Projected wind and solar energy potential in the eastern Mediterranean and Middle East in 2050

The ongoing energy transition from conventional fuels to renewable energy sources (RES) has given nations the potential to achieve levels of energy self-sufficiency previously thought unattainable. RES in the form of utility-scale solar and wind energy are currently the leading alternatives to fossil-fuel generation. Precise location siting that factors in efficiency limitations related to current and future climate variables is essential for enabling the green energy transition envisioned for 2050. In this context, understanding and mapping the intermittency of RES provides insights to energy system operators for their seamless integration into the grid. The Eastern Mediterranean and Middle East (EMME) region has the potential to harness vast amounts of RES. The scarcity of observations from weather station networks and the lack of private sector incentives for transitioning to RES mean that relevant, supporting weather and climate studies have been limited. This study employs the Weather Research and Forecasting model with Chemistry (WRF-CHEM) to estimate the RES technical potential of EMME countries and map the hourly generation profiles per source and country, simulated for the reference year 2015 and considering future conditions. The findings indicate that by 2050, seven countries within the region could transform into net energy exporters, while the remaining nine might remain reliant on energy imports or fossil fuels. Egypt emerges as a "powerhouse", potentially enjoying a potential surplus energy generation of 76 GW per hour, whereas the United Arab Emirates may face an annual deficit of 955 TWh. Further, we derived the hourly generation profiles for wind and solar during different seasons. Four dominant patterns were identified. We find a complementary relationship for six countries, and for four countries, a substitute relationship between solar and wind energy generation. Greece stands out with a near-constant wind energy source, which would facilitate its integration into the national grid.

Kinetics of the reaction of OH with methyl nitrate (223-343 K)

Rate coefficients (k4) for the reaction of hydroxyl radicals (OH) with methyl nitrate (CH3ONO2) were measured over the temperature range 232-343 K using pulsed laser photolysis to generate OH and pulsed laser-induced fluorescence to detect it in real-time and under pseudo-first-order conditions. In order to optimize the accuracy of the rate coefficients obtained, the concentration of CH3ONO2 (the reactant in excess) was measured on-line by absorption spectroscopy at 213.86 nm for which the absorption cross-section was also measured (σ213.86 = 1.65 ± 0.09 × 10-18 cm2 molecule-1). The temperature-dependent rate coefficient is described by k4(T) = 7.5 × 10-13 exp[(-1034 ± 40)/T] cm3 molecule-1 s-1 with a room temperature rate coefficient of k4(296 ± 2 K) = (2.32 ± 0.12) × 10-14 cm3 molecule-1 s-1 where the uncertainty includes the statistical error of 2σ and an estimation of the potential systematic bias of 5%. This new dataset helps to consolidate the database for this rate coefficient and to reduce uncertainty in the atmospheric lifetime of CH3ONO2. As part of this study, an approximate rate coefficient for the reaction of H-atoms with CH3ONO2 (k9) was also derived at room temperature: k9(298 K) = (1.68 ± 0.45) × 10-13 cm3 molecule-1 s-1.

Endogenous Nitric Oxide Can Enhance Oxidative Stress Caused by Air Pollutants and Explain Higher Susceptibility of Individuals with Inflammatory Disorders

Air pollution causes morbidity and excess mortality. In the epithelial lining fluid of the respiratory tract, air pollutants trigger a chemical reaction sequence that causes the formation of noxious hydroxyl radicals that drive oxidative stress. For hitherto unknown reasons, individuals with pre-existing inflammatory disorders are particularly susceptible to air pollution. Through detailed multiphase chemical kinetic analysis, we show that the commonly elevated concentrations of endogenous nitric oxide in diseased individuals can increase the production of hydroxyl radicals via peroxynitrite formation. Our findings offer a molecular rationale of how adverse health effects and oxidative stress caused by air pollutants may be exacerbated by inflammatory disorders.

Health effects of carbonaceous PM2.5 compounds from residential fuel combustion and road transport in Europe

Exposure to fine particulate matter (PM2.5) is associated with an increased risk of morbidity and mortality. In Europe, residential fuel combustion and road transport emissions contribute significantly to PM2.5. Toxicological studies indicate that PM2.5 from these sources is relatively more hazardous, owing to its high content of black and organic carbon. Here, we study the contribution of the emissions from these sectors to long-term exposure and excess mortality in Europe. We quantified the impact of anthropogenic carbonaceous aerosols on excess mortality and performed a sensitivity analysis assuming that they are twice as toxic as inorganic particles. We find that total PM2.5 from residential combustion leads to 72,000 (95% confidence interval: 48,000-99,000) excess deaths per year, with about 40% attributed to carbonaceous aerosols. Similarly, road transport leads to about 35,000 (CI 23,000-47,000) excess deaths per year, with 6000 (CI 4000-9000) due to carbonaceous particles. Assuming that carbonaceous aerosols are twice as toxic as other PM2.5 components, they contribute 80% and 37%, respectively, to residential fuel combustion and road transport-related deaths. We uncover robust national variations in the contribution of each sector to excess mortality and emphasize the importance of country-specific emission reduction policies based on national characteristics and sectoral shares.

Supporting and implementing the beneficial parts of the exposome: The environment can be the problem, but it can also be the solution

In 2005, Christopher P. Wild introduced the exposome concept, encompassing the biochemical changes in the organism in response to the totality of all environmental exposures throughout the entire lifespan and their association with health outcomes. The exposome concept also aimed at to completing the genome, that describes the genetic predisposition as a determinant of disease and death as well as potential targets of intervention. The exposome can be subdivided into multiple pollutomes related to specific chemical and physical pollutants (or other forms of environmental risks), periods of life (infancy, childhood, adolescence, adulthood, and old age) or geographical locations. While exposome research and, in general, health research of the last decades has predominantly focused on what factors contribute to and initiate morbidity and mortality, little is done on factors that will help to develop, maintain, or even increase human health. We want to contribute to this reorientation by supporting and implementing the beneficial exposome, comprising all environmental exposures with the potential to promote health.

Air pollution deaths attributable to fossil fuels: observational and modelling study

OBJECTIVES

To estimate all cause and cause specific deaths that are attributable to fossil fuel related air pollution and to assess potential health benefits from policies that replace fossil fuels with clean, renewable energy sources.

DESIGN

Observational and modelling study.

METHODS

An updated atmospheric composition model, a newly developed relative risk model, and satellite based data were used to determine exposure to ambient air pollution, estimate all cause and disease specific mortality, and attribute them to emission categories.

DATA SOURCES

Data from the global burden of disease 2019 study, observational fine particulate matter and population data from National Aeronautics and Space Administration (NASA) satellites, and atmospheric chemistry, aerosol, and relative risk modelling for 2019.

RESULTS

Globally, all cause excess deaths due to fine particulate and ozone air pollution are estimated at 8.34 million (95% confidence interval 5.63 to 11.19) deaths per year. Most (52%) of the mortality burden is related to cardiometabolic conditions, particularly ischaemic heart disease (30%). Stroke and chronic obstructive pulmonary disease both account for 16% of mortality burden. About 20% of all cause mortality is undefined, with arterial hypertension and neurodegenerative diseases possibly implicated. An estimated 5.13 million (3.63 to 6.32) excess deaths per year globally are attributable to ambient air pollution from fossil fuel use and therefore could potentially be avoided by phasing out fossil fuels. This figure corresponds to 82% of the maximum number of air pollution deaths that could be averted by controlling all anthropogenic emissions. Smaller reductions, rather than a complete phase-out, indicate that the responses are not strongly non-linear. Reductions in emission related to fossil fuels at all levels of air pollution can decrease the number of attributable deaths substantially. Estimates of avoidable excess deaths are markedly higher in this study than most previous studies for these reasons: the new relative risk model has implications for high income (largely fossil fuel intensive) countries and for low and middle income countries where the use of fossil fuels is increasing; this study accounts for all cause mortality in addition to disease specific mortality; and the large reduction in air pollution from a fossil fuel phase-out can greatly reduce exposure.

