Thick Air (Part 1) – Air Pollution and SARS-CoV-2
Preliminary remark of the author
What does air have to do with design?
The author is neither an infectiologist nor a specialist in outdoor or indoor air issues. The idea of this three-part blog post is rather to present current research results in an increasingly confusing situation around SARS-CoV-2 and to put them into a wider context. The common “silo thinking” contains the risk of losing track of one of the most burning issues of the day. The focus of the following considerations is on the importance of air as an elementary part of a recovery process. These considerations are in line with my earlier blogs, which highlight related issues of colour, noise and light (will follow). Air is the element that is least visible, but its design is fundamental. Air and its treatment in air currents are also subject to design, which is particularly important for the healing process. As a place of healing and convalescence, the air quality in hospitals is of an almost elementary importance. In addition to hygiene and safety, precise ventilation and air conditioning contributes to better indoor air quality, thus also to faster patient recovery and demonstrably higher staff productivity.
We focus on the currently known and scientifically proven correlations between the SARS-CoV-2 transmission rate and bad air in 3 parts as follows:
- Part 1 reflects on the relationship between climate change and air quality
- Part 2 focuses on air as one of the 9 basics of “healthy buildings”
- Part 3 examines the relationship between air quality and healing processes in hospitals.
The statements are based on the research results that have been made available to date, most of which are still scarce, and require ongoing scientific reviews and modifications. They do not claim the status of conclusive findings, but are intended as food for thought-provoking impulse.
However, while all these discussions are still taking place far away from their concrete everyday lives for many people, and while topics such as climate targets for 2050 etc. are moving in a future horizon that is not relevant to them, an epidemiological phenomenon has crept up almost unnoticed, which is also occurring directly and with full force on a global scale. It directly affects individuals in all regions of the world and this directly in their existence. Massive cuts in public and private life, which affect everyone to a hitherto unknown extent, are the result. It is the third and so far most devastating pandemic of the 21st century: SARS-CoV-2. (1)
“On 31 December 2019, the outbreak of a new pneumonia with as yet unknown cause was confirmed in Wuhan, China. On 11 February 2020 the WHO proposed the name COVID-19 for the disease.” (2)
As with climate change, one element is at the forefront: air.
While individual findings and interrelationships (e.g. global warming) are scientifically well established, others are only now being suspected and require detailed (and long-term) scientific research.
Outdoor Air: Air Pollution and SARS-CoV-2 (Covid-19)
There is as yet no firm evidence on the link between air pollution and Covid-19. But several scientific studies support the hypothesis that high levels of particulate matter in the air make the lungs more vulnerable to respiratory diseases like Covid-19.
There is evidence of a general link between air pollution and the incidence of lung diseases (3). There seems to be a link between poor air quality (particulate matter and nitrogen dioxide NO2) and severe Covid-19 processes. People who grow up in regions with poor air quality or live in areas with high levels of particulate matter are obviously at risk.
A study by Xiao Wu and Rachel Nethery of Harvard University (4) shows that just one microgram more particulate matter per cubic meter of air increases the death rates by 8% on average.
It is significant that the European coronavirus outbreak started exactly where the worst smog pollution in Europe was recorded weeks before (January 2020): in the northern Italian provinces of Lombardy, Emilia Romagna and Veneto. The air pollution there has been among the most precarious in Europe for decades. According to the Italian Minister of the Environment, Sergio Costa, Italian (pneumonia) deaths have always been in the region of 80,000 per year in previous years, much of it in northern Italy. In this respect, Covid-19 is probably not the causal trigger of the health crisis in northern Italy, but only an additional factor which added to the well-known northern Italian smog crisis and then brought the “barrel to the mill”.
In December and January 2020, the beginning of the SARS-CoV-2 spread in China, air pollution in the Po Valley in northern Italy climbed to new record levels.
Nowhere in Europe have pollution levels been and still are as high as in the Po Valley. This is a huge basin closed on three sides, in which the air remains for weeks in certain weather conditions. In addition, the Po Valley is also home to a great deal of industry and private traffic. There are also too many obsolete cars and heaters and too little public transport.
