In 2017, 3.4 million deaths were attributed to outdoor air pollution, mainly due to conditions such as heart disease, stroke, chronic obstructive pulmonary disease and lung cancer, as well as acute respiratory infections in children.1 Fine particulate matter (PM2.5) penetrates deep into the lungs and enters the bloodstream—causing cardiovascular, cerebrovascular and respiratory problems.2 COVID-19 is a respiratory disease and has led to a pandemic in 2020 . Globally, there are more than 17 million confirmed cases and 675,989 deaths of COVID-19 as of 31 July 2020.3 Evidence suggests that people who are exposed to air pollution are susceptible to pre-existing conditions which make them more likely to get severely ill or even die if they contract COVID-19. In this era of COVID-19, improving air quality has never been more important.

Impact of air pollution on human health

According to WHO, 9 out of 10 people in the world breathe polluted air from combustion processes in factories, toxic dust and smoke from forest fires, vehicular fumes and other sources.4 Long- and short-term air pollution, particularly PM2.5, causes several health problems. In the short-term, poor air quality can cause pneumonia, bronchitis or discomfort such as irritation to the nose, throat, eyes, or skin, dizziness and nausea.5 In the long-term, air pollution causes diseases such as lung cancer, heart disease, respiratory disease and negative effects on organs such as the brain, liver and kidneys.5

Air pollution is responsible for about 34% of the global burden of disease from chronic obstructive pulmonary disease; 18% from diabetes; 14% from lung cancer; 11% from heart disease and 7% from stroke.6 Growing children are most affected, since exposure to air pollution during the developmental stages of life causes lifelong health problems.6  Older adults also suffer serious health effects, as air pollution shortens life expectancy.7

Diseases caused by air pollution and their impact on the severity of COVID-19

Air pollution is a major risk factor for the chronic diseases that increase the severity of and risk of death from COVID-19.  Daniel Kass, Senior Vice President Environmental Health from Vital Strategies, said, “Air pollution causes more than five million deaths each year—ranging from heart and lung diseases to diabetes. These are the same underlying conditions that make people much more likely to become severely ill or die from COVID-19.”  People who suffer from pre-existing conditions have higher risk of COVID-19 since their immune systems are compromised.8

Eight different studies conducted in China found that severely ill COVID-19 patients were 2.4 times more likely to have pre-existing hypertension, 2.5 times more likely to suffer from respiratory diseases and 3.4 times more likely to have cardiovascular diseases.9 Another study on Chinese patients found that the risk of severe symptoms requiring intensive care or ventilation, as well as the risk of death, was elevated by 170% for people with chronic respiratory disease;  60% for people with hypertension or diabetes and 250% for people with cancer.10

The case of Jakarta

As of July 31 2020, the DKI province of Jakarta has recorded one of the highest numbers of cases of COVID-19 in the region with 20,969 cases, as compared to East Java (21,772 cases), South Sulawesi (9,346 cases) and Central Java (9,281 cases).11 In 2019, the annual average level of PM2.5 in DKI Jakarta was 48.27 ug/m3, well above the annual WHO standard of 10 ug/m3 and Indonesia’s annual standard of 15 ug/m3.  bbyGiven the international evidence suggesting the link between air pollution and COVID-19, Budi Haryanto, Professor of the Faculty of Public Health of the University of Indonesia, suspects that air pollution levels in Jakarta, which are, on average, 4-5 times higher than WHO standards, may be contributing to the high number of COVID-19 deaths in the capital city, though no current local study examines this relationship.12

The solution to air pollution has to be sustainable and long-term, as any improvement in air quality due to COVID-19 lockdowns are temporary.“We must remember that these improvements in air quality came at a huge economic and social cost. As places restart their economies, we expect air pollution to return to unacceptably high levels. Despite dramatic declines in vehicle use and shuttering of local industries, we have not seen large improvements in [PM2.5] air quality. This phenomenon illustrates that not all air pollution is locally produced, and that not all locally produced air pollution is from the most visible sources like traffic. COVID-19 has revealed an opportunity to point to other, more high-impact sources of air pollution that must be addressed. Says Daniel Kass referring to the phenomenon of global social restrictions during the pandemic.”

References:

1Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2017 (GBD 2017) Reference Life Table. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2018.
2Ambient air pollution: Health impacts, 25 September 2015. https://www.who.int/airpollution/ambient/health-impacts/en/
3Corona Virus World Statistic. 31 July 2020. https://www.worldometers.info/coronavirus/worldwide-graphs/#total-deaths
4WHO International. 9 out of 10 people worldwide breathe polluted air, but more countries are taking action. (n.d.). May, 2018. https://covid19.who.int/?gclid=Cj0KCQjw9b_4BRCMARIsADMUIyrwQlyF4z-t_712D5tqZ0Xl8GFI0k6c9BlNaZPtsaVu0i0TE_DzNp8aAkyZEALw_wcB
5National Geographic Society. “Air Pollution.” National Geographic Society, October 9, 2012. https://www.nationalgeographic.org/encyclopedia/air-pollution/.
6UN Environment. “Young and Old, Air Pollution Affects the Most Vulnerable.” UN Environment. Accessed July 16, 2020. https://www.unenvironment.org/news-and-stories/blogpost/young-and-old-air-pollution-affects-most-vulnerable.
7Kloog, Itai, Bill Ridgway, Petros Koutrakis, Brent A. Coull, and Joel D. Schwartz. “Long- and Short-Term Exposure to PM2.5 and Mortality.” Epidemiology 24, no. 4 (2013): 555–61. https://doi.org/10.1097/ede.0b013e318294beaa.
8Center for Disease Control and Prevention.  People Who Are at Higher Risk for Severe Illness. June, 2020. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html?CDC_AA_refVal=https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html.
9Yang, Jing, Ya Zheng, Xi Gou, Ke Pu, Zhaofeng Chen, Qinghong Guo, Rui Ji, Haojia Wang, Yuping Wang, and Yongning Zhou. “Prevalence of Comorbidities and Its Effects in Patients Infected with SARS-CoV-2: a Systematic Review and Meta-Analysis.” International Journal of Infectious Diseases 94 (2020): 91–95. https://doi.org/10.1016/j.ijid.2020.03.017.
10Guan, W-jie, Liang W-hua, Zhao, Y, et al. 2020. Comorbidity and its impact on 1590 patients with Covid-19 in China: A Nationwide Analysis.European Respiratory Journal 2020;in press (https://doi.org/10.1183/13993003.00547-2020)
11Kementerian Kesehatan Republik Indonesia. ¹Data Kasus Covid-19 Per Provinsi. 31 July 2020. https://covid19.kemkes.go.id/
12Haryanto, Budi. Paparan Polusi Udara dan Covid. Webinar Rekam Jejak Kualitas Udara di Ibukota dan Sekitarnya Masa Pandemi, P3KLL. 16 Juni 2020.