Abstract

BACKGROUND AND AIM Evidence exists linking exposure to air pollution with increased COVID-19 incidence, severity and mortality. However, little is known about the role of air pollution in persisting symptoms among recovering patients. We designed a cohort study of hospitalized COVID-19 survivors in São Paulo, Brazil, to examine whether ambient air pollution is associated with post-COVID-19 syndrome. METHODS Patients hospitalized between March to August 2020 who were alive six months after hospitalization were included. We collected individual and clinical characteristics during hospitalization and at follow-up assessed ten symptoms with standardized scales, 19 yes/no symptoms, a functional status and a quality-of-life scale and performed four clinical tests. Individual exposure to air pollution was assessed by averaging satellite gridded estimates of annual mean levels of PM2.5 in a 300 m buffer around each participant´s residential address. We also considered greenspace and neighborhood sociodemographic factors in generalized linear mixed models. RESULTS We included 749 patients with a median follow-up of 200 (IQR 185 - 235) days, and 618 (83%) had at least one of the ten symptoms measured with scales. Pain (41%), fatigue (38%) and post-traumatic stress disorder (35%) were the most frequent. Individual exposure to PM2.5 was associated with higher dyspnea and fatigue scores and lower functional status. Clinical and sociodemographic factors exhibited associations with different symptoms while greenspace and neighborhood sociodemographic factors did not show any significant association. CONCLUSIONS We identified a high frequency of persistent symptoms among COVID-19 survivors that were associated with clinical and sociodemographic factors. Ambient levels of air pollution were associated with persistent dyspnea, increased fatigue, and lower functional status at follow-up. Potential mechanisms involving oxidative stress and systemic inflammation can explain these associations but further studies are needed to confirm this novel impact of air pollution on health. KEYWORDS Air pollution, COVID-19; persistent symptoms

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