CONCLUSION

Phasing out fossil fuels is deemed to be an effective intervention to improve health and save lives as part the United Nations' goal of climate neutrality by 2050. Ambient air pollution would no longer be a leading, environmental health risk factor if the use of fossil fuels were superseded by equitable access to clean sources of renewable energy.

Entomological surveillance and spatiotemporal risk assessment of sand fly-borne diseases in Cyprus

Visceral and cutaneous leishmaniases are important public health concerns in Cyprus. Although the diseases, historically prevalent on the island, were nearly eradicated by 1996, an increase in frequency and geographical spread has recently been recorded. Upward trends in leishmaniasis prevalence have largely been attributed to environmental changes that amplify the abundance and activity of its vector, the phlebotomine sand flies. Here, we performed an extensive field study across the island to map the sand fly fauna and compared the presence and distribution of the species found with historical records. We mapped the habitat preferences of Phlebotomus papatasi and P. tobbi, two medically important species, and predicted the seasonal abundance of P. papatasi at unprecedented spatiotemporal resolution using a climate-sensitive population dynamics model driven by high-resolution meteorological forecasting. Our compendium holds a record of 18 species and the locations of a subset, including those of potential public and veterinary health concern. We confirmed that P. papatasi is widespread, especially in densely urbanized areas, and predicted that its abundance uniformly peaks across the island at the end of summer. We identified potential hotspots of P. papatasi activity even after this peak. Our results form a foundation to inform public health planning and contribute to the development of effective, efficient, and environmentally sensitive strategies to control sand fly populations and prevent sand fly-borne diseases.

Inferring the diurnal variability of OH radical concentrations over the Amazon from BVOC measurements

The atmospheric oxidation of biogenic volatile organic compounds (BVOC) by OH radicals over tropical rainforests impacts local particle production and the lifetime of globally distributed chemically and radiatively active gases. For the pristine Amazon rainforest during the dry season, we empirically determined the diurnal OH radical variability at the forest-atmosphere interface region between 80 and 325 m from 07:00 to 15:00 LT using BVOC measurements. A dynamic time warping approach was applied showing that median averaged mixing times between 80 to 325 m decrease from 105 to 15 min over this time period. The inferred OH concentrations show evidence for an early morning OH peak (07:00-08:00 LT) and an OH maximum (14:00 LT) reaching 2.2 (0.2, 3.8) × 106 molecules cm-3 controlled by the coupling between BVOC emission fluxes, nocturnal NOx accumulation, convective turbulence, air chemistry and photolysis rates. The results were evaluated with a turbulence resolving transport (DALES), a regional scale (WRF-Chem) and a global (EMAC) atmospheric chemistry model.

On fine particulate matter and COVID-19 spread and severity: An in vitro toxicological plausible mechanism

COVID-19 pandemic had a significant impact on global public health. The spread of the disease was related to the high transmissibility of SARS-CoV-2 virus but incidence and mortality rate suggested a possible relationship with environmental factors. Air pollution has been hypothesized to play a role in the transmission of the virus and the resulting severity of the disease. Here we report a plausible in vitro toxicological mode of action by which fine particulate matter (PM2.5) could promote a higher infection rate of SARS-CoV-2 and severity of COVID-19 disease. PM2.5 promotes a 1.5 fold over-expression of the angiotensin 2 converting enzyme (ACE2) which is exploited by viral particles to enter human lung alveolar cells (1.5 fold increase in RAB5 protein) and increases their inflammatory state (IL-8 and NF-kB protein expression). Our results provide a basis for further exploring the possible synergy between biological threats and air pollutants and ask for a deeper understanding of how air quality could influence new pandemics in the future.

Impact of air pollution on cardiovascular aging

The world population is aging rapidly, and by some estimates, the number of people older than 60 will double in the next 30 years. With the increase in life expectancy, adverse effects of environmental exposures start playing a more prominent role in human health. Air pollution is now widely considered the most detrimental of all environmental risk factors, with some studies estimating that almost 20% of all deaths globally could be attributed to poor air quality. Cardiovascular diseases are the leading cause of death worldwide and will continue to account for the most significant percentage of non-communicable disease burden. Cardiovascular aging with defined pathomechanisms is a major trigger of cardiovascular disease in old age. Effects of environmental risk factors on cardiovascular aging should be considered in order to increase the health span and reduce the burden of cardiovascular disease in older populations. In this review, we explore the effects of air pollution on cardiovascular aging, from the molecular mechanisms to cardiovascular manifestations of aging and, finally, the age-related cardiovascular outcomes. We also explore the distinction between the effects of air pollution on healthy aging and disease progression. Future efforts should focus on extending the health span rather than the lifespan.

Spatial and sector-specific contributions of emissions to ambient air pollution and mortality in European cities: a health impact assessment

BACKGROUND

Ambient air pollution is a major risk to health and wellbeing in European cities. We aimed to estimate spatial and sector-specific contributions of emissions to ambient air pollution and evaluate the effects of source-specific reductions in pollutants on mortality in European cities to support targeted source-specific actions to address air pollution and promote population health.

METHODS

We conducted a health impact assessment of data from 2015 for 857 European cities to estimate source contributions to annual PM_2·5 and NO₂ concentrations using the Screening for High Emission Reduction Potentials for Air quality tool. We evaluated contributions from transport, industry, energy, residential, agriculture, shipping, and aviation, other, natural, and external sources. For each city and sector, three spatial levels were considered: contributions from the same city, the rest of the country, and transboundary. Mortality effects were estimated for adult populations (ie, ≥20 years) following standard comparative risk assessment methods to calculate the annual mortality preventable on spatial and sector-specific reductions in PM_2·5 and NO₂.

FINDINGS

We observed strong variability in spatial and sectoral contributions among European cities. For PM_2·5, the main contributors to mortality were the residential (mean contribution of 22·7% [SD 10·2]) and agricultural (18·0% [7·7]) sectors, followed by industry (13·8% [6·0]), transport (13·5% [5·8]), energy (10·0% [6·4]), and shipping (5·5% [5·7]). For NO₂, the main contributor to mortality was transport (48·5% [SD 15·2]), with additional contributions from industry (15·0% [10·8]), energy (14·7% [12·9]), residential (10·3% [5·0]), and shipping (9·7% [12·7]). The mean city contribution to its own air pollution mortality was 13·5% (SD 9·9) for PM_2·5 and 34·4% (19·6) for NO₂, and contribution increased among cities of largest area (22·3% [12·2] for PM_2·5 and 52·2% [19·4] for NO₂) and among European capitals (29·9% [12·5] for PM_2·5 and 62·7% [14·7] for NO₂).

INTERPRETATION

We estimated source-specific air pollution health effects at the city level. Our results show strong variability, emphasising the need for local policies and coordinated actions that consider city-level specificities in source contributions.

FUNDING

Spanish Ministry of Science and Innovation, State Research Agency, Generalitat de Catalunya, Centro de Investigación Biomédica en red Epidemiología y Salud Pública, and Urban Burden of Disease Estimation for Policy Making 2023-2026 Horizon Europe project.

