Can atmospheric pollution be considered a co-factor in extremely high level of SARS-CoV-2 lethality in Northern Italy?

Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) is the pathogenic agent of Covid-19, a disease first reported in a small cluster in Wuhan, Hubei Province, China, in December 2019, and subsequently spread all over the world. Due to its high contagiousness and aggressive course, it has been declared by World Health Organization (WHO) a Public Health Emergency of International Concern (A public health emergency, 2019). The course of the disease is often mild, undistinguishable from a common flu, but in a considerable number of cases may require hospitalization, eventually leading to an acute respiratory distress syndrome (ARDS) and death. Air pollution represents one of the most well-known causes of prolonged inflammation, eventually leading to an innate immune system hyper-activation. In a small cohort of mice exposed for three months to particulate matter ≤2.5 μm in diameter (PM2.5), IL-4, TNF-α and transforming growth factor (TGF)-β1 were significantly increased in both serum and lung parenchyma, as well as leucocytes and macrophages In conclusion, it is well known that pollution impairs the first line of defense of upper airways, namely cilia (Cao et al., 2020), thus a subject living in an area with high levels of pollutant is more prone to develop chronic respiratory conditions and suitable to any infective agent. Moreover, as we previously pointed out, a prolonged exposure to air pollution leads to a chronic inflammatory stimulus, even in young and healthy subjects. This, in our opinion, may partly explain a higher prevalence and lethality of a novel, very contagious, viral agent such as SARS-CoV-2, among a population living in areas with a higher level of air pollution, particularly if we consider the relatively high average age of this population. Among elderly living in such a region and affected by other comorbidities, the cilia and upper airways defenses could have been weakened both by age and chronic exposure to air pollution, which, in turn, could facilitate virus invasion by allowing virus reaching lower airways. Subsequently, a dysregulated, weak immune system, triggered by chronic air pollution exposure may lead to ARDS and eventually death, particularly in case of severe respiratory and cardiovascular comorbidities. To read more-


Possibility of Atmospheric pollution can't not be ruled out depending upon period of exposure hours , concentration of virus and personal immunity of attending person sometimes tiny lapse in concentration or avoidable negligence will be sufficient for transmission.
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