COVID-19 prevalence and fatality rates in association with air pollution emission concentrations and emission sources

Combining aggregate and individual-level data to estimate individual-level associations between air pollution and COVID-19 mortality in the United States

Imposing stricter regulations for PM2.5 has the potential to mitigate damaging health and climate change effects. Recent evidence establishing a link between exposure to air pollution and COVID-19 outcomes is one of many arguments for the need to reduce the National Ambient Air Quality Standards (NAAQS) for PM2.5. However, many studies reporting a relationship between COVID-19 outcomes and PM2.5 have been criticized because they are based on ecological regression analyses, where area-level counts of COVID-19 outcomes are regressed on area-level exposure to air pollution and other covariates. It is well known that regression models solely based on area-level data are subject to ecological bias, i.e., they may provide a biased estimate of the association at the individual-level, due to within-area variability of the data. In this paper, we augment county-level COVID-19 mortality data with a nationally representative sample of individual-level covariate information from the American Community Survey along with high-resolution estimates of PM2.5 concentrations obtained from a validated model and aggregated to the census tract for the contiguous United States. We apply a Bayesian hierarchical modeling approach to combine county-, census tract-, and individual-level data to ultimately draw inference about individual-level associations between long-term exposure to PM2.5 and mortality for COVID-19. By analyzing data prior to the Emergency Use Authorization for the COVID-19 vaccines we found that an increase of 1 μg/m3 in long-term PM2.5 exposure, averaged over the 17-year period 2000-2016, is associated with a 3.3% (95% credible interval, 2.8 to 3.8%) increase in an individual's odds of COVID-19 mortality. Code to reproduce our study is publicly available at https://github.com/NSAPH/PM_COVID_ecoinference. The results confirm previous evidence of an association between long-term exposure to PM2.5 and COVID-19 mortality and strengthen the case for tighter regulations on harmful air pollution and greenhouse gas emissions.

Modeling and Analysis of Air Pollution and Environmental Justice: The Case for North Carolina's Hog Concentrated Animal Feeding Operations

BACKGROUND

Concentrated animal feeding operations (CAFOs) emit pollutants that can cause negative impacts on human health. The concentration of hog production in North Carolina raises concerns regarding the disproportionate exposure of vulnerable communities to air pollution from CAFOs.

OBJECTIVES

We investigated whether exposure to gaseous ammonia (NH 3 ) and hydrogen sulfide (H 2 S ) (in 2019) differs between subpopulations by examining demographics, including race/ethnicity, age, educational attainment, language proficiency, and socioeconomic status.

METHODS

We used an Air Monitoring Station (AMS)/Environmental Protection Agency (EPA) Regulatory Model (AERMOD)-based Human Exposure Model (version 3) to estimate ambient concentrations of NH 3 and H 2 S from hog farms in Duplin County and its surrounding counties in North Carolina and estimate subsequent exposures of communities within 50 km of Duplin County, North Carolina, or the Duplin County Region. We combined estimated exposures with 2016 American Community Summary Census data, at the block group level, using spatial analysis to investigate whether exposures to these pollutants differ by race and ethnicity, age, income, education, and language proficiency. Based on these estimations, we assessed associated exposure risks to the impacted communities and used multivariable regression modeling to evaluate the relationship between average ammonia exposures from Duplin regional hog farms and the presence of vulnerable populations.

RESULTS

The average [± standard deviation  ( SD ) ] annual estimated concentration of NH 3 and H 2 S in the Duplin County Region is 1.75 ± 2.81   μ g / m 3 and 0.0087 ± 0.014   μ g / m 3 , respectively. The maximum average annual ambient concentrations are estimated at 54.27 ± 4.12   μ g / m 3 and 0.54 ± 0.041   μ g / m 3 for NH 3 and H 2 S , respectively. Our descriptive analysis reveals that people of low income, people of color, people with low educational attainment, and the linguistically isolated in the Duplin Region are disproportionately exposed to higher levels of pollutants than the average exposure for residents. Alternatively, our statistical results suggests that after adjusting for covariates, communities of color are associated with 1.70% (95% CI: - 3.79 , 0.44) lower NH 3 concentrations per 1-SD increase. One-standard deviation increases in the adults with low educational attainment and children < 19 years of age is associated with 1.26% (95% CI: - 0.77 , 3.33) and 1.20% (95% CI: - 0.62 , 3.05) higher NH 3 exposure per 1-SD increase, respectively.

DISCUSSION

Exposures to NH 3 and H 2 S differed by race and ethnicity, educational attainment, language proficiency, and socioeconomic status. The observed associations between exposure to CAFO-generated pollutants and sociodemographic indicators differed among demographics. The disproportionate distribution of hog facilities and resulting pollutant exposures among communities may have adverse environmental and human health impacts, raising environmental justice concerns. https://doi.org/10.1289/EHP11344.

Environmental factors are associated to hospital outcomes in COVID-19 patients during lockdown and post-lockdown in 2020: A nationwide study

OBJECTIVE

This study analyzed, at a postcode detailed level, the relation-ship between short-term exposure to environmental factors and hospital ad-missions, in-hospital mortality, ICU admission, and ICU mortality due to COVID-19 during the lockdown and post-lockdown 2020 period in Spain.

METHODS

We performed a nationwide population-based retrospective study on 208,744 patients admitted to Spanish hospitals due to COVID-19 based on the Minimum Basic Data Set (MBDS) during the first two waves of the pandemic in 2020. Environmental data were obtained from Copernicus Atmosphere Monitoring Service. The association was assessed by a generalized additive model.

RESULTS

PM2.5 was the most critical environmental factor related to hospital admissions and hospital mortality due to COVID-19 during the lockdown in Spain, PM10, NO2, and SO2and also showed associations. The effect was considerably reduced during the post-lockdown period. ICU admissions in COVID-19 patients were mainly associated with PM2.5, PM10, NO2, and SO2 during the lockdown as well. During the lockdown, exposure to PM2.5 and PM10 were the most critical environmental factors related to ICU mortality in COVID-19.

CONCLUSION

Short-term exposure to air pollutants impacts COVID-19 out-comes during the lockdown, especially PM2.5, PM10, NO2, and SO2. These pollutants are associated with hospital admission, hospital mortality and ICU admission, while ICU mortality is mainly associated with PM2.5 and PM10. Our findings reveal the importance of monitoring air pollutants in respiratory infectious diseases.

The neighborhood built environment and COVID-19 hospitalizations

Research on the associations between the built environment and COVID-19 outcomes has mostly focused on incidence and mortality. Also, few studies on the built environment and COVID-19 have controlled for individual-level characteristics across large samples. In this study, we examine whether neighborhood built environment characteristics are associated with hospitalization in a cohort of 18,042 individuals who tested positive for SARS-CoV-2 between May and December 2020 in the Denver metropolitan area, USA. We use Poisson models with robust standard errors that control for spatial dependence and several individual-level demographic characteristics and comorbidity conditions. In multivariate models, we find that among individuals with SARS-CoV-2 infection, those living in multi-family housing units and/or in places with higher particulate matter (PM2.5) have a higher incident rate ratio (IRR) of hospitalization. We also find that higher walkability, higher bikeability, and lower public transit access are linked to a lower IRR of hospitalization. In multivariate models, we did not find associations between green space measures and the IRR of hospitalization. Results for non-Hispanic white and Latinx individuals highlight substantial differences: higher PM2.5 levels have stronger positive associations with the IRR of hospitalization for Latinx individuals, and density and overcrowding show stronger associations for non-Hispanic white individuals. Our results show that the neighborhood built environment might pose an independent risk for COVID-19 hospitalization. Our results may inform public health and urban planning initiatives to lower the risk of hospitalization linked to COVID-19 and other respiratory pathogens.