Air pollution and child health impacts of decarbonization in 16 global cities: Modelling study

Most research on the air pollution-related health effects of decarbonization has focused on adults. We assess the potential health benefits that could be achieved in children and young people in a global sample of 16 cities through global decarbonization actions. We modelled annual average concentrations of fine particulate matter (PM_2.5) and nitrogen dioxide (NO₂) at 1x1 km resolution in the cities using a general circulation/atmospheric chemistry model assuming removal of all global combustion-related emissions from land transport, industries, domestic energy use and power generation. We modelled the impact on childhood asthma incidence and adverse birth outcomes (low birthweight, pre-term births) using published exposure-response relationships. Removal of combustion emissions was estimated to decrease annual average PM_2.5 by between 2.9 μg/m³ (8.4%) in Freetown and 45.4 μg/m³ (63.7%) in Dhaka. For NO₂, the range was from 0.3 ppb (7.9%) in Freetown to 18.8 ppb (92.3%) in Mexico City. Estimated reductions in asthma incidence ranged from close to zero in Freetown, Tamale and Harare to 149 cases per 100,000 population in Los Angeles. For pre-term birth, modelled impacts ranged from a reduction of 135 per 100,000 births in Dar es Salaam to 2,818 per 100,000 births in Bhubaneswar and, for low birthweight, from 75 per 100,000 births in Dar es Salaam to 2,951 per 100,000 births in Dhaka. The large variations chiefly reflect differences in the magnitudes of air pollution reductions and estimated underlying disease rates. Across the 16 cities, the reduction in childhood asthma incidence represents more than one-fifth of the current burden, and an almost 10% reduction in pre-term and low birthweight births. Decarbonization actions that remove combustion-related emissions contributing to ambient PM_2.5 and NO₂ would likely lead to substantial but geographically-varied reductions in childhood asthma and adverse birth outcomes, though there are uncertainties in causality and the precision of estimates.

Machine Learning Modeling of Aedes albopictus Habitat Suitability in the 21st Century

The Asian tiger mosquito, Aedes albopictus, is an important vector of arboviruses that cause diseases such as dengue, chikungunya, and zika. The vector is highly invasive and adapted to survive in temperate northern territories outside its native tropical and sub-tropical range. Climate and socio-economic change are expected to facilitate its range expansion and exacerbate the global vector-borne disease burden. To project shifts in the global habitat suitability of the vector, we developed an ensemble machine learning model, incorporating a combination of a Random Forest and XGBoost binary classifiers, trained with a global collection of vector surveillance data and an extensive set of climate and environmental constraints. We demonstrate the reliable performance and wide applicability of the ensemble model in comparison to the known global presence of the vector, and project that suitable habitats will expand globally, most significantly in the northern hemisphere, putting at least an additional billion people at risk of vector-borne diseases by the middle of the 21st century. We project several highly populated areas of the world will be suitable for Ae. albopictus populations, such as the northern parts of the USA, Europe, and India by the end of the century, which highlights the need for coordinated preventive surveillance efforts of potential entry points by local authorities and stakeholders.

Noise and Air Pollution as Risk Factors for Hypertension: Part II-Pathophysiologic Insight

Traffic noise and air pollution are environmental stressors found to increase risk for cardiovascular events. The burden of disease attributable to environmental stressors and cardiovascular disease globally is substantial, with a need to better understand the contribution of specific risk factors that may underlie these effects. Epidemiological observations and experimental evidence from animal models and human controlled exposure studies suggest an essential role for common mediating pathways. These include sympathovagal imbalance, endothelial dysfunction, vascular inflammation, increased circulating cytokines, activation of central stress responses, including hypothalamic and limbic pathways, and circadian disruption. Evidence also suggests that cessation of air pollution or noise through directed interventions alleviates increases in blood pressure and intermediate surrogate pathways, supporting a causal link. In the second part of this review, we discuss the current understanding of mechanisms underlying and current gaps in knowledge and opportunities for new research.

Noise and Air Pollution as Risk Factors for Hypertension: Part I-Epidemiology

Traffic noise and air pollution are 2 major environmental health risk factors in urbanized societies that often occur together. Despite cooccurrence in urban settings, noise and air pollution have generally been studied independently, with many studies reporting a consistent effect on blood pressure for individual exposures. In the present reviews, we will discuss the epidemiology of air pollution and noise effects on arterial hypertension and cardiovascular disease (part I) and the underlying pathophysiology (part II). Both environmental stressors have been found to cause endothelial dysfunction, oxidative stress, vascular inflammation, circadian dysfunction, and activation of the autonomic nervous system, thereby facilitating the development of hypertension. We also discuss the effects of interventions, current gaps in knowledge, and future research tasks. From a societal and policy perspective, the health effects of both air pollution and traffic noise are observed well below the current guideline recommendations. To this end, an important goal for the future is to increase the acceptance of environmental risk factors as important modifiable cardiovascular risk factors, given their substantial impact on the burden of cardiovascular disease.

Metal-rich stars are less suitable for the evolution of life on their planets

Atmospheric ozone and oxygen protect the terrestrial biosphere against harmful ultraviolet (UV) radiation. Here, we model atmospheres of Earth-like planets hosted by stars with near-solar effective temperatures (5300 to 6300 K) and a broad range of metallicities covering known exoplanet host stars. We show that paradoxically, although metal-rich stars emit substantially less ultraviolet radiation than metal-poor stars, the surface of their planets is exposed to more intense ultraviolet radiation. For the stellar types considered, metallicity has a larger impact than stellar temperature. During the evolution of the universe, newly formed stars have progressively become more metal-rich, exposing organisms to increasingly intense ultraviolet radiation. Our findings imply that planets hosted by stars with low metallicity are the best targets to search for complex life on land.

Current and future trends in heat-related mortality in the MENA region: a health impact assessment with bias-adjusted statistically downscaled CMIP6 (SSP-based) data and Bayesian inference

BACKGROUND

The Middle East and North Africa (MENA) is one of the regions that is most vulnerable to the negative effects of climate change, yet the potential public health impacts have been underexplored compared to other regions. We aimed to examine one aspect of these impacts, heat-related mortality, by quantifying the current and future burden in the MENA region and identifying the most vulnerable countries.

METHODS

We did a health impact assessment using an ensemble of bias-adjusted statistically downscaled Coupled Model Intercomparison Project phase 6 (CMIP6) data based on four Shared Socioeconomic Pathway (SSP) scenarios (SSP1-2·6 [consistent with a 2°C global warming scenario], SSP2-4·5 [medium pathway scenario], SSP3-7·0 [pessimistic scenario], and SSP5-8·5 [high emissions scenario]) and Bayesian inference methods. Assessments were based on apparent temperature-mortality relationships specific to each climate subregion of MENA based on Koppen-Geiger climate type classification, and unique thresholds were characterised for each 50 km grid cell in the region. Future annual heat-related mortality was estimated for the period 2021-2100. Estimates were also presented with population held constant to quantify the contribution of projected demographic changes to the future heat-mortality burden.

FINDINGS

The average annual heat-related death rate across all MENA countries is currently 2·1 per 100 000 people. Under the two high emissions scenarios (SSP3-7·0 and SSP5-8·5), most of the MENA region will have experienced substantial warming by the 2060s. Annual heat-related deaths of 123·4 per 100 000 people are projected for MENA by 2100 under a high emissions scenario (SSP5-8·5), although this rate would be reduced by more than 80% (to 20·3 heat-related deaths per 100 000 people per year) if global warming could be limited to 2°C (ie, under the SSP1-2·6 scenario). Large increases are also expected by 2100 under the SSP3-7·0 scenario (89·8 heat-related deaths per 100 000 people per year) due to the high population growth projected under this pathway. Projections in MENA are far higher than previously observed in other regions, with Iran expected to be the most vulnerable country.

INTERPRETATION

Stronger climate change mitigation and adaptation policies are needed to avoid these heat-related mortality impacts. Since much of this increase will be driven by population changes, demographic policies and healthy ageing will also be key to successful adaptation.

FUNDING

National Institute for Health Research, EU Horizon 2020.

Air pollution impacts on in-hospital case-fatality rate of ischemic stroke patients

BACKGROUND

A growing body of evidence suggests that air pollution exposure is associated with an increased risk for cardiovascular diseases. Data regarding the impact of long-term air pollution exposure on ischemic stroke mortality are sparse.

