Particulate matter, sulfur dioxide, nitrogen oxides, ozone, carbon monoxide, volatile organic compounds (VOCs) and polycyclic aromatic hydrocarbons (PAHs) are among the outdoor air pollutants that are major factors in diseases, causing especially adverse respiratory effects in humans. On the other hand, the role of respiratory viruses in the pathogenesis of severe respiratory infections is an issue of great importance. The present literature review was aimed at assessing the potential effects of air pollutants on the transmission and severity of respiratory viral infections. We have reviewed the scientific literature regarding the association of outdoor air pollution and respiratory viruses on respiratory diseases. Evidence supports a clear association between air concentrations of some pollutants and human respiratory viruses interacting to adversely affect the respiratory system. Given the undoubted importance and topicality of the subject, we have paid special attention to the association between air pollutants and the transmission and severity of the effects caused by the coronavirus named SARS-CoV-2, which causes the COVID-19. Although to date, and by obvious reasons, the number of studies on this issue are still scarce, most results indicate that chronic exposure to air pollutants delays/complicates recovery of patients of COVID-19 and leads to more severe and lethal forms of this disease. This deserves immediate and in-depth experimental investigations.

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The number of studies published on COVID-19 in recent months is certainly impressive. However, there are still important gaps to know a great number of characteristics of this disease. Among these, some potential ways of transmission of the SARS-CoV-2 and the different reasons for the severity of the disease in different people. Various studies have suggested that certain air pollutants could be increasing the transmission of the coronavirus, as well as the risks of COVID-19 incidence and mortality. In the present preliminary case-study conducted in Tarragona Province (Catalonia, Spain), we studied the potential association of COVID-19 with PM 10 , NO 2 and O 3 , as well as the differences in the incidence and lethality of this disease. This Province is divided into two “health regions”: Camp de Tarragona, with an important industrial complex, and Terres de l’Ebre, with a great agricultural component. In spite of the notable limitations of the current study, our preliminary findings indicate that the industrialized/urban areas of Tarragona Province show a higher incidence and mortality of COVID-19 than the agricultural/rural zones. These – and previous – results would highlight the importance of conducting specific investigations focused on directly assessing whether air pollutants such as particulate matter can act as carriers of the SARS-CoV-2. If confirmed, the recommendation on keeping the “social distance” (1.5–2 m) might need to be adapted to this situation.

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Data about internal exposures are useful to decode the exposome. The paper provides extensive information for EWAS. Information included serves as a guideline - snapshot in time without any claim to comprehensiveness - to interpret HBM data and offers opportunities to collect information about the internal exposure of stressors if no specific BoE is available.

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