Abstract
After the appearance of COVID-19 in China last December 2019, Italy was the first European country to be severely affected by the outbreak. The first diagnosis in Italy was on February 20, 2020, followed by the establishment of a light and a tight lockdown on February 23 and on March 8, 2020, respectively. The virus spread rapidly, particularly in the North of the country in the ‘Padan Plain’ area, known as one of the most polluted regions in Europe. Air pollution has been recently hypothesized to enhance the clinical severity of SARS-CoV-2 infection, acting through adverse effects on immunity, induction of respiratory and other chronic disease, upregulation of viral receptor ACE-2, and possible pathogen transportation as a virus carrier. We investigated the association between air pollution and subsequent COVID-19 mortality rates within two Italian regions (Veneto and Emilia-Romagna). We estimated ground-level nitrogen dioxide through its tropospheric levels using data available from the Sentinel-5P satellites of the European Space Agency Copernicus Earth Observation Programme before the lockdown. We then examined COVID-19 mortality rates in relation to the nitrogen dioxide levels at three 14-day lag points after the lockdown, namely March 8, 22 and April 5, 2020. Using a multivariable negative binomial regression model, we found an association between nitrogen dioxide and COVID-19 mortality. Although ecological data provide only weak evidence, these findings indicate an association between air pollution levels and COVID-19 severity.
Highlights
After the first indigenous Italian case of COVID-19 diagnosed on February 20, 2020 in a small municipality of Lombardy region, Codogno, the SARS-CoV-2 outbreak rapidly swept across all of Italy, resulting in more than 240,000 confirmed positive cases and almost 35,000 deaths by mid-July (CPD, 2020; Docea et al, 2020)
We aimed to investigate if the relation previously reported between air pollution assessed through satellite-detected tropospheric nitrogen dioxide and the early phases of the SARS-CoV-2 outbreak was associated with a higher COVID-19 severity, using available mortality data from two of the previously investigated three regions in Northern Italy
We studied the population of two Northern Italy regions, Veneto and Emilia-Romagna, for which we were able to obtain the daily number of COVID-19 deaths by province of diagnosis
Summary
After the first indigenous Italian case of COVID-19 diagnosed on February 20, 2020 in a small municipality of Lombardy region, Codogno, the SARS-CoV-2 outbreak rapidly swept across all of Italy, resulting in more than 240,000 confirmed positive cases and almost 35,000 deaths by mid-July (CPD, 2020; Docea et al, 2020). Italian authorities swiftly adopted two major interventions, the two national lockdowns to limit the spread of the virus, following two local lockdown adopted in the Codogno area and in the small municipality of Vò, Veneto region (Lavezzo et al, 2020). The second was on March 8, 2020 in the most affected areas and immediately extended the following day to all of Italy (Gabutti et al, 2020; Ministry of Health, 2020b). The second lockdown was seen to be effective in slowing the infection, with a reversal of the epidemic curve beginning 9 days after its implementation (Vinceti et al, 2020)
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