METHODS

The German nationwide inpatient sample was used to analyse all cases of hospitalized patients with ischemic stroke in Germany 2015-2019, which were stratified according to their residency. Data of the German Federal Environmental Agency regarding average values of air pollutants were assessed from 2015 to 2019 at district-level. Data were combined and the impact of different air pollution parameters on in-hospital case-fatality was analyzed.

RESULTS

Overall, 1,505,496 hospitalizations of patients with ischemic stroke (47.7% females; 67.4 % ≥70 years old) were counted in Germany 2015-2019, of whom 8.2 % died during hospitalization. When comparing patients with residency in federal districts with high vs. low long-term air pollution, enhanced levels of benzene (OR 1.082 [95%CI 1.034-1.132],P = 0.001), ozone (O_3, OR 1.123 [95%CI 1.070-1.178],P < 0.001), nitric oxide (NO, OR 1.076 [95%CI 1.027-1.127],P = 0.002) and PM_2.5 fine particulate matter concentrations (OR 1.126 [95%CI 1.074-1.180],P < 0.001) were significantly associated with increased case-fatality independent from age, sex, cardiovascular risk-factors, comorbidities, and revascularization treatments. Conversely, enhanced carbon monoxide, nitrogen dioxide, PM_10, and sulphur dioxide (SO₂) concentrations were not significantly associated with stroke mortality. However, SO_2-concentrations were significantly associated with stroke-case-fatality rate of >8 % independent of residence area-type and area use (OR 1.518 [95%CI 1.012-2.278],P = 0.044).

CONCLUSION

Elevated long-term air pollution levels in residential areas in Germany, notably of benzene, O₃, NO, SO_2, and PM_2.5, were associated with increased stroke mortality of patients.

RESEARCH IN CONTEXT

Evidence before this study: Besides typical, established risk factors, increasing evidence suggests that air pollution is an important and growing risk factor for stroke events, estimated to be responsible for approximately 14 % of all stroke-associated deaths. However, real-world data regarding the impact of long-term exposure to air pollution on stroke mortality are sparse. Added value of this study: The present study demonstrates that the long-term exposure to the air pollutants benzene, O₃, NO, SO₂ and PM_2.5 are independently associated with increased case-fatality of hospitalized patients with ischemic stroke in Germany. Implications of all the available evidence: The results of our study support the urgent need to reduce the exposure to air pollution by tightening emission controls to reduce the stroke burden and stroke mortality.

Fine particulate matter (PM2.5) trends from land surface changes and air pollution policies in China during 1980-2020

High levels of fine particulate matter (PM_2.5) pose a severe air pollution challenge in China. Both land use changes and anthropogenic emissions can affect PM2.5 concentrations. Only a few studies have addressed the long-term impact of land surface changes on PM2.5 in China. We conducted a comprehensive analysis of PM_2.5 trends over China using the Modern-Era Retrospective Analysis for Research and Applications, version 2 (MERRA-2) during 1980-2020. The monthly mean PM_2.5 concentrations of MERRA-2 were evaluated across mainland China against independent surface measurements from 2013 to 2020, showing a good agreement. For the trend analysis, China was subdivided into six regions based on land use and ambient aerosols types. Our results indicate an overall significant PM_2.5 increase over China during 1980-2020 with major changes in-between. Notwithstanding continued urbanization and associated anthropogenic activities, the PM_2.5 reversed to a downward trend around 2007 over most regions except for the part of China that is most affected by desert dust. Statistical analysis suggests that PM_2.5 trends during 1980-2010 were associated with urban expansion and deforestation over eastern and southern China. The trend reversal around 2007 is mainly attributed to Chinese air pollution control measures. A multiple linear regression analysis reveals that PM_2.5 variability is linked to soil moisture and vegetation. Our results suggest that land use and land cover changes as well as pollution controls strongly influenced PM_2.5 trends and that drought conditions affect PM_2.5 particularly over desert and forest regions of China. This work contributes to a better understanding of the changes in PM_2.5 over China.

A data integration framework for spatial interpolation of temperature observations using climate model data

Meteorological station measurements are an important source of information for understanding the weather and its association with risk, and are vital in quantifying climate change. However, such data tend to lack spatial coverage and are often plagued with flaws such as erroneous outliers and missing values. Alternative meteorological data exist in the form of climate model output that have better spatial coverage, at the expense of bias. We propose a probabilistic framework to integrate temperature measurements with climate model (reanalysis) data, in a way that allows for biases and erroneous outliers, while enabling prediction at any spatial resolution. The approach is Bayesian which facilitates uncertainty quantification and simulation based inference, as illustrated by application to two countries from the Middle East and North Africa region, an important climate change hotspot. We demonstrate the use of the model in: identifying outliers, imputing missing values, non-linear bias correction, downscaling and aggregation to any given spatial configuration.

Climate change and human health in the Eastern Mediterranean and Middle East: Literature review, research priorities and policy suggestions

Human health is linked to climatic factors in complex ways, and climate change can have profound direct and indirect impacts on the health status of any given region. Susceptibility to climate change is modulated by biological, ecological and socio-political factors such as age, gender, geographic location, socio-economic status, occupation, health status and housing conditions, among other. In the Eastern Mediterranean and Middle East (EMME), climatic factors known to affect human health include extreme heat, water shortages and air pollution. Furthermore, the epidemiology of vector-borne diseases (VBDs) and the health consequences of population displacement are also influenced by climate change in this region. To inform future policies for adaptation and mitigation measures, and based on an extensive review of the available knowledge, we recommend several research priorities for the region. These include the generation of more empirical evidence on exposure-response functions involving climate change and specific health outcomes, the development of appropriate methodologies to evaluate the physical and psychological effects of climate change on vulnerable populations, determining how climate change alters the ecological determinants of human health, improving our understanding of the effects of long-term exposure to heat stress and air pollution, and evaluating the interactions between adaptation and mitigation strategies. Because national boundaries do not limit most climate-related factors expected to impact human health, we propose that adaptation/mitigation policies must have a regional scope, and therefore require collaborative efforts among EMME nations. Policy suggestions include a decisive region-wide decarbonisation, the integration of environmentally driven morbidity and mortality data throughout the region, advancing the development and widespread use of affordable technologies for the production and management of drinking water by non-traditional means, the development of comprehensive strategies to improve the health status of displaced populations, and fostering regional networks for monitoring and controlling the spread of infectious diseases and disease vectors.

Mortality Attributable to Ambient Air Pollution: A Review of Global Estimates

Since the publication of the first epidemiological study to establish the connection between long-term exposure to atmospheric pollution and effects on human health, major efforts have been dedicated to estimate the attributable mortality burden, especially in the context of the Global Burden of Disease (GBD). In this work, we review the estimates of excess mortality attributable to outdoor air pollution at the global scale, by comparing studies available in the literature. We find large differences between the estimates, which are related to the exposure response functions as well as the number of health outcomes included in the calculations, aspects where further improvements are necessary. Furthermore, we show that despite the considerable advancements in our understanding of health impacts of air pollution and the consequent improvement in the accuracy of the global estimates, their precision has not increased in the last decades. We offer recommendations for future measurements and research directions, which will help to improve our understanding and quantification of air pollution-health relationships.

