Since the onset of the COVID-19 pandemic, public health in India has been further pushed into a compromised state. As cases spike with each passing day, and with the vaccine availability still months away, nothing is more terrifying than the thought of our loved ones becoming COVID positive during these already stressful times. As of November 20, there have been 1,355,963 deaths due to the coronavirus globally, reports World Health Organization. In India itself there have been 133,773 deaths.

But COVID-19 is not the only health hazard that we should be worried about. The northern region of the country is facing its share of severely deteriorating air quality starting from October which will likely go on till April next year. COVID combined with air pollution is a deadly mixture. Not only have we seen higher air pollution leading to greater mortality in COVID cases, but now we are also seeing greater spread of COVID due to air pollution.

Higher spread of COVID due to air pollution

Central Pollution Control Board (CPCB) recorded the Air Quality Index (AQI) of Delhi at an all-time severe of 406 on Nov 6 and 7. During this time, the union territory also reported more than 6,000 COVID cases daily. The Indian Medical Association said that 13 percent of this spike in cases is attributed to air pollution.

Reduced immunity

14 out of the top 20 most polluted cities in the world are in India in terms of PM2.5 levels according to the World Health Organisation. Lungs of the residents of these cities are that of smokers even if they have never smoked in their life, affecting their lung capacity and increasing the risk of respiratory infections.

According to various health and climate experts, higher air pollution levels in cities like Delhi and Mumbai over a prolonged period have compromised the population’s immunity, making them more susceptible to the coronavirus.

Air Transmission of COVID-19 in Outdoor Environments

PM2.5 particles in the air may also be causing the virus to stay airborne longer increasing the risk of infection. An NCBI study notes that “fine particulates prolong the atmospheric lifetime of infectious viruses, thus favouring transmission.” COVID virus may latch onto PM2.5 particles in the air causing them to stay airborne for relatively longer and spread further.

Higher risk of Mortality

Both COVID and air pollution lead to inflammation in the body and target our lungs, heart and respiratory system. “If both long-term exposure to air pollution and infection with the COVID-19 virus come together then we have an additive adverse effect on health, particularly with respect to the heart and blood vessels, which leads to greater vulnerability and less resilience to COVID-19. If you already have heart disease, then air pollution and coronavirus infection will cause trouble that can lead to heart attacks, heart failure and stroke,” said co-author of the CVR paper.

Long-term exposure to air pollution has been associated with high risk of mortality from COVID-19 as per many global studies.

• A study published in Cardiovascular Research, an international journal of the European Society of Cardiology, has estimated that air pollution could be contributing to 15 percent of COVID-19 deaths globally.

• Another study published in Harvard University shows that an increase of 1 microgram per cubic meter in PM 2.5 leads to an 8% increase in death rate due to COVID-19.

• While a research by the University of Cambridge found a relation between the severity of COVID-19 infection and long-term exposure to air pollutants. Dr Miguel Martins, senior author on the study, added: “Our study adds to growing evidence from Northern Italy and the USA that high levels of air pollution are linked to deadlier cases of COVID-19. This is something we saw during the previous SARS outbreak back in 2003, where long-term exposure to air pollutants had a detrimental effect on the prognosis of SARS patients in China. This highlights the importance of reducing air pollution for the protection of human health, both in relation to the COVID-19 pandemic and beyond.”

• Research studies across the US, Italy and China show that air pollution is linked to significantly higher rates of death in people with COVID-19. “We found that an increase of only 1μg/m3 in PM2.5 is associated with a 15% increase in the COVID-19 death rate,” the team concluded.

So What Can We Do?

Cold and dry conditions seem to increase the spread of the virus, while warm and wet climates tend to reduce the spread of COVID-19. Every winter, we already see a spike in respiratory illnesses in Delhi NCR as a result of worsening air pollution and temperatures dropping. This winter we need to be extra careful with the added risk of COVID-19.

So how can we ensure that air pollution doesn’t put us at a bigger risk of contracting COVID-19? Here are some measures you can take both outside and indoors to stay safe:

Safety when Outside your homes

• Apart from keeping personal hygiene and social distancing, wear N95 masks when outdoors which will protect you against both the virus from people around you as well as air pollution and any COVID particles which may be air-borne on dust particles.

• If wearing disposable masks, please replace them regularly. If wearing washable masks, do wash them regularly.

• If possible, avoid stepping out of your house during the time of day when AQI is in the Very Poor or Severe category. Especially avoid strenuous outdoor exercise during peak pollution hours. You can track air quality outdoors using the free Airveda app.

• Avoid crowded places and keep your masks on in public spaces even when indoors.

People with Pre-conditions

• For people with chronic lung diseases like asthma and COPD, adherence to prescribed medication is a must. Please make sure you take your inhalers and other medication as prescribed by your pulmonologist.

• It might also be a good idea to pay a visit to your pulmonologist to get checked up and ensure that you are equipped with the necessary preventative medication.

• Regular neti and salt gargles can keep your sinuses clear of infection and certain superfoods like turmeric etc. are also known to help with inflammation.

Safety for your homes

• According to CDC, poor indoor ventilation can lead to the build-up of virus load. Monitor CO2 levels in your home to ensure CO2 levels stay within prescribed limits. Monitor outdoor air quality, and don’t lose the opportunity to ventilate your house when air quality outdoors is good.

• ISHRAE guidelines on indoor air quality specify that the reduction of indoor PM2.5 dust levels can help with the mitigation of air-borne COVID-19 transmission. Use indoor plants and, if possible, purifiers to keep the indoor environment clean.

• A relative humidity level of 40%~70% is considered to be the most suitable environment for humans and decreases problems from pathogens. Measure your humidity indoors and use humidifiers/dehumidifiers if necessary to maintain humidity in that range.

Finally, the extent and severity of the long-term respiratory complications of COVID-19 infection remain to be seen, but emerging data indicate that many patients experience persistent respiratory symptoms months after their initial illness. People with severe symptoms of the virus could be dealing with complications for years even after recovery.

There is strong indication that the post-COVID world will consist of a large percentage of the population dealing with respiratory health issues and being much more sensitive to air pollution and its effects on lung health. As a nation and as a worldwide community, we can no longer choose to ignore the ill-effects of man-made air pollution and must deal with it on a war footing. There is a strong need for the Government and citizens to join hands in combating air pollution through strict policy enforcement for the reduction of sources as well as citizen awareness and disciplined lifestyle changes to reduce our own carbon footprint.

Please share your own thoughts and ideas for how we can tackle air pollution in the comments below.