Mapping the long-term associations between air pollutants and COVID-19 risks and the attributable burdens in the continental United States

Numerous studies have investigated the associations between COVID-19 risks and long-term exposure to air pollutants, revealing considerable heterogeneity and even contradictory regional results. Studying the spatial heterogeneity of the associations is essential for developing region-specific and cost-effective air-pollutant-related public health policies for the prevention and control of COVID-19. However, few studies have investigated this issue. Using the USA as an example, we constructed single/two-pollutant conditional autoregressions with random coefficients and random intercepts to map the associations between five air pollutants (PM_2.5, O₃, SO₂, NO₂, and CO) and two COVID-19 outcomes (incidence and mortality) at the state level. The attributed cases and deaths were then mapped at the county level. This study included 3108 counties from 49 states within the continental USA. The county-level air pollutant concentrations from 2017 to 2019 were used as long-term exposures, and the county-level cumulative COVID-19 cases and deaths through May 13, 2022, were used as outcomes. Results showed that considerably heterogeneous associations and attributable COVID-19 burdens were found in the USA. The COVID-19 outcomes in the western and northeastern states appeared to be unaffected by any of the five pollutants. The east of the USA bore the greatest COVID-19 burdens attributable to air pollution because of its high pollutant concentrations and significantly positive associations. PM_2.5 and CO were significantly positively associated with COVID-19 incidence in 49 states on average, whereas NO₂ and SO₂ were significantly positively associated with COVID-19 mortality. The remaining associations between air pollutants and COVID-19 outcomes were not statistically significant. Our study provided implications regarding where a major concern should be placed on a specific air pollutant for COVID-19 control and prevention, as well as where and how to conduct additional individual-based validation research in a cost-effective manner.

A spatial and contextual exposome-wide association study and polyexposomic score of COVID-19 hospitalization

Environmental exposures have been linked to COVID-19 severity. Previous studies examined very few environmental factors, and often only separately without considering the totality of the environment, or the exposome. In addition, existing risk prediction models of severe COVID-19 predominantly rely on demographic and clinical factors. To address these gaps, we conducted a spatial and contextual exposome-wide association study (ExWAS) and developed polyexposomic scores (PES) of COVID-19 hospitalization leveraging rich information from individuals' spatial and contextual exposome. Individual-level electronic health records of 50 368 patients aged 18 years and older with a positive SARS-CoV-2 PCR/Antigen lab test or a COVID-19 diagnosis between March 2020 and October 2021 were obtained from the OneFlorida+ Clinical Research Network. A total of 194 spatial and contextual exposome factors from 10 data sources were spatiotemporally linked to each patient based on geocoded residential histories. We used a standard two-phase procedure in the ExWAS and developed and validated PES using gradient boosting decision trees models. Four exposome measures significantly associated with COVID-19 hospitalization were identified, including 2-chloroacetophenone, low food access, neighborhood deprivation, and reduced access to fitness centers. The initial prediction model in all patients without considering exposome factors had a testing-area under the curve (AUC) of 0.778. Incorporation of exposome data increased the testing-AUC to 0.787. Similar findings were observed in subgroup analyses focusing on populations without comorbidities and aged 18-24 years old. This spatial and contextual exposome study of COVID-19 hospitalization confirmed previously reported risk factor but also generated novel predictors that warrant more focused evaluation.

A Literature Review of the Effects of Air Pollution on COVID-19 Health Outcomes Worldwide: Statistical Challenges and Data Visualization

Several peer-reviewed papers and reviews have examined the relationship between exposure to air pollution and COVID-19 spread and severity. However, many of the existing reviews on this topic do not extensively present the statistical challenges associated with this field, do not provide comprehensive guidelines for future researchers, and review only the results of a relatively small number of papers. We reviewed 139 papers, 127 of which reported a statistically significant positive association between air pollution and adverse COVID-19 health outcomes. Here, we summarize the evidence, describe the statistical challenges, and make recommendations for future research. To summarize the 139 papers with data from geographical locations around the world, we also present anopen-source data visualization tool that summarizes these studies and allows the research community to contribute evidence as new research papers are published.

Air pollution and respiratory infections: the past, present, and future

Air pollution levels across the globe continue to rise despite government regulations. The increase in global air pollution levels drives detrimental human health effects, including 7 million premature deaths every year. Many of these deaths are attributable to increased incidence of respiratory infections. Considering the COVID-19 pandemic, an unprecedented public health crisis that has claimed the lives of over 6.5 million people globally, respiratory infections as a driver of human mortality is a pressing concern. Therefore, it is more important than ever to understand the relationship between air pollution and respiratory infections so that public health measures can be implemented to ameliorate further morbidity and mortality. This article aims to review the current epidemiologic and basic science research on interactions between air pollution exposure and respiratory infections. The first section will present epidemiologic studies organized by pathogen, followed by a review of basic science research investigating the mechanisms of infection, and then conclude with a discussion of areas that require future investigation.

The effect of air quality parameters on new COVID-19 cases between two different climatic and geographical regions in Turkey

Different health management strategies may need to be implemented in different regions to cope with diseases. The current work aims to evaluate the relationship between air quality parameters and the number of new COVID-19 cases in two different geographical locations, namely Western Anatolia and Western Black Sea in Turkey. Principal component analysis (PCA) and regression model were utilized to describe the effect of environmental parameters (air quality and meteorological parameters) on the number of new COVID-19 cases. A big difference in the mean values for all air quality parameters has appeared between the two areas. Two regression models were developed and showed a significant relationship between the number of new cases and the selected environmental parameters. The results showed that wind speed, SO₂, CO, NO_X, and O₃ are not influential variable and does not affect the number of new cases of COVID-19 in the Western Black Sea area, while only wind speed, SO₂, CO, NO_X, and O₃ are influential parameters on the number of new cases in Western Anatolia. Although the environmental parameters behave differently in each region, these results revealed that the relationship between the air quality parameters and the number of new cases is significant.

Associations of COVID-19 Hospitalizations, ICU Admissions, and Mortality with Black and White Race and Their Mediation by Air Pollution and Other Risk Factors in the Louisiana Industrial Corridor, March 2020-August 2021

Louisiana ranks among the bottom five states for air pollution and mortality. Our objective was to investigate associations between race and Coronavirus Disease 2019 (COVID-19) hospitalizations, intensive care unit (ICU) admissions, and mortality over time and determine which air pollutants and other characteristics may mediate COVID-19-associated outcomes. In our cross-sectional study, we analyzed hospitalizations, ICU admissions, and mortality among positive SARS-CoV-2 cases within a healthcare system around the Louisiana Industrial Corridor over four waves of the pandemic from 1 March 2020 to 31 August 2021. Associations between race and each outcome were tested, and multiple mediation analysis was performed to test if other demographic, socioeconomic, or air pollution variables mediate the race-outcome relationships after adjusting for all available confounders. Race was associated with each outcome over the study duration and during most waves. Early in the pandemic, hospitalization, ICU admission, and mortality rates were greater among Black patients, but as the pandemic progressed, these rates became greater in White patients. However, Black patients were disproportionately represented in these measures. Our findings imply that air pollution might contribute to the disproportionate share of COVID-19 hospitalizations and mortality among Black residents in Louisiana.

Spatial associations of long-term exposure to diesel particulate matter with seasonal and annual mortality due to COVID-19 in the contiguous United States

BACKGROUND

People with certain underlying respiratory and cardiovascular conditions might be at an increased risk for severe illness from COVID-19. Diesel Particulate Matter (DPM) exposure may affect the pulmonary and cardiovascular systems. The study aims to assess if DPM was spatially associated with COVID-19 mortality rates across three waves of the disease and throughout 2020.

METHODS

We tested an ordinary least squares (OLS) model, then two global models, a spatial lag model (SLM) and a spatial error model (SEM) designed to explore spatial dependence, and a geographically weighted regression (GWR) model designed to explore local associations between COVID-19 mortality rates and DPM exposure, using data from the 2018 AirToxScreen database.

RESULTS

The GWR model found that associations between COVID-19 mortality rate and DPM concentrations may increase up to 77 deaths per 100,000 people in some US counties for every interquartile range (0.21 μg/m3) increase in DPM concentration. Significant positive associations between mortality rate and DPM were observed in New York, New Jersey, eastern Pennsylvania, and western Connecticut for the wave from January to May, and in southern Florida and southern Texas for June to September. The period from October to December exhibited a negative association in most parts of the US, which seems to have influenced the year-long relationship due to the large number of deaths during that wave of the disease.

CONCLUSIONS

Our models provided a picture in which long-term DPM exposure may have influenced COVID-19 mortality during the early stages of the disease. That influence appears to have waned over time as transmission patterns evolved.

