Double whammy: air pollution and Covid-19

In the past eight months of this year, 791 people have died in Nepal from Covid-19. In the whole of 2019, air pollution directly killed 42,100 people in the country.

Poor air quality in cities and inside homes due to smoky kitchen fires kill far more people across South Asia than SARS-CoV-2. But now, researchers say, there is a looming danger that as winter approaches, deterioration of air quality and Covid-19 will emerge as a double whammy.

Even before the pandemic, the World Health Organisation (WHO) was already warning that poor air quality in the Indo-Gangetic plains that includes a part of the Tarai in Nepal was already the reducing average lifespan of tens of millions of people by 3.7 years.

“Long-term exposure to air pollution can cause many of the health conditions associated with increased vulnerability to Covid-19, such as diabetes and chronic heart and lung diseases,” says the State of Global Air 2020 released on Wednesday. 

The report shows that air pollution is among the biggest risk factors for all major mortality in the region, surpassed only by high blood pressure, tobacco use, and poor diet.

Air pollution accounted for 6.7 million deaths globally, 2.1 million in South Asia, and nearly 42,100 deaths in Nepal in 2019 alone. Nepal ranks among the top 10 countries with the highest PM2.5 concentrations (harmful particles less than 2.5 microns suspended in the air).  Bangladesh, India and Pakistan also made the cut.

The report says that 100% of the population in India lives in areas where PM2.5 levels are higher than the WHO Air Quality Guideline. Nepal is not far behind with 98% of its people living in such areas. 

The report, a collaboration between the Boston-based Health Effects Institute and the Institute for Health Metrics and Evaluation comes as the Covid-19 pandemic has claimed more than 116,000 lives in India and 765 in Nepal. Pollution and SARS-Cov-2 both affect the respiratory tract and lead to pneumonia. In fact, patients with pre-existing heart and lung disease are at high risk of coronavirus infection.

On Wednesday, there were a total of 44,476 active cases after an additional 5,743 positives with Kathmandu Valley alone reporting 3,107 of them. With 2,996 discharged in the last 24 hours, the recovery rate now stands at 68.7%. There are a total of 269 patients in ICU and 87 on ventilator support. Bagmati province accounts for the most of them, 152 in ICU and 59 on ventilator. 

More than 65% of all deaths due to chronic obstructive pulmonary disorder (COPD) in 2019 were linked to air pollution in Nepal. In India, it was 60%, and over 30% of the deaths due to ischemic heart disease in 2019 were linked to air pollution in both countries.

These figures will only increase with the upcoming winter months which is also the flu season. India is already struggling with over 7.6 million Covid-19 cases. Nepal’s capital Kathmandu has run out of hospital beds including ICUs, oxygen, ventilators, and there is a shortage of other medical supplies. 

Although the full links between air pollution and Covid-19 are not yet known, there is clear evidence connecting air pollution and increased heart and lung disease. There is growing concern that air pollution exposures, especially in the most polluted regions of South Asia, could exacerbate the effects of Covid-19 significantly.

“Exposures to air pollution have been shown to affect the human body’s immune defence making an individual more susceptible to respiratory infections such as pneumonia,” says Pallavi Pant, air quality scientist at the Health Effects Institute. “Air pollution exposures are linked with a range of diseases including chronic heart and lung diseases – all of which contribute to poorer outcomes in patients infected with the virus.” 

Researchers say it is likely that people living in areas with high air pollution will experience more adverse outcomes from Covid-19. The report also found that air pollution is a leading risk factor to health both in Nepal and India followed by smoking and high blood pressure. 

Even though there is now greater awareness in Nepal and in South Asia about the impact of poor air quality, not even steps have been taken at the nation state level. There is also no cross-border collaboration in controlling air quality especially as the annual season for crops residue burning is sending plumes of pollution across South Asia.

“Although there have been actions and air quality improvements in some countries, including Nepal, there has been little or no sustained progress over the last decade in the most polluted countries of South Asia and Africa,” says the report.

In the first-ever comprehensive analysis of air pollution’s global impact on newborns, the report finds that outdoor and household particulate matter pollution contributed to the deaths of nearly 500,000 infants in their first month of life. Nearly two-thirds (64%) of the infant deaths are linked to use of household burning of solid fuels, hitting hardest in South Asia and Sub-Saharan Africa.

In Nepal, 22% of all neonatal mortality is linked to air pollution, most of which is attributed to indoor pollution from kitchen fires. This is much higher than the figure in India where 46% of all neonatal deaths due to air pollution is attributed to household air pollution.