Co-exposure to urban particulate matter and aircraft noise adversely impacts the cerebro-pulmonary-cardiovascular axis in mice

Worldwide, up to 8.8 million excess deaths/year have been attributed to air pollution, mainly due to the exposure to fine particulate matter (PM). Traffic-related noise is an additional contributor to global mortality and morbidity. Both health risk factors substantially contribute to cardiovascular, metabolic and neuropsychiatric sequelae. Studies on the combined exposure are rare and urgently needed because of frequent co-occurrence of both risk factors in urban and industrial settings. To study the synergistic effects of PM and noise, we used an exposure system equipped with aerosol generator and loud-speakers, where C57BL/6 mice were acutely exposed for 3d to either ambient PM (NIST particles) and/or noise (aircraft landing and take-off events). The combination of both stressors caused endothelial dysfunction, increased blood pressure, oxidative stress and inflammation. An additive impairment of endothelial function was observed in isolated aortic rings and even more pronounced in cerebral and retinal arterioles. The increase in oxidative stress and inflammation markers together with RNA sequencing data indicate that noise particularly affects the brain and PM the lungs. The combination of both stressors has additive adverse effects on the cardiovascular system that are based on PM-induced systemic inflammation and noise-triggered stress hormone signaling. We demonstrate an additive upregulation of ACE-2 in the lung, suggesting that there may be an increased vulnerability to COVID-19 infection. The data warrant further mechanistic studies to characterize the propagation of primary target tissue damage (lung, brain) to remote organs such as aorta and heart by combined noise and PM exposure.

The impact of climatic factors on tick-related hospital visits and borreliosis incidence rates in European Russia

Tick-borne diseases are among the challenges associated with warming climate. Many studies predict, and already note, expansion of ticks’ habitats to the north, bringing previously non-endemic diseases, such as borreliosis and encephalitis, to the new areas. In addition, higher temperatures accelerate phases of ticks’ development in areas where ticks have established populations. Earlier works have shown that meteorological parameters, such as temperature and humidity influence ticks’ survival and define their areas of habitat. Here, we study the link between climatic parameters and tick-related hospital visits as well as borreliosis incidence rates focusing on European Russia. We have used yearly incidence rates of borreliosis spanning a period of 20 years (1997-2016) and weekly tick-related hospital visits spanning two years (2018-2019). We identify regions in Russia characterized by similar dynamics of incidence rates and dominating tick species. For each cluster, we find a set of climatic parameters that are significantly correlated with the incidence rates, though a linear regression approach using exclusively climatic parameters to incidence prediction was less than 50% effective. On a weekly timescale, we find correlations of different climatic parameters with hospital visits. Finally, we trained two long short-term memory neural network models to project the tick-related hospital visits until the end of the century, under the RCP8.5 climate scenario, and present our findings in the evolution of the tick season length for different regions in Russia. Our results show that the regions with an expected increase in both tick season length and borreliosis incidence rates are located in the southern forested areas of European Russia. Oppositely, our projections suggest no prolongation of the tick season length in the northern areas with already established tick population.

A dynamically structured matrix population model for insect life histories observed under variable environmental conditions

Various environmental drivers influence life processes of insect vectors that transmit human disease. Life histories observed under experimental conditions can reveal such complex links; however, designing informative experiments for insects is challenging. Furthermore, inferences obtained under controlled conditions often extrapolate poorly to field conditions. Here, we introduce a pseudo-stage-structured population dynamics model to describe insect development as a renewal process with variable rates. The model permits representing realistic life stage durations under constant and variable environmental conditions. Using the model, we demonstrate how random environmental variations result in fluctuating development rates and affect stage duration. We apply the model to infer environmental dependencies from the life history observations of two common disease vectors, the southern (Culex quinquefasciatus) and northern (Culex pipiens) house mosquito. We identify photoperiod, in addition to temperature, as pivotal in regulating larva stage duration, and find that carefully timed life history observations under semi-field conditions accurately predict insect development throughout the year. The approach we describe augments existing methods of life table design and analysis, and contributes to the development of large-scale climate- and environment-driven population dynamics models for important disease vectors.

Rate Coefficients for OH + NO (+N2) in the Fall-off Regime and the Impact of Water Vapor

The termolecular, association reaction between OH and NO is a source of nitrous acid (HONO), an important atmospheric trace gas. Rate coefficients for the title reaction as recommended by evaluation panels differ substantially at the temperatures and pressures that prevail in the Earth's boundary layer where the reaction is in the fall-off regime between low- and high-pressure limiting rate coefficients. Using pulsed laser methods for generation and detection of OH, we have reinvestigated the kinetics of the title reaction at pressures of 22-743 Torr (1 Torr = 1.333 hPa) and temperatures (273, 298, and 333 K) in pure N₂ and in N₂-H₂O bath gases. In situ optical absorption measurements were used to rule out any bias due to NO₂ or HONO impurities. Our rate coefficients (k₁) in N₂ bath gas are parametrized in terms of low-pressure (k₀) and high-pressure (k_∞) rate coefficients and a fall-off parameter (F_C) with k_1,0^N₂ = 7.24 × 10^-31 (T/300 K)^-2.17 cm⁶ molecule^-2 s^-1, k_1,∞ = 3.3 × 10^-12 (T/300 K)^-0.3 cm³ molecule^-1 s^-1, and F_C = 0.53. Used with the "Troe" expression for termolecular reactions, these parameters accurately reproduce the current data in the fall-off regime and also capture literature rate coefficients at extrapolated temperatures. The presence of water vapor was found to enhance the rate coefficients of the title reaction significantly. The low-pressure limiting rate coefficient in H₂O bath gas is a factor 5-6 larger than in N₂, at room temperature (k_1,0^H₂O = 4.55 × 10^-30 (T/300 K)^-4.85 cm⁶ molecule^-2 s^-1) indicating that H₂O is much more efficient in quenching the association complex HONO* through collisional energy transfer. Based on measurements in N₂-H₂O mixtures, a parametrization of k₁ including both N₂ and H₂O as third-body quenchers was derived. Neglecting the effect of H₂O results, e.g., in an underestimation of k₁ by >10% in the tropical boundary layer.

Synergistic HNO3-H2SO4-NH3 upper tropospheric particle formation

New particle formation in the upper free troposphere is a major global source of cloud condensation nuclei (CCN)^1-4. However, the precursor vapours that drive the process are not well understood. With experiments performed under upper tropospheric conditions in the CERN CLOUD chamber, we show that nitric acid, sulfuric acid and ammonia form particles synergistically, at rates that are orders of magnitude faster than those from any two of the three components. The importance of this mechanism depends on the availability of ammonia, which was previously thought to be efficiently scavenged by cloud droplets during convection. However, surprisingly high concentrations of ammonia and ammonium nitrate have recently been observed in the upper troposphere over the Asian monsoon region^5,6. Once particles have formed, co-condensation of ammonia and abundant nitric acid alone is sufficient to drive rapid growth to CCN sizes with only trace sulfate. Moreover, our measurements show that these CCN are also highly efficient ice nucleating particles-comparable to desert dust. Our model simulations confirm that ammonia is efficiently convected aloft during the Asian monsoon, driving rapid, multi-acid HNO₃-H₂SO₄-NH₃ nucleation in the upper troposphere and producing ice nucleating particles that spread across the mid-latitude Northern Hemisphere.

Prevalence of SARS-CoV-2 in Pregnant Women Assessed by RT-PCR in Franconia, Germany: First Results of the SCENARIO Study (SARS-CoV-2 prEvalence in pregNAncy and at biRth In FrancOnia)

Purpose Detection of SARS-CoV-2-infected pregnant women admitted to maternity units during a pandemic is crucial. In addition to the fact that pregnancy is a risk factor for severe COVID-19 and that medical surveillance has to be adjusted in infected women and their offspring, knowledge about infection status can provide the opportunity to protect other patients and healthcare workers against virus transmission. The aim of this prospective observational study was to determine the prevalence of SARS-CoV-2 infection among pregnant women in the hospital setting.

Material and Methods All eligible pregnant women admitted to the nine participating hospitals in Franconia, Germany, from 2 June 2020 to 24 January 2021 were included. COVID-19-related symptoms, secondary diseases and pregnancy abnormalities were documented. SARS-CoV-2 RNA was detected by RT-PCR from nasopharyngeal swabs. The prevalence of acute SARS-CoV-2 infection was estimated by correcting the positive rate using the Rogan–Gladen method. The risk of infection for healthcare workers during delivery was estimated using a risk calculator.