The impact of air pollution on COVID-19 incidence, severity, and mortality: A systematic review of studies in Europe and North America

BACKGROUND

Air pollution is speculated to increase the risks of COVID-19 spread, severity, and mortality.

OBJECTIVES

We systematically reviewed studies investigating the relationship between air pollution and COVID-19 cases, non-fatal severity, and mortality in North America and Europe.

METHODS

We searched PubMed, Web of Science, and Scopus for studies investigating the effects of harmful pollutants, including particulate matter with diameter ≤2.5 or 10 μm (PM2.5 or PM10), ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2) and carbon monoxide (CO), on COVID-19 cases, severity, and deaths in Europe and North America through to June 19, 2021. Articles were included if they quantitatively measured the relationship between exposure to air pollution and COVID-19 health outcomes.

RESULTS

From 2,482 articles screened, we included 116 studies reporting 355 separate pollutant-COVID-19 estimates. Approximately half of all evaluations on incidence were positive and significant associations (52.7%); for mortality the corresponding figure was similar (48.1%), while for non-fatal severity this figure was lower (41.2%). Longer-term exposure to pollutants appeared more likely to be positively associated with COVID-19 incidence (63.8%). PM2.5, PM10, O3, NO2, and CO were most strongly positively associated with COVID-19 incidence, while PM2.5 and NO2 with COVID-19 deaths. All studies were observational and most exhibited high risk of confounding and outcome measurement bias.

DISCUSSION

Air pollution may be associated with worse COVID-19 outcomes. Future research is needed to better test the air pollution-COVID-19 hypothesis, particularly using more robust study designs and COVID-19 measures that are less prone to measurement error and by considering co-pollutant interactions.

Environmental policies for the treatment of waste generated by COVID-19: Text mining review

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.

Assessing the impact of long-term exposure to nine outdoor air pollutants on COVID-19 spatial spread and related mortality in 107 Italian provinces

This paper investigates the air quality in 107 Italian provinces in the period 2014-2019 and the association between exposure to nine outdoor air pollutants and the COVID-19 spread and related mortality in the same areas. The methods used were negative binomial (NB) regression, ordinary least squares (OLS) model, and spatial autoregressive (SAR) model. The results showed that (i) common air pollutants-nitrogen dioxide (NO₂), ozone (O₃), and particulate matter (PM_2.5 and PM₁₀)-were highly and positively correlated with large firms, energy and gas consumption, public transports, and livestock sector; (ii) long-term exposure to NO₂, PM_2.5, PM₁₀, benzene, benzo[a]pyrene (BaP), and cadmium (Cd) was positively and significantly correlated with the spread of COVID-19; and (iii) long-term exposure to NO_2, O₃, PM_2.5, PM₁₀, and arsenic (As) was positively and significantly correlated with COVID-19 related mortality. Specifically, particulate matter and Cd showed the most adverse effect on COVID-19 prevalence; while particulate matter and As showed the largest dangerous impact on excess mortality rate. The results were confirmed even after controlling for eighteen covariates and spatial effects. This outcome seems of interest because benzene, BaP, and heavy metals (As and Cd) have not been considered at all in recent literature. It also suggests the need for a national strategy to drive down air pollutant concentrations to cope better with potential future pandemics.

Increased personal protective equipment consumption during the COVID-19 pandemic: An emerging concern on the urban waste management and strategies to reduce the environmental impact

Personal protective equipments (PPEs) are essential protective products for individuals exposed to microorganism, toxic substances, and pathogens. However, the advent of the coronavirus pandemic generated a heavy demand for PPE, which has led to a rapid accumulation of plastic waste related to potentially infectious PPE in the urban waste stream. Mismanagement of these wastes can lead to subsequent environmental problems. This study estimates the daily consumption of facemasks, gloves, and daily medical waste generation during the SARs-CoV-2 pandemic in the selected 33 countries worldwide. The results indicate that China used the highest daily facemasks and gloves among these selected countries, followed by India, the US, Brazil, Indonesia, and Japan. Moreover, India is the first one in medical waste production, followed by the USA, Brazil, the United Kingdom, France, and Spain. The article also provides viable strategies and discusses the pros and cons of strategies to address the unprecedented generation of plastic waste material during the pandemic. This manuscript also encourages scientific communities and policymakers to pay exceptional attention to the pandemic's plastic waste.

The effect of online meeting and health screening on business travel: A stated preference case study in Hong Kong

This study quantifies the effects of health control measures at the airport on passenger behaviour related to business travel. A stated preference survey was conducted over potential air travellers in Hong Kong in the context of COVID-19 pandemic. Panel latent class models were estimated to understand passenger preference toward new travel requirements given the applicability of online meeting. Online meeting is applicable in cases where it is a good substitute of air travel and achieves the same outcomes of a trip, and inapplicable otherwise. Empirical results indicate that traveller subgroups are affected in different ways. When an online meeting is inapplicable, nearly 75% of the respondents prefer to travel for business and undertake health screenings. These passengers (identified as "captive" business travellers) perceive such measures necessary to lower health related risks during air travel. As such, they are willing to spend up to 21 to 38 min on the health control measures such as vaccination record requirements and test involving sample collection. When an online meeting is applicable, the share of "choice" business travellers is about 45%, among whom the attitudes towards health control measures become more averse. The average weighted willingness-to-pay for the time saved at health checkpoints increase significantly. The aviation industry thus faces a "double-hit" problem: operation costs will increase due to pandemic control measures, and the resultant inconvenience, extra time and costs further reduces travel demand. Unlike previous short pandemics, business travel is likely to suffer with an extended decline until the pandemic is fully controlled. These identified challenges call for financial and operational support to help the aviation industry reach a sustainable "new normal". The high value of time saved at check points also justifies investments that make the pandemic control and health measures efficient and smooth. Travellers' time spent on airport health control should be within 20 min to avoid substantial negative impacts on business travel demand.

A survey on the correlation between PM2.5 concentration and the incidence of suspected and positive cases of COVID-19 referred to medical centers: A case study of Tehran

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; PM_2.5 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: N_ave = 466; PC: N_ave = 223), level III: orange, unhealthy for sensitive groups (SC: N_ave = 564; PC: N_ave = 275), and Level IV: red, unhealthy (SC: N_ave = 558; PC: N_ave = 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.

Spatial Associations of Long-term Exposure to Diesel Particulate Matter with Seasonal and Annual Mortality Due to COVID-19 in the Contiguous United States

Background People with certain underlying respiratory and cardiovascular conditions might be at an increased risk for severe illness from COVID-19. Diesel Particulate Matter (DPM) exposure may affect the pulmonary and cardiovascular systems. The study aims to assess if DPM was spatially associated with COVID-19 mortality across three waves of the disease and throughout 2020. Methods We tested an ordinary least square (OLS) model, then two global models, spatial lag model (SLM) and spatial error model (SEM), designed to explore spatial dependence, and a geographically weighted regression (GWR) model designed to explore local associations. Results The GWR model found that associations between COVID-19 deaths and DPM concentrations may increase up to 57, 36, 43, and 58 deaths per 100,000 people in some US counties for every 1 µg/m ³ increase in DPM concentration. Relative significant positive association are observed in New York, New Jersey, eastern Pennsylvania, and western Connecticut for the wave from January to May, and in southern Florida and southern Texas for June to September. The period from October to December exhibit a negative association in most parts of the US, which seems to have influenced the year-long relationship due to the large number of deaths during that wave of the disease. Conclusions Our models provided a picture in which long-term DPM exposure may have influenced COVID-19 mortality during the early stages of the disease, but that influence appears to have waned over time as transmission patterns evolved.

A review on the biological, epidemiological, and statistical relevance of COVID-19 paired with air pollution

This narrative review paper is aimed to critically evaluate recent studies of the associations between air pollution and the outcomes in the COVID-19 pandemic. The main air pollutants we have considered are carbon monoxide (CO), nitrogen dioxide (NO₂), ground-level ozone (O₃), particulate matter (PM_2.5 and PM₁₀), and sulfur dioxide (SO₂). We, specifically, evaluated the influences of these pollutants, both individually and collaboratively, across various geographic areas and exposure windows. We further reviewed the proposed biological mechanisms underlying the association between air pollution and COVID-19. Ultimately, we aim to inform policy and public health practice regarding the implications of COVID-19 and air pollution.

