Does air pollution explain COVID-19 fatality and mortality rates? A multi-city study in São Paulo state, Brazil

Abstract

Since air pollution compromise the respiratory system and COVID-19 disease is caused by a respiratory virus, it is expected that air pollution plays an important role in the current COVID-19 pandemic. Exploratory studies have observed positive associations between air pollution and COVID-19 cases, deaths, fatality, and mortality rate. However, no study focused on Brazil, one of the most affected countries by the pandemic. Thus, this study aimed to understand how long-term exposure to PM 10 , PM 2.5 , and NO 2 contributed to COVID-19 fatality and mortality rates in São Paulo state in 2020. Air quality data between 2015 and 2019 in 64 monitoring stations within 36 municipalities were considered. The COVID-19 fatality was calculated considering cases and deaths from the government’s official data and the mortality rate was calculated considering the 2020 population. Linear regression models were well-fitted for PM 2.5 concentration and fatality ( R 2 = 0.416; p = 0.003), NO 2 concentration and fatality ( R 2 = 0.232; p = 0.005), and NO 2 concentration and mortality ( R 2 = 0.273; p = 0.002). This study corroborates other authors’ findings and enriches the discussion for having considered a longer time series to represent long-term exposure to the pollutants and for having considered one of the regions with the highest incidence of COVID-19 in the world. Thus, it reinforces measures to reduce the concentration of air pollutants which are essential for public health and will increase the chance to survive in future respiratory disease epidemics.

Impacts of exposure to air pollution, radon and climate drivers on the COVID-19 pandemic in Bucharest, Romania: A time series study

“…In good accordance with existing literature ( Shao et al, 2022 ; Xu et al, 2022 ; Lipsitt et al, 2021 ; Frontera et al, 2020 ; Zoran et al, 2020a , 2020b ; Islam et al, 2021 ; Amin et al, 2020 ; Hassanzadeh et al, 2020 ; Li et al, 2020 ; Páez-Osuna et al, 2022 ), this study demonstrates a positive moderate correlation between outdoor exposure to daily average air pollutants PM2.5, PM10, NO 2 , SO 2 , CO concentrations, and increased daily new COVID-19 confirmed (DNC) cases and deaths (DND). A possible explanation may also indicates that air pollutants exposure may enhance virus-induced lung damage and inflammation, suggesting contribution to COVI-19 pathogenesis ( Domingo et al, 2020 ; Marquès et al, 2021 ; Huang et al, 2020 ; Zhu et al, 2020 ; Feng et al, 2022 ; Leirião et al, 2022 ).…”

“…Particulate matter -PM in different size fractions (PM1 μm, PM2.5 μm, and PM10 μm) and gaseous air pollutants (ozone-O 3 , nitrogen dioxide-NO 2 , sulfur dioxide-SO 2 , carbon monoxide-CO) may have an important impact on COVID-19 disease transmission ( Marquès and Domingo, 2021 , 2022 ; Marquès et al, 2022 ; Zoran et al, 2021 , 2022 ; Domingo et al, 2020 ; López-Feldman et al, 2021 ). Due to their increased oxidative toxicity, epidemiologic studies have shown a connection between outdoor ( Shao et al, 2022 ; Xu et al, 2022 ; Ho et al, 2021 ; Bakadia et al, 2021 ; Cao et al, 2021 ; Copat et al, 2020 ; Mu et al, 2021 ; Rahimi et al, 2021 ) acute and chronic exposure ( Wang et al, 2022 ) to high levels of air pollutants in large urban areas, that are responsible for respiratory and cardiovascular morbidity and higher mortality rates ( Hvidtfeldt et al, 2021 ; Domingo and Rovira, 2020 ; Leirião et al, 2022 ; Prinz and Richter, 2022 ; Khan et al, 2019 ; Travaglio et al, 2021 ). Was demonstrated that long-term exposure to particulate matter PM10 concentrations above WHO guidelines implemented by the Directive 2008/50/EU and the US-EPA, exacerbate COVID-19 health outcomes.…”

Air Pollution and COVID-19 Mortality in Brazil

“…Our study is also consistent with this local literature in Brazil. For example, in the state of São Paulo, exposure to PM 2.5 was associated with a 6.10% increase in mortality by COVID-19 [25]. Two other studies examined changes in air quality during the lockdown period [26,27].…”

2030 Agenda: discussion on Brazilian priorities facing air pollution and climate change challenges

“…This perspective was also reinforced by Pamplona et al ( 2020 ), who correlated air pollution in the city of São Paulo with congestive heart failure. The recent study by Leirião et al ( 2022 ) also showed that the levels of pollution found in São Paulo probably contributed to the increase in deaths due to the COVID-19 pandemic, emphasizing that reducing pollution levels is also essential from the perspective of coping and improving the chances of death survival in future respiratory disease pandemics.…”