Northern Italy was and is therefore not only heavily polluted as an industrial region, there is also little wind blowing there. A long period of inversion weather keeps the air trapped above the plain. This creates ideal conditions for coronaviruses, which are excreted in droplets and sometimes as micrometer-sized aerosols, to float in the air for minutes. As is generally known, aerosols are generally not stable and usually change over time depending on air humidity, temperature and other physical and chemical processes.
This is why no other region of the EU has as many people falling ill or dying prematurely from smog as northern Italy. However, proving that someone actually falls ill or dies because of smog is difficult and concrete figures and studies are lacking. Nevertheless, experts believe that the regular, high levels of pollution in the Po Valley shorten the life expectancy of many people. Numerous studies show that wherever there is a high concentration of particulate matter in the air, the number of fatal strokes, heart disease and respiratory diseases like asthma increases dramatically.
On 17 March 2020 a study was published by the Italian Institute of Health (ISS) on this issue (5). The study analysed data from the first 2,000 deaths in Italy in 2020. The average age of the deceased was 79.5 years. Only 0.8% of those examined had no pre-existing conditions before infection. The remaining 99.2% suffered from at least one serious pre-existing condition. Half had three or more diseases, the most common being high blood pressure, diabetes, cancer as well as heart and respiratory problems.
In May 2020, the Journal of Infection published a hypothesis (6) that the atmosphere, which is rich in air pollutants (especially over highly industrialised areas), together with certain climatic conditions, can favour a longer permanence of virus particles in the air, thereby favouring “indirect” diffusion in addition to direct diffusion.
The authors referred to a Chinese study (7), which found a close link between severe viral respiratory diseases causing infection in 10-20% of the population and air pollution in their region.
The Covid-19 measures introduced by the authorities have led to a significant reduction in emissions (8).
A situation comparable to that in northern Italy was also emerging in China.
The figures below show how the concentration of nitrogen dioxide (a pollutant released during the combustion of fossil fuels) over China has decreased in the first weeks after the lunar New Year compared to the previous year (2019).
Conclusion: Covid-19 illustrates the importance and potential effects of global air pollution on individual health. The studies known to date, some of which have not yet been reviewed, indicate that the atmosphere, which is rich in air pollutants, together with certain climatic conditions, can favour a longer permanence of virus particles in the air, thereby favouring “indirect”diffusion in addition to direct (human-to-human) diffusion. If this hypothesis is confirmed, it could provide evidence – at the macro level – for a greater degree of control over the risk of infection spreading. Indeed, possible developments in diffusion can be partially anticipated by weather forecasts and seasonal forecasting systems, so that timely containment measures could be taken in critical regions. It could also further reinforce the need to reduce air pollution levels as part of public health measures to contain the spread of Covid-19 and other infections. (10)
(1) On the terminology:
Coronavirus: Coronaviruses are a family of viruses, which also includes the virus SARS-CoV-2, which is currently rampant worldwide. As it did not initially bear a name, it was referred to as the “novel coronavirus” in the first few weeks.
SARS-CoV-2: The WHO gave the novel coronavirus the name “Sars-CoV-2” (“Severe Acute Respiratory Syndrome”-Coronavirus-2). The name refers to the virus that can cause symptoms, but does not have to.
Covid-2: The respiratory disease caused by sars-CoV-2 has been called “Covid-19” (coronavirus disease 2019). Covid-19 patients are people who carry the SARS-CoV-2 virus and show symptoms.
(7) Characteristics of COVID-19 infection in Beijing. Tian S, Hu N, Lou J, Chen K, Kang X,XiangZ,ChenH,WangD,LiuN,LiuD,ChenG,ZhangY,LiD,LiJ,LianH,Niu S, Zhang L, Zhang J. J Infect. 2020 Feb 27. pii: S0163-4453(20)30101-8. doi:10. 1016/j.jinf.2020.02.018.
(8) Monitor Air Pollution Lombardia: www.arpalombardia.it
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