A city-level analysis of PM2.5 pollution, climate and COVID-19 early spread in Spain

Purpuse

The COVID-19 outbreak has escalated into the worse pandemic of the present century. The fast spread of the new SARS-CoV-2 coronavirus has caused devastating health and economic crises all over the world, with Spain being one of the worst affected countries in terms of confirmed COVID-19 cases and deaths per inhabitant. In this situation, the Spanish Government declared the lockdown of the country.

Methods

The variations of air pollution in terms of fine particulate matter (PM2.5) levels in seven representative cities of Spain are analyzed here considering the effect of meteorology during the national lockdown. The possible associations of PM2.5 pollution and climate with COVID-19 accumulated cases were also analyzed.

Results

While the epidemic curve was flattened, the results of the analysis show that the 4-week Spanish lockdown significantly reduced the PM2.5 levels in only one city despite the drastically reduced human activity. Furthermore, no associations between either PM2.5 exposure or environmental conditions and COVID-19 transmission were found during the early spread of the pandemic.

Conclusions

A longer period applying human activity restrictions is necessary in order to achieve significant reductions of PM2.5 levels in all the analyzed cities. No effect of PM2.5 pollution or weather on COVID-19 incidence was found for these pollutant levels and period of time.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s40201-022-00786-2.

A, Ruheili A. Modeling the contribution of Nitrogen Dioxide, Vertical pressure velocity and PM2.5 to COVID-19 fatalities

The COVID-19 caused by the severe acute respiratory syndrome coronavirus was reported in China in December 2019. The severity and lethality 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 0.69, 0.94, 0.68, 0.47, and 0.61 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.

Use of Low-Cost Sensors to Characterize Occupational Exposure to PM2.5 Concentrations Inside an Industrial Facility in Santa Ana, CA: Results from a Worker- and Community-Led Pilot Study

PM2.5 is an air contaminant that has been widely associated with adverse respiratory and cardiovascular health, leading to increased hospital admissions and mortality. Following concerns reported by workers at an industrial facility located in Santa Ana, California, workers and community leaders collaborated with experts in the development of an air monitoring pilot study to measure PM2.5 concentrations to which employees and local residents are exposed during factory operating hours. To detect PM2.5, participants wore government-validated AtmoTube Pro personal air monitoring devices during three separate workdays (5 AM–1:30 PM) in August 2021. Results demonstrated a mean PM2.5 level inside the facility of 112.3 µg/m3, nearly seven-times greater than outdoors (17.3 µg/m3). Of the eight workers who wore personal indoor sampling devices, five showed measurements over 100 μg/m3. Welding-related activity inside the facility resulted in the greatest PM2.5 concentrations. This study demonstrates the utility of using low-cost air quality sensors combined with employee knowledge and participation for the investigation of workplace air pollution exposure as well as facilitation of greater health-related awareness, education, and empowerment among workers and community members. Results also underscore the need for basic measures of indoor air pollution control paired with ongoing air monitoring within the Santa Ana facility, and the importance of future air monitoring studies aimed at industrial facilities.

Does air pollution explain COVID-19 fatality and mortality rates? A multi-city study in São Paulo state, Brazil

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, PM_2.5, 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 PM_2.5 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.

Air pollution impact on the Covid-19 mortality in Iran considering the comorbidity (obesity, diabetes, and hypertension) correlations

Since the rise of the Covid-19 pandemic, several researchers stated the possibility of a positive relationship between Covid-19 spread and climatic parameters. An ecological study in 12 Iranian cities using the report of daily deaths from Covid-19 (March to August 2020) and validated data on air pollutants, considering average concentrations in each city in the last year used to analyze the association between chronic exposure to air pollutants and the death rate from Covid-19 in Iran. Poisson regression models were used, with generalized additive models and adjustment variables. A significant increase of 2.7% (IC(95%) 2.6-4.4) was found in the mortality rate due to Covid-19 due to an increase of 1 μg/m³ of NO₂. The results suggest an association between Covid-19 mortality and NO₂ exposure. As a risk approximation associated with air pollution, more precise analysis is done. The results also show a good consistency with studies from other regions; this paper's results can be useful for the public health policymakers and decision-making to control the Covid-19 spread.

Identifying Louisiana communities at the crossroads of environmental and social vulnerability, COVID-19, and asthma

The COVID-19 pandemic has disproportionately affected the socially and environmentally vulnerable, including through indirect effects on other health conditions. Asthma is one such condition, which may be exacerbated by both prolonged adverse in-home exposures if quarantining in unhealthy homes and prolonged outdoor exposures if the ambient air quality is unhealthy or hazardous. As both are often the case in Environmental Justice (EJ) communities, here we have analyzed data at the census tract (CT) level for Louisiana to assess any correlation between social and environmental vulnerability, and health issues like COVID-19 and asthma. Higher Social Vulnerability Index (SVI), Particulate Matter less than 2.5 μm in diameter (PM2.5) and Ozone levels were associated with higher rates of cumulative COVID-19 incidence at various time points during the pandemic, as well as higher average annual asthma hospitalization rates and estimated asthma prevalence. Further, cumulative COVID-19 incidence during the first three months of the pandemic was moderately correlated with both asthma hospitalizations and estimated prevalence, suggesting similar underlying factors may be affecting both conditions. Additionally, 137 CTs were identified where social and environmental vulnerabilities co-existed, of which 75 (55%) had high estimated prevalence of asthma. These areas are likely to benefit from asthma outreach that considers both social and environmental risk factors. Fifteen out of the 137 CTs (11%) not only had higher estimated prevalence of asthma but also a high burden of COVID-19. Further research in these areas may help to elucidate any common social determinants of health that underlie both asthma and COVID-19 burdens, as well as better clarify the possible role of the environment as related to the COVID-19 burden in Louisiana.

Community-Engaged Use of Low-Cost Sensors to Assess the Spatial Distribution of PM2.5 Concentrations across Disadvantaged Communities: Results from a Pilot Study in Santa Ana, CA

PM_2.5 is an air pollutant that is widely associated with adverse health effects, and which tends to be disproportionately located near low-income communities and communities of color. We applied a community-engaged research approach to assess the distribution of PM_2.5 concentrations in the context of community concerns and urban features within and around the city of Santa Ana, CA. Approximately 183 h of one-minute average PM_2.5 measurements, along with high-resolution geographic coordinate measurements, were collected by volunteer community participants using roughly two dozen low-cost AtmoTube Pro air pollution sensors paired with real-time GPS tracking devices. PM_2.5 varied by region, time of day, and month. In general, concentrations were higher near the city’s industrial corridor, which is an area of concern to local community members. While the freeway systems were shown to correlate with some degree of elevated air pollution, two of four sampling days demonstrated little to no visible association with freeway traffic. Concentrations tended to be higher within socioeconomically disadvantaged communities compared to other areas. This pilot study demonstrates the utility of using low-cost air pollution sensors for the application of community-engaged study designs that leverage community knowledge, enable high-density air monitoring, and facilitate greater health-related awareness, education, and empowerment among communities. The mobile air-monitoring approach used in this study, and its application to characterize the ambient air quality within a defined geographic region, is in contrast to other community-engaged studies, which employ fixed-site monitoring and/or focus on personal exposure. The findings from this study underscore the existence of environmental health inequities that persist in urban areas today, which can help to inform policy decisions related to health equity, future urban planning, and community access to resources.

