A Surprise Surge in Air Pollution May Be Causing More Coronavirus Complications
By: Robert Roy Britt
Tags: Covid 19, Health, Air Pollution, Coronavirus, Pollution

A Surprise Surge in Air Pollution May Be Causing More Coronavirus Complications

Lax federal enforcement of air quality standards linked to poorer health across America

Photo: James Jordan Photography/Getty Images

Spikes in pollution caused by a federal relaxation of air quality standards in March led to increases in Covid-19 deaths in the most industrialized areas of the United States, new research suggests. Meanwhile, several other recent studies reveal that people who live in the most polluted areas are more likely to be infected by Covid-19 when exposed to the coronavirus, and then are more likely to suffer severe symptoms and die from the disease.

The revelations, which many scientists have been expecting since air pollution is known to exacerbate respiratory diseases, are based on early pandemic data and studies that mostly have not yet gone through peer review by other scientists. They come as the White House is working to roll back numerous clean-air regulations, and as air pollution—which was declining for decades — is surging back.

Because many of the nation’s worst polluters are concentrated in lower-income areas with high proportions of people of color, air pollution and any relaxation of air quality standards have a disproportionately negative impact — on health in general and with Covid-19 specifically — for populations that are already suffering systemic barriers to good health.

“While we might believe that the pandemic lowered pollution everywhere, that in fact has not been true, and in some places pollution increased substantially because of this rollback.”

“Even absent the pandemic, rolling back regulations will have a detrimental effect to public health,” says Francesca Dominici, PhD, a professor of biostatistics, population, and data science at the Harvard T.H. Chan School of Public Health. “And now with a pandemic that we know affects our lungs, this is an irresponsible act” that will “further increase health and environmental injustice.”

Exacerbating Covid-19

It’s well established that long-term exposure to air pollution harms lung function and has many other negative health effects. Because Covid-19 is a respiratory disease, scientists expected that pollution would make people more susceptible to catching the disease, and then worsen its outcomes.

The data is now rolling in.

People who have lived for decades in heavily polluted U.S. counties are 8% more likely to die from Covid-19 than people in the least-polluted counties, Dominici and her colleagues concluded in a study earlier this year that has not yet been published in a scientific journal. The research, reported previously by some news outlets, accounted for socioeconomic and behavioral variables and other factors.

A similar study in the Netherlands, published last month, found the risk of death from Covid-19 was 16% higher for people living amid the worst pollution. A study in Italy found a similar connection.

Separately, Dominici and her team are in the process of reviewing all studies by various research groups that all link exposure to heavy air pollution with coronavirus spreadability or Covid-19 outcomes.

Her preliminary take, she tells Elemental, is that people who have had long-term exposure to air pollution are not just more likely to die from Covid-19, but also more easily infected by the coronavirus that causes it. And even short-term increases in air pollution can raise the spreadability of the virus and the severity of the illness. “There is enough scientific evidence that makes [these links] at the very least plausible,” Dominici says.

Lax regulation leads quickly to Covid-19 deaths

On March 26, the Environmental Protection Agency announced it would not enforce air pollution standards during the pandemic.

Claudia Persico, PhD, an assistant professor at American University who studies environmental policy, inequality, and health policy, wondered if that decision would impact on emissions — and the pandemic. So Persico and her colleague Kathryn Johnson examined data from more than 21,000 industrial sites around the United States, all categorized as emitting toxic pollutants. These include factories, power plants, and mining facilities. They are concentrated near large population centers, and two-thirds of Americans live within three miles of one.

The study, which has not yet been published by a scientific journal, found that starting on exactly March 26, pollution from many of these sites spiked and remained higher through the study period, ending April 25, compared to before March 26.

“While we might believe that the pandemic lowered pollution everywhere, that in fact has not been true, and in some places pollution increased substantially because of this rollback,” Persico says. “This suggests that polluters respond to the absence of regulatory enforcement by potentially increasing their pollution, on average.”

Notably, in counties with the highest number of heavy polluters — where pollution surged the most — daily cases of Covid-19 spiked 38.8%, and deaths rose 19.1%. The death spike was 21.6% in counties where Black people make up a majority of the population, and about 5% counties that are predominantly white.