Results Of 2414 recruited pregnant women, six were newly diagnosed RT-PCR positive for SARS-CoV-2, which yielded a prevalence of SARS-CoV-2 infection of 0.26% (95% CI, 0.10 – 0.57%). Combining active room ventilation and wearing FFP2 masks showed an estimated reduction of risk of infection for healthcare workers in the delivery room to < 1%.

Conclusions The prevalence of newly diagnosed SARS-CoV-2 infection during pregnancy in this study is low. Nevertheless, a systematic screening in maternity units during pandemic situations is important to adjust hygienic and medical management. An adequate hygienic setting can minimise the calculated infection risk for medical healthcare workers during patientsʼ labour.

Global health burden of ambient PM2.5 and the contribution of anthropogenic black carbon and organic aerosols

Chronic exposure to fine particulate matter (PM_2.5) poses a major global health risk, commonly assessed by assuming equivalent toxicity for different PM_2.5 constituents. We used a data-informed global atmospheric model and recent exposure-response functions to calculate the health burden of ambient PM_2.5 from ten source categories. We estimate 4.23 (95% confidence interval 3.0-6.14) million excess deaths annually from the exposure to ambient PM_2.5. We distinguished contributions and major sources of black carbon (BC), primary organic aerosols (POA) and anthropogenic secondary organic aerosols (aSOA). These components make up to ∼20% of the total PM_2.5 in South and East Asia and East Africa. We find that domestic energy use by the burning of solid biofuels is the largest contributor to ambient BC, POA and aSOA globally. Epidemiological and toxicological studies indicate that these compounds may be relatively more hazardous than other PM_2.5 compounds such as soluble salts, related to their high potential to inflict oxidative stress. We performed sensitivity analyses by considering these species to be more harmful compared to other compounds in PM_2.5, as suggested by their oxidative potential using a range of potential relative risks. These analyses show that domestic energy use emerges as the leading cause of excess mortality attributable to ambient PM_2.5, notably in Asia and Africa. We acknowledge the uncertainties inherent in our assumed enhanced toxicity of the anthropogenic organic and BC aerosol components, which suggest the need to better understand the mechanisms and magnitude of the associated health risks and the consequences for regulatory policies. However our assessment of the importance of emissions from domestic energy use as a cause of premature mortality is robust to a range of assumptions about the magnitude of the excess risk.

Das Exposom charakterisiert die Auswirkungen unserer Umwelt auf Stoffwechsel und Gesundheit

Aktuelle Befunde der großen globalen epidemiologischen Studien wie dem „Global Burden of Disease“-Projekt legen nahe, dass bereits jetzt nahezu ⅔ der jährlichen globalen Todesfälle ursächlich auf chronische nicht übertragbare Erkrankungen wie Atherosklerose oder Diabetes zurückzuführen sind. Dies liegt vor allem an der Überalterung der Menschen in westlichen Gesellschaften, aber auch einer zunehmenden Belastung durch Boden-, Wasser- und Luftverschmutzung, Lärmbelastung, mentale Stressfaktoren und weitere Umweltrisikofaktoren. Vor etwa 15 Jahren wurde das Exposom-Konzept etabliert, um die Auswirkungen unserer Umwelt auf die Gesundheit zu erforschen. Das Exposom beschreibt dabei die Summe aller Expositionen, die lebenslang auf uns einwirken und dabei biochemische und metabolische Prozesse in unserem Körper überwiegend ungünstig verändern und so zu Gesundheitsschäden und frühzeitigen Todesfällen beitragen. Mit dieser Übersicht wird das Exposom-Konzept anhand von ausgewählten Studien erklärt und seine Bedeutung für die zukünftige Gesundheitsforschung sowie die präventive Medizin, vor allem im Hinblick auf kardiovaskuläre Erkrankungen und Therapie, erläutert.

Revisiting future extreme precipitation trends in the Mediterranean

Global warming is anticipated to intensify the hydrological cycle. However, this is neither expected to be globally uniform nor is the relationship between temperature increase and rainfall intensities expected to be linear. The objective of this study is to assess changes in annual rainfall extremes, total annual precipitation, and their relationship in the larger Mediterranean region. We use an up-to-date ensemble of 33 regional climate simulations from the EURO-CORDEX initiative at 0.11° resolution. We analyse the significance of trends for 1951-2000 and 2001-2100 under a 'business-as-usual' pathway (RCP8.5). Our future projections indicate a strong north/south Mediterranean gradient, with significant, decreasing trends in the magnitude of daily precipitation extremes in the south and the Maghreb region (up to -10 mm/decade) and less profound, increasing trends in the north. Despite the contrasting future trends, the 50-year daily precipitation extremes are projected to strongly increase (up to 100%) throughout the region. The 100-year extremes, derived with traditional extreme value approaches from the 1951-2000 simulations, underestimate the magnitude of these extreme events in the 2001-2100 projections by 30% for the drier areas of the Mediterranean (200-500 mm average annual rainfall) and by up to 20-30% for the wetter parts of the region. These 100-year extremes can occur at any time in any Mediterranean location. The contribution of the wettest day per year to the annual total precipitation is expected to increase (5-30%) throughout the region. The projected increase in extremes and the strong reductions in mean annual precipitation in the drier, southern and eastern Mediterranean will amplify the challenges for water resource management.

Physical Activity in Polluted Air-Net Benefit or Harm to Cardiovascular Health? A Comprehensive Review

Both exposure to higher levels of polluted air and physical inactivity are crucial risk factors for the development and progression of major noncommunicable diseases and, in particular, of cardiovascular disease. In this context, the World Health Organization estimated 4.2 and 3.2 million global deaths per year in response to ambient air pollution and insufficient physical activity, respectively. While regular physical activity is well known to improve general health, it may also increase the uptake and deposit of air pollutants in the lungs/airways and circulation, due to increased breathing frequency and minute ventilation, thus increasing the risk of cardiovascular disease. Thus, determining the tradeoff between the health benefits of physical activity and the potential harmful effects of increased exposure to air pollution during physical activity has important public health consequences. In the present comprehensive review, we analyzed evidence from human and animal studies on the combined effects of physical activity and air pollution on cardiovascular and other health outcomes. We further report on pathophysiological mechanisms underlying air pollution exposure, as well as the protective effects of physical activity with a focus on oxidative stress and inflammation. Lastly, we provide mitigation strategies and practical recommendations for physical activity in areas with polluted air.

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.

Heart healthy cities: genetics loads the gun but the environment pulls the trigger

The world's population is estimated to reach 10 billion by 2050 and 75% of this population will live in cities. Two-third of the European population already live in urban areas and this proportion continues to grow. Between 60% and 80% of the global energy use is consumed by urban areas, with 70% of the greenhouse gas emissions produced within urban areas. The World Health Organization states that city planning is now recognized as a critical part of a comprehensive solution to tackle adverse health outcomes. In the present review, we address non-communicable diseases with a focus on cardiovascular disease and the urbanization process in relation to environmental risk exposures including noise, air pollution, temperature, and outdoor light. The present review reports why heat islands develop in urban areas, and how greening of cities can improve public health, and address climate concerns, sustainability, and liveability. In addition, we discuss urban planning, transport interventions, and novel technologies to assess external environmental exposures, e.g. using digital technologies, to promote heart healthy cities in the future. Lastly, we highlight new paradigms of integrative thinking such as the exposome and planetary health, challenging the one-exposure-one-health-outcome association and expand our understanding of the totality of human environmental exposures.