Decrease in life expectancy due to COVID-19 disease not offset by reduced environmental impacts associated with lockdowns in Italy

The consequence of the lockdowns implemented to address the COVID-19 pandemic on human health damage due to air pollution and other environmental issues must be better understood. This paper analyses the effect of reducing energy demand on the evolution of environmental impacts during the occurrence of 2020-lockdown periods in Italy, with a specific focus on life expectancy. An energy metabolism analysis is conducted based on the life cycle assessment (LCA) of all monthly energy consumptions, by sector, category and province area in Italy between January 2015 to December 2020. Results show a general decrease (by ∼5% on average) of the LCA midpoint impact categories (global warming, stratospheric ozone depletion, fine particulate matter formation, etc.) over the entire year 2020 when compared to past years. These avoided impacts, mainly due to reductions in fossil energy consumptions, are meaningful during the first lockdown phase between March and May 2020 (by ∼21% on average). Regarding the LCA endpoint damage on human health, ∼66 Disability Adjusted Life Years (DALYs) per 100,000 inhabitants are estimated to be saved. The analysis shows that the magnitude of the officially recorded casualties is substantially larger than the estimated gains in human lives due to the environmental impact reductions. Future research could therefore investigate the complex cause-effect relationships between the deaths occurred in 2020 imputed to COVID-19 disease and co-factors other than the SARS-CoV-2 virus.

Short-term air pollution exposure and COVID-19 infection in the United States

The Sars-CoV-2 disease (known as COVID-19) has become a global public health emergency. Researchers have been unveiling the transmission mechanisms and disclosing possible contributing factors. Studies have theorized plausible linkage mechanisms between air pollution exposure and COVID-19 infection and have divided the air pollution exposure into two types: long-term exposure and short-term exposure. However, present studies on impacts of short-term exposure have not reached a conclusive result and are mostly focusing on Asian and European countries. In this study, we conduct a nationwide analysis to examine the association between short-term air pollution exposure and COVID-19 infection in the United States. Daily confirmed cases, air pollution information, and meteorological factors at the county level were collected between March 1st and June 30th, 2020. A total of 806 (out of 3143) counties were included in this study, with 554 counties for PM2.5 and 670 counties for ozone (O3), which account for around 2.1 million cumulative confirmed cases, i.e., about 80% of all confirmed cases in the U.S. over the study period. A generalized additive model was applied to investigate the relationship between short-term exposure to PM2.5/O3 and COVID-19 confirmed cases. The statistically significant results indicate that, with every 10 μg/m3 increase in mean pollutant concentration, the number of daily confirmed cases increases by 9.41% (CI: 8.77%-10.04%) for PM2.5 and by 2.42% (CI: 1.56%-3.28%) for O3. The relative risks associated with short-term PM2.5 exposure remain positive after isolating the impacts of long-term exposure. The results of this study suggest that short-term exposure to air pollution, especially to PM2.5, may contribute to the spread and course of the pandemic. This finding has important implications for policymakers and the public to take preventive measures such as staying at home on polluted days while improving ventilation indoors to lower the probability of infection.

Effects of meteorology and human‐mobility on UK's air quality during COVID‐19

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.

Diesel Exhaust Particles Impair Therapeutic Effect of Human Wharton's Jelly-Derived Mesenchymal Stem Cells against Experimental Colitis through ROS/ERK/cFos Signaling Pathway

Background and Objectives

Epidemiological investigations have shown positive correlations between increased diesel exhaust particles (DEP) in ambient air and adverse health outcomes. DEP are the major constituent of particulate atmospheric pollution and have been shown to induce proinflammatory responses both in the lung and systemically. Here, we report the effects of DEP exposure on the properties of human Wharton’s jelly-derived mesenchymal stem cells (WJ-MSCs), including stemness, regeneration, and immunomodulation.

Methods and Results

Non-apoptotic concentrations of DEP (10 μg/ml) inhibited the migration and osteogenic differentiation capacity of WJ-MSCs. Gene expression profiling showed that DEP increased intracellular reactive oxygen species (ROS) and expression of pro-inflammatory and metabolic-process-related genes including cFos. Furthermore, WJ-MSCs cultured with DEP showed impaired suppression of T cell proliferation that was reversed by inhibition of ROS or knockdown of cFos. ERK inhibition assay revealed that DEP-induced ROS regulated cFos through activation of ERK but not NF-κB signaling. Overall, low concentrations of DEP (10 μg/ml) significantly suppressed the stemness and immunomodulatory properties of WJ-MSCs through ROS/ERK/cFos signaling pathways. Furthermore, WJ-MSCs cultured with DEP impaired the therapeutic effect of WJ-MSCs in experimental colitis mice, but was partly reversed by inhibition of ROS.

Conclusions

Taken together, these results indicate that exposure to DEP enhances the expression of pro-inflammatory cytokines and immune responses through a mechanism involving the ROS/ERK/cFos pathway in WJ-MSCs, and that DEP-induced ROS damage impairs the therapeutic effect of WJ-MSCs in colitis. Our results suggest that modulation of ROS/ERK/cFos signaling pathways in WJ-MSCs might be a novel therapeutic strategy for DEP-induced diseases.

Long-Term Air Pollution Exposure and COVID-19 Mortality: A Patient-Level Analysis from New York City

RATIONALE

Risk factors for COVID-19 mortality may include environmental exposures, such as air pollution.

OBJECTIVES

Determine whether, amongst adults hospitalized with PCR-confirmed COVID-19, long-term air pollution exposure is associated with risk for mortality, intensive care unit (ICU) admission or intubation.

METHODS

We performed a retrospective analysis of SARS-CoV-2 PCR positive patients admitted to seven New York City hospitals from March 8, 2020 to August 30, 2020. The primary outcome was mortality; secondary outcomes were ICU admission and intubation. We estimated the annual average fine particulate matter (PM2.5), nitrogen dioxide (NO2) and black carbon (BC) concentrations at patients' residential addresses. We employed double-robust Poisson regression to analyze associations between annual average PM2.5, NO2 and BC exposure and COVID-19 outcomes, adjusting for age, sex, race/ethnicity, hospital, insurance and time from onset of the pandemic.

RESULTS

Of the 6,542 patients, 41% were female and aged median 65 years (IQR 53, 77). Over 50% self-identified as a person of color [N=1,687 (26%) Hispanic, N=1,659 (25%) Black]. Air pollution exposures were generally low. Overall, 31% (N=2,044) of the cohort died, 19% (N=1,237) were admitted to the ICU and 16% (1,051) were intubated. In multivariable models, higher long-term exposure to PM2.5 was associated with increased risk of mortality (RR 1.11, 95% CI 1.02, 1.21 per 1µg/m3 increase in PM2.5) and ICU admission (RR 1.13, 95% CI 1.00, 1.28 per 1µg/m3 increase in PM2.5). In multivariable models, neither NO2 nor BC exposure was associated with COVID-19 mortality, ICU admission or intubation.

CONCLUSIONS

Amongst patients hospitalized with COVID-19, higher long-term PM2.5 exposure was associated with increased risk of mortality and ICU admission. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).

The casual effects of COVID-19 lockdown on air quality and short-term health impacts in China

The outbreak of coronavirus (COVID-19) has forced China to lockdown many cities and restrict transportation, industrial, and social activities. This provides a great opportunity to look at the impacts of pandemic quarantine on air quality and premature death due to exposure to air pollution. In this study, we applied the difference-in-differences (DID) model to quantify the casual impacts of COVID-19 lockdown on air quality at 278 cities across China. A widely used exposure-response function was further utilized to estimate the short-term health impacts associated with changes in PM2.5 due to lockdown. Results show that lockdown has caused drastic reduction in air pollution level in terms of all criteria pollutants except ozone. On average, concentrations of PM2.5, PM10, NO2, SO2 and CO are estimated to drop by 14.3 μg/m3, 22.2 μg/m3, 17.7 μg/m3, 2.9 μg/m3, and 0.18 mg/m3 as the result of lockdown. Cities with more confirmed cases of COVID-19 are related to stronger responses in air quality, despite that similar lockdown measures were implemented by the local governments. The improvement of air quality caused by COVID-19 lockdown in northern cities is found to be smaller than that of southern cities. Avoided premature death associated with PM2.5 exposures over the 278 cities was estimated to be 50.8 thousand. Our results re-emphasize the effectiveness of emission controls on air quality and associated health impacts. The high cost of lockdown, still high level of air pollution during lockdown and smaller effects in northern cities implies that source-specific mitigation policies are needed for continuous and sustainable reduction of air pollution.