“This increase in pollution actually contributed to a worsening of the pandemic,” Persico said on July 15 in a webinar organized by the American Lung Association.

The increased deaths could be attributed in part to long-term exposure to pollution and the harmful effects it has on a person’s respiratory system, Persico says by email.

But, she adds, “I am fairly confident of a direct connection” between the spikes in pollution starting March 26 and subsequent Covid-19 deaths. That’s because the study established cause-and-effect by analyzing Covid-19 data before and after March 26, then comparing what happened in counties with the highest number of polluting sites to a control group of counties with fewer such sites. That allowed the researchers to account for differences in demographics, stay-at-home orders, and other pandemic factors and trends.

Bad air was already deadly

Dirty air is responsible for more than 100,000 premature deaths in the United States every year, researchers reported last year in the Proceedings of the National Academy of Sciences. It is known to reduce lung function, cause heart attacks and strokes, and aggravate asthma, among other ills, according to the EPA.

Long-term exposure to fine particulate matter, the soot and grit that is one type of outdoor air pollution, is “a major contributor to cardiovascular disease and death,” scientists concluded in a global study last month in Lancet Planetary Health journal. While the United States has lower pollution levels than many countries in the study, “there is substantial evidence that these [U.S.] levels still contribute to increases in cardiovascular disease and death,” study leader Perry Hystad, PhD, an environmental epidemiologist at Oregon State University, says by email.

Other research has found air pollution has a negative effect on everything from a pregnant woman’s placenta to cognitive development in children. Research last year found women were 16% more likely to have a miscarriage following even short-term exposure to heavy air pollution.

Averaged out across the entire global population, air pollution robs the world’s people of 2.9 years of life expectancy, versus 2.2 years for tobacco smoking, researchers concluded earlier this year in the journal Cardiovascular Research.

“Air pollution is a leading cause of premature mortality and loss of life expectancy, in particular through cardiovascular diseases,” says Thomas Münzel, director of the Cardiology Center at the University Medical Center in Mainz, Germany, and a co-author of the paper.

How air pollution worsens Covid-19

Because air pollution causes cardiovascular and lung diseases, Münzel says by email that it makes sense that pollution would worsen Covid-19 infections, too, as the new studies show. He explains how: Fine particulate matter, many times smaller than the diameter of human hair and invisible to us, penetrates deep into the lungs and even the bloodstream. Münzel says particulate matter is known to cause the overexpression of a protein called ACE2, which is common in the nose, mouth, throat, and lungs. ACE2 is the very protein that the coronavirus latches onto to gain entry into our cells. The overexpression of ACE2 is thought to cause an increased load of the coronavirus in a person who has been exposed to it. Inhaling a small amount of coronavirus does not always lead to an infection. Scientists don’t know what the threshold is, but more virus particles means an infection is more likely, and the outcome is more apt to be worse.

The evidence that pollution can worsen Covid-19 symptoms and increase the risk of death is no surprise to Afif El-Hasan, MD, a pediatrician in California who focuses on asthma. And it’s not just soot and grit causing the problems.

Fine particulate matter, along with the many chemicals in air pollution, poison the cells they touch, triggering an immune system response that includes inflammation of cells and body tissue, says El-Hasan, a spokesperson for the American Lung Association. Inhaling ozone, the haze of toxic gas referred to as smog that’s a by-product of burning fossil fuels, “is like giving the inside of your lungs a sunburn,” he says.

Previous research has shown that long-term exposure to particulate matter creates chronic inflammation in the body and raises the risk of “acute respiratory distress syndrome,” which is now known to be among the main conditions that ends up killing people with Covid-19.

This invasion of the body by pollutants can permanently damage cells and reduce function of the lungs and other organs, with the negative effects increasing with more exposure over time, ultimately weakening the immune system. The damage is worse when it starts early: The lungs of children exposed to heavy air pollution don’t develop as well as in kids who live with cleaner air, El-Hasan says.

