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Facing the covid-19 and air pollution ‘twindemic’

Experts fear the deadly coupling of covid-19 and dipping air quality in parts of India could lead to an increase in fatalities this winter

People with co-morbidities will be at greater risk. (Photo credit: Hindustan Times)
People with co-morbidities will be at greater risk. (Photo credit: Hindustan Times)

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As temperatures in parts of north India begin to dip, air quality too is on a downward curve. Earlier this week, Delhi saw its air quality index, or AQI, reach the moderate category, in the 100-200 range. The System of Air Quality and Weather Forecasting And Research (SAFAR-India) forecasts a further dip in quality given the change in wind direction and sharp increase in stubble-burning fires that are being observed in Punjab, Haryana and neighbouring areas. Meanwhile, the number of covid-19 cases in Delhi has crossed 291,000, with more than 5,500 deaths recorded so far.

As India prepares for its first winter with covid-19, regions that face pollution problems every year in this season are scrambling to prepare for what could turn out to be a frantic few months. On 5 October, Delhi chief minister Arvind Kejriwal announced an anti-pollution campaign, acknowledging that “polluted air can be life-threatening in view of the covid-19 pandemic”—both hit the lungs hard.

The Capital has topped lists of the world’s most polluted cities in recent years. Apart from vehicular and industrial emissions, stubble burning has led to a blanket of smog hanging over the city for days. Worse, given the increase in sowing this year, more fires are expected as farmers prepare their fields for the next crop.

Experts predict an aggravation in health issues, particularly so for those already suffering from co-morbidities. “So far, the pandemic in India has coincided with seasons of relatively good air quality but as winter approaches and air quality worsens, this may be a factor that moves relatively mild covid-19 infections to more severe cases. Not only are those more severe cases worse for each individual but if severity shifts on average, then it may overwhelm healthcare resources,” says Michael Brauer, a professor at the School of Population and Public Health at the University of British Columbia, Canada.

In a recent opinion piece for the Delhi-based Collaborative Clean Air Policy Centre, which evaluates and compares policy options for India’s health-damaging air pollution problems, Brauer explained that although direct evidence of the impact of air pollution on covid-19 is limited and more time will be needed for proper studies, evidence from the SARS epidemic (caused by a similar virus) in 2003 indicated a link between air pollution and increased mortality.

“Thousands more will die this winter due to the long- and short-term damage that air pollution causes to our lungs, blood vessels, heart, and brain. Globally, almost 20,000 people a day die because of air pollution. Thousands among these will most certainly die due to the combination of air pollution and covid-19,” says Jeffery K. Smith, a Geneva-based consultant with the World Health Organization on air pollution and urban health projects. “Science is still developing a consensus and gathering evidence. However, we know air pollution causes oxidative stress in the body,” Smith explains on email. “We also know that high blood pressure, ischemic heart disease, lung disease and obesity cause oxidative stress. People with these conditions are largely the same people that have been identified so far as having the greatest risk of severe cases or death due to covid-19.”

An additional factor is that most of the key crop-growing regions in north India saw an increase in sowing as well as above-normal rainfall this year. “This year we have had 44% additional sowing than last year. We have had good rain. You are going to have a bumper harvest, which means a bumper residue and more burning,” says Jai Dhar Gupta, founder of the clean air solutions firm Nirvana Being.

Over the past six-seven years, Gupta has been monitoring wind direction and its effect on the flow of smoke from stubble burning. “This is the first time in six years I have seen the wind direction (from the north-west) change in the last week of September, which is bad news,” Gupta says on the phone. Simply put, this means the smoke from Punjab and Haryana might reach Delhi much earlier this year— the city usually wakes up to smog around 22-25 October.

Just remaining indoors won’t be enough, says Gupta. “Our homes are not sealed and your indoor air quality can be much worse than what’s outside because the kitchen is a huge source of pollution. You are not really safe indoors either. You may be safe from covid-19 but definitely not air pollution,” he adds. “This is unprecedented. What we and our bodies are going to go through over the next four months—if you combine it with covid-19. There’s no data on it.”

Research has shown that pollution particles—PM2.5 and other contaminants like nitrogen oxide (NO2)—can hit cardiovascular health and other body functions once they reach the bloodstream. Recent examples from around the world also show that air pollution could possibly make the body more susceptible to the SARS-CoV-2 virus that causes covid-19.

According to a policy research working paper by Bo Pieter Johannes Andrée for the World Bank Group, similar estimates from 355 municipalities in the Netherlands suggested that expected covid-19 cases increase by nearly 100% when pollution concentrations increase by 20%.

A paper published in July in the journal Science Of The Total Environment assessed the impact of NO2 levels as a contributing factor to covid-19 deaths in 66 administrative regions in France, Germany, Italy and Spain. It concluded that of the 4,443 fatalities till March, 3,487 (78%) were in five regions located in north Italy and central Spain. “Additionally, the same five regions show the highest NO2 concentrations combined with downwards airflow which prevent an efficient dispersion of air pollution,” states an abstract of the paper. According to a policy research working paper by Bo Pieter Johannes Andrée for the World Bank Group, similar estimates from 355 municipalities in the Netherlands suggested that expected covid-19 cases increase by nearly 100% when pollution concentrations increase by 20%.

“Air pollution makes us especially more vulnerable to all respiratory diseases like covid-19,” says Smith. “This is why thousands of pneumonia deaths each winter are now linked to air pollution as a cause. The particles themselves and the inflammation caused by the particles reduce the immune system response and also the blood’s ability to deliver as much oxygen as it would normally be able to do.”

Researchers in the West have warned of a covid-19 and influenza “twindemic” . For the next three-four months, areas in north India too will be subjected to their own kind of “twindemic”.


Here's how you can fix your indoor air

  • Get rid of carpets or carpeted flooring. Jai Dhar Gupta also recommends cutting down on the use of brooms, etc. “Carpets are like a sink for PM 2.5 particles,” he adds.
  • Have a good exhaust system for the kitchen. Ensure that the kitchen air is not entering the living spaces. “Open your doors and windows between 2-5pm when typically the air quality is the best, so that you replenish your oxygen levels,” says Gupta.
  • Use vacuum cleaners with a HEPA filter to capture finer dust particles. “If you have a vacuum without a HEPA filter, you are putting all the harmful stuff back into the air,” he says.
  • Michael Brauer says physical distancing, masks and hand hygiene are critical—and are also the “easiest actions to take” to prevent transmission. “If there are settings where they are not feasible, then ventilation can also be helpful. However, improved ventilation in areas or at times with poor air quality is also a concern for health unless the air can also be filtered,” he adds.

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