Characteristics of air quality in different climatic zones of China during the COVID-19 lockdown

The diverse climate types and the complex anthropogenic source emissions in China lead to the great regional differences of air pollution mechanisms. The COVID-19 lockdown has given us a precious opportunity to understand the effect of weather conditions and anthropogenic sources on the distribution of air pollutants in different climate zones. In this study, to understand the impact of meteorological and socio-economic factors on air pollution during COVID-19 lockdown, we divided 358 Chinese cities into eight climate regions. Temporal, spatial and diurnal variations of six major air pollutants from January 1 to April 18, 2020 were analyzed. The differences in the characteristics of air pollutants in different climate zones were obvious. PM2.5 reduced by 59.0%-64.2% in cold regions (North-East China (NEC) and North-Western (NW)), while O3 surged by 99.0%-99.9% in warm regions (Central South (CS) and Southern Coast (SC)). Diurnal variations of atmospheric pollutants were also more prominent in cold regions. Moreover, PM2.5, PM10, CO and SO2 showed more prominent reductions (20.5%-64.2%) in heating regions (NEC, NW, NCP and MG) than no-heating regions (0.8%-48%). Climate has less influence on NO2, which dropped by 41.2%-57.1% countrywide during the lockdown. The influences of weather conditions on the atmospheric pollutants in different climate zones were different. The wind speed was not the primary reason for the differences in air pollutants in different climate zones. Temperature, precipitation, and air pollution emissions led to prominent regional differences in air pollutants throughout the eight climates. The effect of temperature on PM, SO2, CO, and NO2 varied obviously with the latitude, at which condition temperature was negatively correlated to PM, SO2, CO, and NO2 in the north but positively in the south. The temperature was positively correlated to ozone in different climate zones, and the correlation was the highest in NEC and the lowest in SC. The rainfall has a strong removal effect on atmospheric pollutants in the climate regions with more precipitation, but it increases the pollutant concentrations in the climate regions with less precipitation. In regions with more emission sources, air pollutants experienced more significant variations and returned to pre-lockdown levels earlier.

Exposure to air pollution and COVID-19 severity: A review of current insights, management, and challenges

Several epidemiological studies have suggested a link between air pollution and respiratory tract infections. The outbreak of coronavirus disease 2019 (COVID-19) poses a great threat to public health worldwide. However, some parts of the globe have been worse affected in terms of prevalence and deaths than others. The causes and conditions of such variations have yet to be explored. Although some studies indicated a possible correlation between air pollution and COVID-19 severity, there is yet insufficient data for a meaningful answer. This review summarizes the impact of air pollution on COVID-19 infections and severity and discusses the possible management strategies and challenges involved. The available literature investigating the correlation between air pollution and COVID-19 infections and mortality are included in the review. The studies reviewed here suggest that exposure to air pollution, particularly to PM_2.5 and NO₂ , is positively correlated with COVID-19 infections and mortality. Some data indicate that air pollution can play an important role in the airborne transmission of SARS-CoV-2. A high percentage of COVID-19 incidences has been reported in the most polluted areas, where patients needed hospital admission. The available data also show that both short-term and long-term air pollution may enhance COVID-19 severity. However, most of the studies that showed a link between air pollution and COVID-19 infections and mortality did not consider potential confounders during the correlation analysis. Therefore, more specific studies need to be performed focusing on some additional confounders such as individual age, population density, and pre-existing comorbidities to determine the impact of air pollution on COVID-19 infections and deaths. Integr Environ Assess Manag 2021;17:1114-1122. © 2021 SETAC.

Environmental risk factors and cardiovascular diseases: a comprehensive review

Noncommunicable diseases (NCDs) are fatal for more than 38 million people each year and are thus the main contributors to the global burden of disease accounting for 70% of mortality. The majority of these deaths are caused by cardiovascular disease. The risk of NCDs is strongly associated with exposure to environmental stressors such as pollutants in the air, noise exposure, artificial light at night and climate change, including heat extremes, desert storms and wildfires. In addition to the traditional risk factors for cardiovascular disease such as diabetes, arterial hypertension, smoking, hypercholesterolemia and genetic predisposition, there is a growing body of evidence showing that physicochemical factors in the environment contribute significantly to the high NCD numbers. Furthermore, urbanization is associated with accumulation and intensification of these stressors. This comprehensive expert review will summarize the epidemiology and pathophysiology of environmental stressors with a focus on cardiovascular NCDs. We will also discuss solutions and mitigation measures to lower the impact of environmental risk factors with focus on cardiovascular disease.

PM2.5, NO2, wildfires, and other environmental exposures are linked to higher Covid 19 incidence, severity, and death rates

Numerous studies have linked outdoor levels of PM_2.5, PM₁₀, NO₂, O₃, SO₂, and other air pollutants to significantly higher rates of Covid 19 morbidity and mortality, although the rate in which specific concentrations of pollutants increase Covid 19 morbidity and mortality varies widely by specific country and study. As little as a 1-μg/m³ increase in outdoor PM_2.5 is estimated to increase rates of Covid 19 by as much as 0.22 to 8%. Two California studies have strongly linked heavy wildfire burning periods with significantly higher outdoor levels of PM_2.5 and CO as well as significantly higher rates of Covid 19 cases and deaths. Active smoking has also been strongly linked significantly increased risk of Covid 19 severity and death. Other exposures possibly related to greater risk of Covid 19 morbidity and mortality include incense, pesticides, heavy metals, dust/sand, toxic waste sites, and volcanic emissions. The exact mechanisms in which air pollutants increase Covid 19 infections are not fully understood, but are probably related to pollutant-related oxidation and inflammation of the lungs and other tissues and to the pollutant-driven alternation of the angiotensin-converting enzyme 2 in respiratory and other cells.

COVID-19 and environmental concerns: A rapid review

COVID-19 has slowed global economic growth and consequently impacted the environment as well. Parallelly, the environment also influences the transmission of this novel coronavirus through various factors. Every nation deals with varied population density and size; air quality and pollutants; the nature of land and water, which significantly impact the transmission of coronavirus. The WHO (Ziaeepour et al., 2008) [1] has recommended rapid reviews to provide timely evidence to the policymakers to respond to the emergency. The present study follows a rapid review along with a brief bibliometric analysis of 328 research papers, which synthesizes the evidence regarding the environmental concerns of COVID-19. The novel contribution of this rapid review is threefold. One, we take stock of the diverse findings as regards the transmission of the novel coronavirus in different types of environments for providing conclusive directions to the ongoing debate regarding the transmission of the virus. Two, our findings provide topical insights as well as methodological guidance for future researchers in the field. Three, we inform the policymakers on the efficacy of environmental measures for controlling the spread of COVID-19.

Threshold effects of COVID-19-confirmed cases on change in pollutants changes: evidence from the Chinese top ten cities

A more comprehensive understanding of the impact of the COVID-19 pandemic on changes in pollution could serve us to better deal with the environmental challenges caused by the pandemic. Existing studies mainly focused on the linear impact of the pandemic on the pollutants without considering the impact of other factors. To fill the research gap, the nonlinear relationship between pandemic and pollutants with considering the temperature factor was explored by developing panel threshold regression approach. In the proposed approach, the number of confirmed cases was set as explanatory variable, concentrations of NO2 and PM2.5 were set as explained variables, temperature was used as threshold variable, and other air pollution indicators were used as control variables. The results showed that there is a threshold effect between the changes in confirmed COVID-19 cases and the concentrations of PM2.5 and NO2, confirming the impact of the pandemic on pollutions was nonlinear. The results also show that the negative impact of pandemic on pollution increased when the temperature was rising. This work had theoretical and practical significance. The nonlinear research perspective of this article provided a methodological reference for exploring the relationship between epidemic and pollutant-related variables. Furthermore, this study expanded the scope of application of the threshold panel regression model and enriched the quantitative analysis of epidemics and pollutants.

Air pollution and the pandemic: Long-term PM2.5 exposure and disease severity in COVID-19 patients

Background and objective

Ecological studies have suggested an association between exposure to particulate matter ≤2.5 μm (PM_2.5) and coronavirus disease 2019 (COVID‐19) severity. However, these findings are yet to be validated in individual‐level studies. We aimed to determine the association of long‐term PM_2.5 exposure with hospitalization among individual patients infected with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2).