For lower-income communities and people of color spending a lifetime in a highly polluted area, multiple risks pile up, he explains: lack of lung development early; lifelong damage from pollution; natural decline in lung function later in life; and lack of access to good health care, healthy food, and a safe place to exercise.

“It’s a perfect storm,” El-Hasan says. “People who’ve been living long-term in areas of high pollution have reduced natural defenses in their bodies, and it makes it easier for Covid or any other infection to be invasive.”

Black people are 3.57 times more likely to die from Covid-19 than whites, by one estimate.

While residents can’t do much about the air pollution where they live, El-Hasan encourages everyone to plan outdoor activities for days and times when there is less pollution, if possible — most weather apps include air quality reports — and to be diligent about taking any medications prescribed for heart disease, diabetes, or asthma. And it won’t hurt to mask up, he says: “It holds in your own droplets to protect other people, and it protects you from other people, and yes, it can help a little bit with pollution as well.”

Skies were thick with smog on this day in 1972 in the Los Angeles suburb of San Gabriel. Photo: EPA/Gene Daniels via the National Archives

From better to worse

America’s emergence from the smog-shrouded 1970s is owed to the 1963 Clean Air Act and amendments signed by President Richard Nixon in 1970. The legislation has proven effective at clearing the air and improving public health, and it’s been good for the economy, according to multiple analyses.

Between 1970 and 2017, the combined emissions of the most common pollutants fell 73%, the EPA states. : “Fewer premature deaths and illnesses means Americans experience longer lives, better quality of life, lower medical expenses, fewer school absences, and better worker productivity,” the agency says. The EPA’s research on the Clean Air Act finds that the dollar benefits now exceed the costs by more than 30-to-1.

The reduction in fine-particle air pollution between 1999 and 2013 led to annual savings in the U.S. economy that reached $25.5 billion in 2013, by lowering health care cost and mortality, according to an analysis last year in the journal American Economic Review. But the clearing trend is reversing. Based on 2018 data, the most recent that’s been analyzed:

The number of days “unhealthy for sensitive groups” in metro areas across the country was 15% higher in 2018 than the yearly average from 2013 to 2016.

The average amount of particulate matter in the United States rose 5.5% from 2016 to 2018, reversing the long downward trend.

The upshot is that about 43% of U.S. residents now live in counties with unhealthy pollution levels, according to the American Lung Association.

The rise in particulate matter began during the Obama administration, and is in part due to global warming and above-normal wildfire activity, says Paul Billings, national senior vice president for public policy with the American Lung Association. But Billings is concerned about the reduction in oversight and enforcement of the Clean Air Act and the apparent reduced industry compliance revealed in Persico’s study.

It’s well documented that the EPA, under President Donald Trump, has weakened or rolled back regulations on gas-mileage standards, light bulb efficiency, and coal-fired power plants, among other significant sources of air pollution. Among Trump’s most significant plans is to repeal the Clean Power Plan, an Obama-era rule that sets carbon emission targets and requires the EPA to guide states on limiting emissions. The rule’s repeal would cause an additional 36,000 U.S. deaths each decade and an additional 630,000 respiratory infections just in children, according to an article in JAMA written by Dominici, the Harvard researcher, and a colleague. Likewise, they say, rollbacks of fuel economy standards would lead to thousands more deaths.

“We’ve seen with the Trump Administration’s EPA, a relentless attack on common-sense safeguards [with] efforts to undermine, repeal, and delay pollution cleanup,” Billings tells Elemental. “We know that many polluters, left to their own devices, will cheat.”

Billings, Dominici, and other health experts think air-quality standards should be tightened, as they have been a few times over the decades already, to further safeguard health. By law, the standards must be reviewed every five years, and they are under review this year. But the current EPA has made clear it does not intend to do any tightening, Billings says.

In the meantime, relaxing enforcement of clean-air laws during a pandemic “is sort of a double whammy for the people who are most vulnerable, most at risk,” Billings says, “Without oversight, we’re seeing the potential for increased emissions that clearly is harming health, and with this synergistic effect of air pollution and an infectious disease like Covid, we’re seeing really terrible results from a public health perspective.”