conclusion: Our results indicate alterations in systemic inflammatory markers in 8-y-old children in relation to early-life exposure to traffic-related air pollution. https://doi.org/10.1289/EHP460.
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Rationale: Epidemiologic evidence indicates that exposures to fine particulate matter air pollution (PM2.5) contribute to global burden of disease, primarily as a result of increased risk of cardiovascular morbidity and mortality. However, mechanisms by which PM2.5 exposure induces cardiovascular injury remain unclear. PM2.5-induced endothelial dysfunction and systemic inflammation have been implicated, but direct evidence is lacking. Objective: To examine whether acute exposure to PM2.5 is associated with endothelial injury and systemic inflammation. Methods and results: Blood was collected from healthy, non-smoking, young adults over three study periods that included episodes of elevated PM2.5 levels. Microparticles and immune cells in blood were measured by flow cytometry, and plasma cytokine/growth factors were measured using multiplexing laser beads. PM2.5 exposure was associated with elevated levels of endothelial microparticles (annexin V(+)/CD41-/CD31(+)) including subtypes expressing arterial-, venous-, and lung-specific markers, but not microparticles expressing CD62(+) These changes were accompanied by suppressed circulating levels of pro-angiogenic growth factors (EGF, sCD40L, PDGF, RANTES, GROα, and VEGF), and an increase in the levels of anti-angiogenic (TNFα, IP-10) and proinflammatory cytokines (MCP-1, MIP-1α/β, IL-6, and IL-1β), and markers of endothelial adhesion (sICAM-1 and sVCAM-1). PM2.5 exposure also was associated with an inflammatory response characterized by elevated levels of circulating CD14(+), CD16(+), CD4(+), and CD8(+), but not CD19(+) cells. Conclusions: Episodic PM2.5 exposures are associated with increased endothelial cell apoptosis, an anti-angiogenic plasma profile, and elevated levels of circulating monocytes, and T, but not B, lymphocytes. These changes could contribute to the pathogenic sequelae of atherogenesis and acute coronary events.
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Context: -Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are a continuum of lung changes arising from a wide variety of lung injuries, frequently resulting in significant morbidity and frequently in death. Research regarding the molecular pathophysiology of ALI/ARDS is ongoing, with the aim toward developing prognostic molecular biomarkers and molecular-based therapy. Objective: -To review the clinical, radiologic, and pathologic features of ALI/ARDS; and the molecular pathophysiology of ALI/ARDS, with consideration of possible predictive/prognostic molecular biomarkers and possible molecular-based therapies. Data sources: -Examination of the English-language medical literature regarding ALI and ARDS. Conclusions: -ARDS is primarily a clinicoradiologic diagnosis; however, lung biopsy plays an important diagnostic role in certain cases. A significant amount of progress has been made in the elucidation of ARDS pathophysiology and in predicting patient response, however, currently there is no viable predictive molecular biomarkers for predicting the severity of ARDS, or molecular-based ARDS therapies. The proinflammatory cytokines TNF-α (tumor necrosis factor α), interleukin (IL)-1β, IL-6, IL-8, and IL-18 are among the most promising as biomarkers for predicting morbidity and mortality.
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Tumor necrosis factor-alpha, interleukin-1beta, interleukin-6, and transforming growth factor-beta are cytokines synthesized by alveolar macrophages. We investigated the effect of sulfur dioxide, a major air pollutant, on the production of these cytokines by alveolar macrophages. The cells were layered on a polycarbonate membrane and exposed for 30 min to 0.0, 1.0, 2.5, and 5.0 ppm sulfur dioxide at 37 degrees C and 100% air humidity. The cells were incubated for 24 h after exposure, thus allowing cytokine release. Cytotoxic effects of sulfur dioxide were evaluated by trypan blue exclusion. Cytokines were measured with enzyme-linked immunosorbent assays (i.e., tumor necrosis factor-alpha, interleukin-1beta, and interleukin-6) or by use of a specific bioassay (i.e., transforming growth factor-beta). The toxicity of sulfur dioxide for alveolar macrophages ranged from 3.1 % to 9.5 %. A 30-min exposure to sulfur dioxide induced a significant decrease in spontaneous and lipopolysaccharide-stimulated tumor necrosis factor-alpha (p < .001) and lipopolysaccharide-stimulated interleukin-1beta release (p < .05). The release of interleukin-6 and transforming growth factor-beta was not affected significantly by sulfur dioxide exposure. Our results demonstrated a functional impairment of alveolar macrophages after sulfur dioxide exposure (i.e., release of tumor necrosis factor-alpha and interleukin-1beta). Neither spontaneous nor stimulated release of interleukin-6 and transforming growth factors were influenced by exposure to sulfur dioxide.