Methods

We estimated the 10‐year (2009–2018) PM_2.5 exposure at the residential zip code of COVID‐19 patients diagnosed at the University of Cincinnati healthcare system between 13 March 2020 and 30 September 2020. Logistic regression was used to determine the odds ratio (OR) and 95% CI for COVID‐19 hospitalizations associated with PM_2.5, adjusting for socioeconomic characteristics and comorbidities.

Results

Among the 14,783 COVID‐19 patients included in our study, 13.6% were hospitalized; the geometric mean (SD) PM_2.5 was 10.48 (1.12) μg/m³. In adjusted analysis, 1 μg/m³ increase in 10‐year annual average PM_2.5 was associated with 18% higher hospitalization (OR: 1.18, 95% CI: 1.11–1.26). Likewise, 1 μg/m³ increase in PM_2.5 estimated for the year 2018 was associated with 14% higher hospitalization (OR: 1.14, 95% CI: 1.08–1.21).

Conclusion

Long‐term PM_2.5 exposure is associated with increased hospitalization in COVID‐19. Therefore, more stringent COVID‐19 prevention measures may be needed in areas with higher PM_2.5 exposure to reduce the disease morbidity and healthcare burden.

Resilience and Equity in a Time of Crises: Investing in Public Urban Greenspace Is Now More Essential Than Ever in the US and Beyond

The intersecting negative effects of structural racism, COVID-19, climate change, and chronic diseases disproportionately affect racial and ethnic minorities in the US and around the world. Urban populations of color are concentrated in historically redlined, segregated, disinvested, and marginalized neighborhoods with inadequate quality housing and limited access to resources, including quality greenspaces designed to support natural ecosystems and healthy outdoor activities while mitigating urban environmental challenges such as air pollution, heat island effects, combined sewer overflows and poor water quality. Disinvested urban environments thus contribute to health inequity via physical and social environmental exposures, resulting in disparities across numerous health outcomes, including COVID-19 and chronic diseases such as cancer and cardiovascular diseases (CVD). In this paper, we build off an existing conceptual framework and propose another conceptual framework for the role of greenspace in contributing to resilience and health equity in the US and beyond. We argue that strategic investments in public greenspaces in urban neighborhoods impacted by long term economic disinvestment are critically needed to adapt and build resilience in communities of color, with urgency due to immediate health threats of climate change, COVID-19, and endemic disparities in chronic diseases. We suggest that equity-focused investments in public urban greenspaces are needed to reduce social inequalities, expand economic opportunities with diversity in workforce initiatives, build resilient urban ecosystems, and improve health equity. We recommend key strategies and considerations to guide this investment, drawing upon a robust compilation of scientific literature along with decades of community-based work, using strategic partnerships from multiple efforts in Milwaukee Wisconsin as examples of success.

The effect of environmental diesel exhaust pollution on SARS-CoV-2 infection: The mechanism of pulmonary ground glass opacity

Diesel exhaust particles (DEP) are the major components of atmospheric particulate matter (PM) and chronic exposure is recognized to enhance respiratory system complications. Although the spread of SARS-CoV-2 was found to be associated with the PMs, the mechanism by which exposure to DEP increases the risk of SARS-CoV-2 infection is still under discussion. However, diesel fine PM (dPM) elevate the probability of SARS-CoV-2 infection, as it coincides with the increase in the number of ACE2 receptors. Expression of ACE2 and its colocalized activator, transmembrane protease serine 2 (TMPRSS2) facilitate the entry of SARS-CoV-2 into the alveolar epithelial cells exposed to dPM. Thus, the coexistence of PM and SARS-CoV-2 in the environment augments inflammation and exacerbates lung damage. Increased TGF-β1 expression due to DEP accompanies the proliferation of the extracellular matrix. In this case, "multifocal ground-glass opacity" (GGO) in a CT scan is an indication of a cytokine storm and severe pneumonia in COVID-19.

Effects of air pollution and climatology on COVID-19 mortality in Spain

The health, economic, and social impact of COVID-19 has been significant across the world. Our objective was to evaluate the association between air pollution (through NO2 and PM2.5 levels) and COVID-19 mortality in Spanish provinces from February 3, 2020, to July 14, 2020, adjusting for climatic parameters. An observational and ecological study was conducted with information extracted from Datadista repository (Datadista, 2020). Air pollutants (NO2 and PM2.5 levels) were analyzed as potential determinants of COVID-19 mortality. Multilevel Poisson regression models were used to analyze the risk of mortality after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Models were adjusted by four climatic variables (hours of solar radiation, precipitation, daily temperature and wind speed) and population size. The mean levels of PM2.5 and NO2 across all provinces and time in Spain were 8.7 μg/m3 (SD 9.7) and 8.7 μg/m3 (SD 6.2), respectively. High levels of PM2.5 (IRR = 1.016, 95% CI: 1.007-1.026), NO2 (IRR = 1.066, 95% CI: 1.058-1.075) and precipitation (IRRNO2 = 0.989, 95% CI: 0.981-0.997) were positively associated with COVID-19 mortality, whereas temperature (IRRPM2.5 = 0.988, 95% CI: 0.976-1.000; and IRRNO2 = 0.771, 95% CI: 0.761-0.782, respectively) and wind speed (IRRNO2 = 1.095, 95% CI: 1.061-1.131) were negatively associated with COVID-19 mortality. Air pollution can be a key factor to understand the mortality rate for COVID-19 in Spain. Furthermore, climatic variables could be influencing COVID-19 progression. Thus, air pollution and climatology ought to be taken into consideration in order to control the pandemic.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11869-021-01062-2.

COVID-19, the Built Environment, and Health

BACKGROUND

Since the dawn of cities, the built environment has both affected infectious disease transmission and evolved in response to infectious diseases. COVID-19 illustrates both dynamics. The pandemic presented an opportunity to implement health promotion and disease prevention strategies in numerous elements of the built environment.

OBJECTIVES

This commentary aims to identify features of the built environment that affect the risk of COVID-19 as well as to identify elements of the pandemic response with implications for the built environment (and, therefore, for long-term public health).

DISCUSSION

Built environment risk factors for COVID-19 transmission include crowding, poverty, and racism (as they manifest in housing and neighborhood features), poor indoor air circulation, and ambient air pollution. Potential long-term implications of COVID-19 for the built environment include changes in building design, increased teleworking, reconfigured streets, changing modes of travel, provision of parks and greenspace, and population shifts out of urban centers. Although it is too early to predict with confidence which of these responses may persist, identifying and monitoring them can help health professionals, architects, urban planners, and decision makers, as well as members of the public, optimize healthy built environments during and after recovery from the pandemic. https://doi.org/10.1289/EHP8888.

How changes in human activities during the lockdown impacted air quality parameters: A review

The health emergency linked to the spread of COVID-19 has led to important reduction in industrial and logistics activities, as well as to a drastic changes in citizens' behaviors and habits. The restrictions on working activities, journeys and relationships imposed by the lockdown have had important consequences, including for environmental quality. This review aims to provide a structured and critical evaluation of the recent scientific bibliography that analyzed and described the impact of lockdown on human activities and on air quality. The results indicate an important effect of the lockdown during the first few months of 2020 on air pollution levels, compared to previous periods. The concentrations of particulate matter, nitrogen dioxide, sulfur dioxide and carbon monoxide have decreased. Tropospheric ozone, on the other hand, has significantly increased. These results are important indicators that can become decision drivers for future policies and strategies in industrial and logistics activities (including the mobility sector) aimed at their environmental sustainability. The scenario imposed by COVID-19 has supported the understanding of the link between the reduction of polluting emissions and the state of air quality and will be able to support strategic choices for the future sustainable growth of the industrial and logistics sector.

Early Spread of COVID-19 in the Air-Polluted Regions of Eight Severely Affected Countries

COVID-19 escalated into a pandemic posing several humanitarian as well as scientific challenges. We here investigated the geographical character of the early spread of the infection and correlated it with several annual satellite and ground indexes of air quality in China, the United States, Italy, Iran, France, Spain, Germany, and the United Kingdom. The time of the analysis corresponded with the end of the first wave infection in China, namely June 2020. We found more viral infections in those areas afflicted by high PM 2.5 and nitrogen dioxide values. Higher mortality was also correlated with relatively poor air quality. In Italy, the correspondence between the Po Valley pollution and SARS-CoV-2 infections and induced mortality was the starkest, originating right in the most polluted European area. Spain and Germany did not present a noticeable gradient of pollution levels causing non-significant correlations. Densely populated areas were often hotspots of lower air quality levels but were not always correlated with a higher viral incidence. Air pollution has long been recognised as a high risk factor for several respiratory-related diseases and conditions, and it now appears to be a risk factor for COVID-19 as well. As such, air pollution should always be included as a factor for the study of airborne epidemics and further included in public health policies.