[Air pollution and cardiovascular diseases]

Air pollution in the environment and in households is responsible worldwide for almost 9 million preventable premature deaths per year and almost 800,000 such deaths within Europe. Air pollution therefore shortens life expectancy worldwide by almost 3 years. Smoking, a proven cardiovascular risk factor, shortens the mean life expectancy by 2.2 years. Epidemiological studies have shown that air pollution from fine and coarse particulate matter is associated with increased cardiovascular morbidity and mortality. Responsible for this are mainly cardiovascular diseases, such as coronary heart disease, heart attack, heart failure, stroke, hypertension and also diabetes, which are mainly caused or aggravated by fine particulate matter. After inhalation fine particulate matter can reach the brain directly and also reach the bloodstream via a transition process. There, the particles are absorbed by the blood vessels where they stimulate the formation of reactive oxygen species (ROS) in the vascular wall. They therefore promote the formation of atherosclerotic changes and in this way increase the cardiovascular risks, especially an increase in chronic ischemic heart disease and stroke. Recent studies also reported that in coronavirus disease 2019 (COVID-19) patients a high degree of air pollution is correlated with severe disease courses with cardiovascular complications and pulmonary diseases. This necessitates preventive measures, such as lowering of the upper limits for air pollutants. Individual measures to mitigate the health consequences of fine particulate matter are also discussed.

Air pollution declines during COVID-19 lockdowns mitigate the global health burden

The lockdown response to COVID-19 has resulted in an unprecedented reduction in global economic activity and associated air pollutant levels, especially from a decline in land transportation. We utilized a network of >10,000 air quality stations distributed over 34 countries during lockdown dates up until 15 May 2020 to obtain lockdown related anomalies for nitrogen dioxide, ozone and particulate matter smaller than 2.5 μm in diameter (PM_2.5). Pollutant anomalies were related to short-term health outcomes using empirical exposure-response functions. We estimate that there were a net total of 49,900 (11,000 to 90,000; 95% confidence interval) excess deaths and 89,000 (64,700 to 107,000) pediatric asthma emergency room visits avoided during lockdowns. In China and India alone, the PM_2.5-related avoided excess mortality was 19,600 (15,300 to 24,000) and 30,500 (5700 to 68,000), respectively. While the state of COVID-19 imposed lockdown is not sustainable, these findings illustrate the potential health benefits gained by reducing "business as usual" air pollutant emissions from economic activities primarily through finding alternative transportation solutions.

Regional and global contributions of air pollution to risk of death from COVID-19

AIMS

The risk of mortality from the coronavirus disease that emerged in 2019 (COVID-19) is increased by comorbidity from cardiovascular and pulmonary diseases. Air pollution also causes excess mortality from these conditions. Analysis of the first severe acute respiratory syndrome coronavirus (SARS-CoV-1) outcomes in 2003, and preliminary investigations of those for SARS-CoV-2 since 2019, provide evidence that the incidence and severity are related to ambient air pollution. We estimated the fraction of COVID-19 mortality that is attributable to the long-term exposure to ambient fine particulate air pollution.

METHODS AND RESULTS

We characterized global exposure to fine particulates based on satellite data, and calculated the anthropogenic fraction with an atmospheric chemistry model. The degree to which air pollution influences COVID-19 mortality was derived from epidemiological data in the USA and China. We estimate that particulate air pollution contributed ∼15% (95% confidence interval 7-33%) to COVID-19 mortality worldwide, 27% (13 - 46%) in East Asia, 19% (8-41%) in Europe, and 17% (6-39%) in North America. Globally, ∼50-60% of the attributable, anthropogenic fraction is related to fossil fuel use, up to 70-80% in Europe, West Asia, and North America.

CONCLUSION

Our results suggest that air pollution is an important cofactor increasing the risk of mortality from COVID-19. This provides extra motivation for combining ambitious policies to reduce air pollution with measures to control the transmission of COVID-19.

Model Calculations of Aerosol Transmission and Infection Risk of COVID-19 in Indoor Environments

The role of aerosolized SARS-CoV-2 viruses in airborne transmission of COVID-19 has been debated. The aerosols are transmitted through breathing and vocalization by infectious subjects. Some authors state that this represents the dominant route of spreading, while others dismiss the option. Here we present an adjustable algorithm to estimate the infection risk for different indoor environments, constrained by published data of human aerosol emissions, SARS-CoV-2 viral loads, infective dose and other parameters. We evaluate typical indoor settings such as an office, a classroom, choir practice, and a reception/party. Our results suggest that aerosols from highly infective subjects can effectively transmit COVID-19 in indoor environments. This "highly infective" category represents approximately 20% of the patients who tested positive for SARS-CoV-2. We find that "super infective" subjects, representing the top 5-10% of subjects with a positive test, plus an unknown fraction of less-but still highly infective, high aerosol-emitting subjects-may cause COVID-19 clusters (>10 infections). In general, active room ventilation and the ubiquitous wearing of face masks (i.e., by all subjects) may reduce the individual infection risk by a factor of five to ten, similar to high-volume, high-efficiency particulate air (HEPA) filtering. A particularly effective mitigation measure is the use of high-quality masks, which can drastically reduce the indoor infection risk through aerosols.

Model Calculations of Aerosol Transmission and Infection Risk of COVID-19 in Indoor Environments

The role of aerosolized SARS-CoV-2 viruses in airborne transmission of COVID-19 has been debated. The aerosols are transmitted through breathing and vocalization by infectious subjects. Some authors state that this represents the dominant route of spreading, while others dismiss the option. Here we present an adjustable algorithm to estimate the infection risk for different indoor environments, constrained by published data of human aerosol emissions, SARS-CoV-2 viral loads, infective dose and other parameters. We evaluate typical indoor settings such as an office, a classroom, choir practice, and a reception/party. Our results suggest that aerosols from highly infective subjects can effectively transmit COVID-19 in indoor environments. This "highly infective" category represents approximately 20% of the patients who tested positive for SARS-CoV-2. We find that "super infective" subjects, representing the top 5-10% of subjects with a positive test, plus an unknown fraction of less-but still highly infective, high aerosol-emitting subjects-may cause COVID-19 clusters (>10 infections). In general, active room ventilation and the ubiquitous wearing of face masks (i.e., by all subjects) may reduce the individual infection risk by a factor of five to ten, similar to high-volume, high-efficiency particulate air (HEPA) filtering. A particularly effective mitigation measure is the use of high-quality masks, which can drastically reduce the indoor infection risk through aerosols.

Guidelines for Modeling and Reporting Health Effects of Climate Change Mitigation Actions

BACKGROUND

Modeling suggests that climate change mitigation actions can have substantial human health benefits that accrue quickly and locally. Documenting the benefits can help drive more ambitious and health-protective climate change mitigation actions; however, documenting the adverse health effects can help to avoid them. Estimating the health effects of mitigation (HEM) actions can help policy makers prioritize investments based not only on mitigation potential but also on expected health benefits. To date, however, the wide range of incompatible approaches taken to developing and reporting HEM estimates has limited their comparability and usefulness to policymakers.

OBJECTIVE

The objective of this effort was to generate guidance for modeling studies on scoping, estimating, and reporting population health effects from climate change mitigation actions.

METHODS

An expert panel of HEM researchers was recruited to participate in developing guidance for conducting HEM studies. The primary literature and a synthesis of HEM studies were provided to the panel. Panel members then participated in a modified Delphi exercise to identify areas of consensus regarding HEM estimation. Finally, the panel met to review and discuss consensus findings, resolve remaining differences, and generate guidance regarding conducting HEM studies.

RESULTS

The panel generated a checklist of recommendations regarding stakeholder engagement: HEM modeling, including model structure, scope and scale, demographics, time horizons, counterfactuals, health response functions, and metrics; parameterization and reporting; approaches to uncertainty and sensitivity analysis; accounting for policy uptake; and discounting.

DISCUSSION

This checklist provides guidance for conducting and reporting HEM estimates to make them more comparable and useful for policymakers. Harmonization of HEM estimates has the potential to lead to advances in and improved synthesis of policy-relevant research that can inform evidence-based decision making and practice. https://doi.org/10.1289/EHP6745.

