Assessment of the potential role of atmospheric particulate pollution and airborne transmission in intensifying the first wave pandemic impact of SARS-CoV-2/COVID-19 in Northern Italy
Authors: Di Girolamo Paolo 
Published: December 2020

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which exploded in Wuhan (Hebei Region, China) in late 2019, has later spread around the world, causing pandemic effects on humans. During the first wave of the pandemic, Italy, and especially its Northern regions around the Po Valley, faced severe consequences in terms of infected individuals and casualties (more than 31,000 deaths and 255,000 infected people by mid-May 2020). While the spread and effective impact of the virus is primarily related to the lifestyles and social habits of the different human communities, environmental and meteorological factors also play a role. Among these, particulate pollution may directly impact the human respiratory system or act as virus carrier, thus behaving as potential amplifying factor in the pandemic spread of SARS-CoV-2. Enhanced levels of PM2.5 and PM10 particles in Northern Italy were observed over the 2-month period preceding the virus pandemic spread. Threshold levels for PM10 (< 50 μg/m3) were exceeded on 20–35 days over the period January–February 2020 in many areas in the Po Valley, where major effects in terms of infections and casualties occurred, with levels in excess of 80 μg/m3 occasionally observed in the 1–3 weeks preceding the contagious activation around February 25, 2020. Threshold values for PM2.5 indicated in WHO air quality guidelines (< 25 μg/m3) were exceeded on more than 40 days over the period January–February 2020 in large portions of the Po Valley, with levels up to 70 μg/m3 observed in the weeks preceding the contagious activation. In this paper, PM10 particle measurements are compared with epidemiologic parameters’ data. Specifically, a statistical analysis is carried out to correlate the infection rate, or incidence of the pathology, the mortality rate, and the case fatality rate with PM concentrations. The study considers epidemiologic data for all 110 Italian provinces, as reported by the Italian Statistics Institute, over the period 20 February–31 March 2020. Corresponding PM10 concentrations covering the period 15–26 February 2020 were collected from the network of air quality monitoring stations run by different regional and provincial environment agencies. The case fatality rate is found to be highly correlated to the average PM10 concentration, with a correlation coefficient of 0.89 and a slope of the regression line of (6.7 ± 0.3) × 10−3 m3/μg, which implies a doubling (from 3 to 6%) of the mortality rate of infected patients for an average PM10 concentration increase from 22 to 27 μg/m3. Infection and mortality rates are also found to be correlated with PM10 concentrations, with correlation coefficients being 0.82 and 0.80, respectively, and the slopes of the regression lines indicating a doubling (from 1 to 2‰) of the infection rate and a tripling (from 0.1 to 0.3‰) of the mortality rate for an average PM10 concentration increase from 25 to 29 μg/m3. Considerations on the exhaled particles’ sizes, their concentrations and residence times, the transported viral dose and the minimum infective dose, in combination with PM2.5 and PM10 pollution measurements and an analytical microphysical model, allowed assessing the potential role of airborne transmission through virus-laden PM particles, in addition to droplet and the traditional airborne transmission, in conveying SARS-CoV-2 in the human respiratory system. In specific circumstances which can be found in indoor environments, the number of small potentially infectious particles coalescing on PM2.5 and PM10 particles is estimated to exceed the number of infectious particles needed to activate COVID-19 infection in humans.