Association between short-term exposure to air pollution and COVID-19 hospital admission/mortality during warm seasons

COVID-19 is a new viral infection that is usually accompanied by respiratory complications. Air pollution has been linked to cardiorespiratory-related diseases and even premature mortality. The short-term exposure to air pollution may aggravate pulmonary symptoms in COVID-19 patients. The relationship between the short-term exposure to air pollution and hospital admission and mortality resulting from COVID-19 will be examined in Tehran, Iran, during the spring and summer of 2020. The statistics of PM_2.5, PM₁₀, and 8-h maximum ozone (O₃) concentrations, meteorological conditions, and COVID-19 hospital admissions/mortality were analyzed. The cross-correlation and temporal relationship between the daily concentration of the aforementioned pollutants (as well as the meteorological conditions) and the COVID-19 hospital admissions/mortality rate was calculated for each month. The concentration of PM_2.5, PM₁₀, and 8-h maximum O₃, along with temperature, increased in the summer. The hospital admissions and mortality associated with COVID-19 decreased from the first peak in the spring and then increased to its second peak in the summer. The short-term exposure to ambient PM_2.5, PM₁₀, O₃, and elevated temperatures is associated with higher rates of COVID-19-related hospital admissions/mortality throughout the summer. Among these variables, the correlation with O₃ was statistically significant in more summer months. The short-term exposure to air pollution (especially O₃) may increase the susceptibility of the population infected with COVID-19 and, therefore, increases the rate of hospital admissions and mortality even during the warm seasons.

Long-Term Exposure to PM2.5, Facemask Mandates, Stay Home Orders and COVID-19 Incidence in the United States

Long-term PM_2.5 exposure might predispose populations to SARS-CoV-2 infection and intervention policies might interrupt SARS-CoV-2 transmission and reduce the risk of COVID-19. We conducted an ecologic study across the United States, using county-level COVID-19 incidence up to 12 September 2020, to represent the first two surges in the U.S., annual average of PM_2.5 between 2000 and 2016 and state-level facemask mandates and stay home orders. We fit negative binomial models to assess COVID-19 incidence in association with PM_2.5 and policies. Stratified analyses by facemask policy and stay home policy were also performed. Each 1-µg/m³ increase in annual average concentration of PM_2.5 exposure was associated with 7.56% (95% CI: 3.76%, 11.49%) increase in COVID-19 risk. Facemask mandates and stay home policies were inversely associated with COVID-19 with adjusted RRs of 0.8466 (95% CI: 0.7598, 0.9432) and 0.9193 (95% CI: 0.8021, 1.0537), respectively. The associations between PM_2.5 and COVID-19 were consistent among counties with or without preventive policies. Our study added evidence that long-term PM_2.5 exposure increased the risk of COVID-19 during each surge and cumulatively as of 12 September 2020, in the United States. Although both state-level implementation of facemask mandates and stay home orders were effective in preventing the spread of COVID-19, no clear effect modification was observed regarding long-term exposure to PM_2.5 on the risk of COVID-19.

A state-of-the-art review on WWTP associated bioaerosols: Microbial diversity, potential emission stages, dispersion factors, and control strategies

Wastewater treatment plants (WWTPs) associated bioaerosols have emerged as one of the critical sustainability indicators, ensuring health and well-being of societies and cities. In this context, this review summarizes the various wastewater treatment technologies which have been studied with a focus of bioaerosols emissions, potential emission stages, available sampling strategies, survival and dispersion factors, dominant microbial species in bioaerosols, and possible control approaches. Literature review revealed that most of the studies were devoted to sampling, enumerating and identifying cultivable microbial species of bioaerosols, as well as measuring their concentrations. However, the role of treatment technologies and their operational factors are investigated in limited studies only. Moreover, few studies have been reported to investigate the presence and concentrations of air borne virus and fungi in WWTP, as compared to bacterial species. The common environmental factors, affecting the survival and dispersion of bioaerosols, are observed as relative humidity, temperature, wind speed, and solar illumination. Further, research studies on recent episodes of COVID-19 (SARS-CoV-2 virus) pandemic also revealed that continuous and effective surveillance on WWTPs associated bioaerosols may led to early sign for future pandemics. The evaluation of reported data is bit complicated, due to the variation in sampling approaches, ambient conditions, and site activities of each study. Therefore, such studies need a standardized methodology and improved guidance to help informed future policies, contextual research, and support a robust health-based risk assessment process. Based on this review, an integrated sampling and analysis framework is suggested for future WWTPs to ensure their sustainability at social and/or health associated aspects.

An external exposome-wide association study of COVID-19 mortality in the United States

The risk factors for severe COVID-19 beyond older age and certain underlying health conditions are largely unknown. Recent studies suggested that long-term environmental exposures may be important determinants of severe COVID-19. However, very few environmental factors have been studied, often separately, without considering the totality of the external environment (i.e., the external exposome). We conducted an external exposome-wide association study (ExWAS) using the nationwide county-level COVID-19 mortality data in the contiguous US. A total of 337 variables characterizing the external exposome from 8 data sources were integrated, harmonized, and spatiotemporally linked to each county. A two-phase procedure was used: (1) in Phase 1, a random 50:50 split divided the data into a discovery set and a replication set, and associations between COVID-19 mortality and individual factors were examined using mixed-effect negative binomial regression models, with multiple comparisons addressed, and (2) in Phase 2, a multivariable regression model including all variables that are significant from both the discovery and replication sets in Phase 1 was fitted. A total of 13 and 22 variables were significant in the discovery and replication sets in Phase 1, respectively. All the 4 variables that were significant in both sets in Phase 1 remained statistically significant in Phase 2, including two air toxicants (i.e., nitrogen dioxide or NO₂, and benzidine), one vacant land measure, and one food environment measure. This is the first external exposome study of COVID-19 mortality. It confirmed some of the previously reported environmental factors associated with COVID-19 mortality, but also generated unexpected predictors that may warrant more focused evaluation.

Season, not lockdown, improved air quality during COVID-19 State of Emergency in Nigeria

Globally, ambient air pollution claims ~9 million lives yearly, prompting researchers to investigate changes in air quality. Of special interest is the impact of COVID-19 lockdown. Many studies reported substantial improvements in air quality during lockdowns compared with pre-lockdown or as compared with baseline values. Since the lockdown period coincided with the onset of the rainy season in some tropical countries such as Nigeria, it is unclear if such improvements can be fully attributed to the lockdown. We investigate whether significant changes in air quality in Nigeria occurred primarily due to statewide COVID-19 lockdown. We applied a neural network approach to derive monthly average ground-level fine aerosol optical depth (AODf) across Nigeria from year 2001-2020, using the Multi-angle Implementation of Atmospheric Correction (MAIAC) AODs from Terra and Aqua Moderate Resolution Imaging Spectroradiometer (MODIS) satellites, AERONET aerosol optical properties, meteorological and spatial parameters. During the year 2020, we found a 21% or 26% decline in average AODf level across Nigeria during lockdown (April) as compared to pre-lockdown (March), or during the easing phase-1 (May) as compared to lockdown, respectively. Throughout the 20-year period, AODf levels were highest in January and lowest in May or June, but not April. Comparison of AODf levels between 2020 and 2019 shows a small decline (1%) in pollution level in April of 2020 compare to 2019. Using a linear time-lag model to compare changes in AODf levels for similar months from 2002 to 2020, we found no significant difference (Levene's test and ANCOVA; α = 0.05) in the pollution levels by year, which indicates that the lockdown did not significantly improve air quality in Nigeria. Impact analysis using multiple linear regression revealed that favorable meteorological conditions due to seasonal change in temperature, relative humidity, planetary boundary layer height, wind speed and rainfall improved air quality during the lockdown.