Environmental Factors Such as Noise and Air Pollution and Vascular Disease

Significance: According to the World Health Organization, noncommunicable diseases are the globally leading cause of mortality. Recent Advances: About 71% of 56 million deaths that occurred worldwide are due to noncommunicable cardiovascular risk factors, including tobacco smoking, unhealthy diets, lack of physical activity, overweight, arterial hypertension, diabetes, and hypercholesterolemia, which can be either avoided or substantially reduced. Critical Issues: Thus, it is estimated that 80% of premature heart disease, stroke, and diabetes can be prevented. More recent evidence indicates that environmental stressors such as noise and air pollution contribute significantly to the global burden of cardiovascular disease. In the present review, we focus primarily on important environmental stressors such as transportation noise and air pollution. We discuss the pathophysiology of vascular damage caused by these environmental stressors, with emphasis on early subclinical damage of the vasculature such as endothelial dysfunction and the role of oxidative stress. Future Directions: Lower legal thresholds and mitigation measures should be implemented and may help to prevent vascular damage.

Cardiovascular disease burden from ambient air pollution in Europe reassessed using novel hazard ratio functions

Aims

Ambient air pollution is a major health risk, leading to respiratory and cardiovascular mortality. A recent Global Exposure Mortality Model, based on an unmatched number of cohort studies in many countries, provides new hazard ratio functions, calling for re-evaluation of the disease burden. Accordingly, we estimated excess cardiovascular mortality attributed to air pollution in Europe.

Methods and results

The new hazard ratio functions have been combined with ambient air pollution exposure data to estimate the impacts in Europe and the 28 countries of the European Union (EU-28). The annual excess mortality rate from ambient air pollution in Europe is 790 000 [95% confidence interval (95% CI) 645 000–934 000], and 659 000 (95% CI 537 000–775 000) in the EU-28. Between 40% and 80% are due to cardiovascular events, which dominate health outcomes. The upper limit includes events attributed to other non-communicable diseases, which are currently not specified. These estimates exceed recent analyses, such as the Global Burden of Disease for 2015, by more than a factor of two. We estimate that air pollution reduces the mean life expectancy in Europe by about 2.2 years with an annual, attributable per capita mortality rate in Europe of 133/100 000 per year.

Conclusion

We provide new data based on novel hazard ratio functions suggesting that the health impacts attributable to ambient air pollution in Europe are substantially higher than previously assumed, though subject to considerable uncertainty. Our results imply that replacing fossil fuels by clean, renewable energy sources could substantially reduce the loss of life expectancy from air pollution.

COVID-19 lockdowns cause global air pollution declines

The lockdown response to coronavirus disease 2019 (COVID-19) has caused an unprecedented reduction in global economic and transport activity. We test the hypothesis that this has reduced tropospheric and ground-level air pollution concentrations, using satellite data and a network of >10,000 air quality stations. After accounting for the effects of meteorological variability, we find declines in the population-weighted concentration of ground-level nitrogen dioxide (NO₂: 60% with 95% CI 48 to 72%), and fine particulate matter (PM_2.5: 31%; 95% CI: 17 to 45%), with marginal increases in ozone (O₃: 4%; 95% CI: -2 to 10%) in 34 countries during lockdown dates up until 15 May. Except for ozone, satellite measurements of the troposphere indicate much smaller reductions, highlighting the spatial variability of pollutant anomalies attributable to complex NO_x chemistry and long-distance transport of fine particulate matter with a diameter less than 2.5 µm (PM_2.5). By leveraging Google and Apple mobility data, we find empirical evidence for a link between global vehicle transportation declines and the reduction of ambient NO₂ exposure. While the state of global lockdown is not sustainable, these findings allude to the potential for mitigating public health risk by reducing "business as usual" air pollutant emissions from economic activities. Explore trends here: https://nina.earthengine.app/view/lockdown-pollution.

COVID-19 lockdowns cause global air pollution declines

The lockdown response to coronavirus disease 2019 (COVID-19) has caused an unprecedented reduction in global economic and transport activity. We test the hypothesis that this has reduced tropospheric and ground-level air pollution concentrations, using satellite data and a network of >10,000 air quality stations. After accounting for the effects of meteorological variability, we find declines in the population-weighted concentration of ground-level nitrogen dioxide (NO₂: 60% with 95% CI 48 to 72%), and fine particulate matter (PM_2.5: 31%; 95% CI: 17 to 45%), with marginal increases in ozone (O₃: 4%; 95% CI: -2 to 10%) in 34 countries during lockdown dates up until 15 May. Except for ozone, satellite measurements of the troposphere indicate much smaller reductions, highlighting the spatial variability of pollutant anomalies attributable to complex NO_x chemistry and long-distance transport of fine particulate matter with a diameter less than 2.5 µm (PM_2.5). By leveraging Google and Apple mobility data, we find empirical evidence for a link between global vehicle transportation declines and the reduction of ambient NO₂ exposure. While the state of global lockdown is not sustainable, these findings allude to the potential for mitigating public health risk by reducing "business as usual" air pollutant emissions from economic activities. Explore trends here: https://nina.earthengine.app/view/lockdown-pollution.

COVID-19 lockdowns cause global air pollution declines

The lockdown response to coronavirus disease 2019 (COVID-19) has caused an unprecedented reduction in global economic and transport activity. We test the hypothesis that this has reduced tropospheric and ground-level air pollution concentrations, using satellite data and a network of >10,000 air quality stations. After accounting for the effects of meteorological variability, we find declines in the population-weighted concentration of ground-level nitrogen dioxide (NO2: 60% with 95% CI 48 to 72%), and fine particulate matter (PM2.5: 31%; 95% CI: 17 to 45%), with marginal increases in ozone (O3: 4%; 95% CI: -2 to 10%) in 34 countries during lockdown dates up until 15 May. Except for ozone, satellite measurements of the troposphere indicate much smaller reductions, highlighting the spatial variability of pollutant anomalies attributable to complex NOx chemistry and long-distance transport of fine particulate matter with a diameter less than 2.5 µm (PM2.5). By leveraging Google and Apple mobility data, we find empirical evidence for a link between global vehicle transportation declines and the reduction of ambient NO2 exposure. While the state of global lockdown is not sustainable, these findings allude to the potential for mitigating public health risk by reducing "business as usual" air pollutant emissions from economic activities. Explore trends here: https://nina.earthengine.app/view/lockdown-pollution.

COVID-19 lockdowns cause global air pollution declines

The lockdown response to coronavirus disease 2019 (COVID-19) has caused an unprecedented reduction in global economic and transport activity. We test the hypothesis that this has reduced tropospheric and ground-level air pollution concentrations, using satellite data and a network of >10,000 air quality stations. After accounting for the effects of meteorological variability, we find declines in the population-weighted concentration of ground-level nitrogen dioxide (NO₂: 60% with 95% CI 48 to 72%), and fine particulate matter (PM_2.5: 31%; 95% CI: 17 to 45%), with marginal increases in ozone (O₃: 4%; 95% CI: -2 to 10%) in 34 countries during lockdown dates up until 15 May. Except for ozone, satellite measurements of the troposphere indicate much smaller reductions, highlighting the spatial variability of pollutant anomalies attributable to complex NO_x chemistry and long-distance transport of fine particulate matter with a diameter less than 2.5 µm (PM_2.5). By leveraging Google and Apple mobility data, we find empirical evidence for a link between global vehicle transportation declines and the reduction of ambient NO₂ exposure. While the state of global lockdown is not sustainable, these findings allude to the potential for mitigating public health risk by reducing "business as usual" air pollutant emissions from economic activities. Explore trends here: https://nina.earthengine.app/view/lockdown-pollution.