Isabella Annesi-Maesano,In China and Italy, ‘the first sites of the epidemics are regions that are very polluted,’” Interviewed by Émilie Massemin, Reporterre, March 31, 2020.

A translation of En Chine et en Italie, « les premiers foyers épidémiques sont des zones très polluées » Reporterre, 2020/03/31.

Translated by Dennis Riches

China, Northern Italy, Iran… “The fact that the first outbreaks were located in highly polluted areas is no accident,” says researcher Isabella Annesi-Maesano. Fine particulate pollution, as well as agricultural spraying, can carry coronavirus.

Isabella Annesi-Maesano is Director of Research at the National Institute of Health and Medical Research (INSERM) and head of the Allergy and Respiratory Diseases Epidemiology Team (EPAR) at the Pierre-Louis Institute of Epidemiology and Public Health (IPLESP) and Sorbonne University.

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How can fine particles carry the coronavirus?

SARS-CoV-2, which penetrates the body through the nose and mouth to cause damage to the lungs, can use fine airborne particles as a means of transport. When we look at the larger ones, those 10 microns in diameter, under a microscope, we see that they are the vector of many things: viruses, pollens, spores, etc. The smallest fine particles, less than 2.5 microns in diameter, aggregate by trapping these same bacteria, spores, pollens, molds… SARS-CoV-2 included. These particles can be transported very far. Scientific papers show that desert sand carrying organic matter contributes to the fertilization of the Amazon rainforest!

But the most important thing to remember is that pollution carries the virus and that aerosol contamination is possible, even if the transmission of the disease is mainly by droplets. And this mode of transmission through pollution is not specific to SARS-CoV-2. It has already been observed during the outbreak of SARS-CoV-1 in 2002-2003 but also for viral bronchiolitis in children, influenza, avian influenza, tuberculosis… More broadly, the fact that the first outbreaks were located in China, Iran and Northern Italy, highly polluted areas, is no accident. Researchers from the Italian Environmental Medicine Society examined a map of pollution in Italy and found that the most polluted areas were also the ones with the most deaths. They even found a link between a spike in death and a high level of pollution fourteen days earlier.

Agricultural spraying. At the moment, farmers are planting and preparing the land, sometimes in a very important way.

You write that pollution makes us more susceptible to infections: how?

Air pollution is irritating and damages the mucous membranes of the airways. In response, they decompensate, become more permeable and pathogens penetrate them more easily. This is true for SARS-CoV-2,but not only for this disease: when the environment is heavily polluted, people more easily catch a cold or start a pollinosis.

In addition, fine particles cross the barrier of the pulmonary alveoli, join the bloodstream and attack all organs, causing systemic inflammation. Air pollution is thus responsible not only for many respiratory problems but also for cardiovascular, neurological, and metabolic problems: stroke, diabetes, obesity… Two-thirds of pollution-related diseases are cardio-vascular! And once people get sick, the pollution further aggravates their pathology and makes them vulnerable to infections like SARS-CoV-2.

Finally, many of these environmental pathologies are treated with anti-inflammatory and cortisone-type drugs, which can aggravate Covid-19 infection.

Are masks effective in protecting against contamination through air pollution?

To limit the spread of the virus, everyone should have been equipped with surgical masks at the beginning of the epidemic: the sick to block droplets, healthy individuals to limit the risk of contagion… If everyone is equipped with a mask, the contamination decreases, especially from those who do not yet know that they are sick.

On the other hand, there is no mask that protects 100% of pollution, especially fine particulate pollution. And the masks that protect the best are very expensive.

But in any case, France has no masks, let alone masks of a good level of protection—the FFP2. It seems that manufacturing processes are moving forward, but in hospitals the situation remains very critical. There are even services where caregivers are told that you don’t have to wear a mask! It’s not true. Moreover, when health minister Olivier Véran claims that masks are useless, he himself knows that this is not true.

What policy and/or collective measures do you advocate to limit this pollution to fine particulate matter, and more generally to contain the Covid-19 epidemic?

Agricultural spraying should be reduced and avoided near the most densely populated areas. We also need to reduce all sources of pollution—cars, airplanes, etc., but that is already the case. When you go to the Airparif air quality monitoring site, you see that pollution levels have dropped significantly since the start of containment.

You have co-authored an op-ed published on the website of an environmental association calling for a limit on the application of agricultural sprays. What role do you think researchers, particularly with politicians and citizens, can play in helping to contain the epidemic?

We should be able to interact more easily with politicians. Today, that is not the case. The first scientific council that advised the President of the Republic on the management of the epidemic did not have a single pulmonologist, while Covid-19 is a respiratory disease, and not a single specialist in health and environment, but it had too many infectious disease specialists and virologists focused on developing a vaccine that would not be ready until next year at best.

Finally, policies need to give more resources to research. To fight diseases, studies are needed. However, some subjects of study have been abandoned due to lack of funding. I myself have filed an application to work on the link between Covid-19 and pollution. Before I can start work, I have to wait for it to be reviewed and validated by a committee, which can take weeks. It’s way too long. And then it’s not certain that it will be accepted!

Another article on this subject, from April 8, 2020:

Lisa Friedman, “New Research Links Air Pollution to Higher Coronavirus Death Rates,” New York Times, April 8, 2020.

Additional note, added by translator on April 6, 2020:

Dr. Pablo Goldschmidt:

It was in Italy, in Lombardy, where the most people died of mesothelioma. There were fiber cement factories that used asbestos. Until 1992, when it was banned, it was found in rooves and factory insulation… Mesothelioma is lung cancer caused by asbestosis or asbestos. Of the autopsies performed in Lombardy in the past ten years, 85 percent were deemed as work-related deaths—malignant tumors of the lungs and peritoneum… Lombardy has a population of ten million, and most of the workers in the asbestos industry are here—and it is the place with the most asbestos-related cases worldwide… between 2000 and 2012, 4,442 malignant mesotheliomas—invasive lung cancer from asbestos—occurred, including 2,850 in men and 1,592 in women. And the cases increasing. This year, there were already 3.6 percent more cases among men and 3.3% more among women over 65 compared to previous years. And by 2030 there will be 20,000 more… in this region, which is already punished enough due to a lack of funds, a reduction in the number of beds, the lack of respirators, old people live with lung cancer or other chronic conditions that cause a viral infection to become a fatal infection. A lung affected by mineral fibers reacts differently [to an infection] than a healthy one. And it is no coincidence that more people die in an area with asbestos factories.

Source: Hugo Martin, “Para un prestigioso científico argentino, ‘el coronavirus no merece que el planeta esté en un estado de parate total,’” (Leading Argentinian scientist: Dealing with the corona virus does not require a total shutdown of the planet). Interview with Pablo Goldschmidt, Infobae, 2020/03/28, https://www.infobae.com/tag/pablo-goldschmidt/

See the full interview with Dr. Pablo Goldschmidt here.

UPDATE, MAY 2, 2020

Coronavirus: a link between pollution and mortality of the disease?, FranceInfo, May 1, 2020.

Italian scientists are conducting a study to establish whether there is a link between urban pollution and complications associated with Covid-19…

Can pollution be a vehicle for accelerating the Covid-19 epidemic? Italian scientists apparently have an answer to this question. “This is a study that will gain some attention,” says our journalist Alban Mikoczy, live from Rome. It says there is a link between pollution and the severity of the disease. For this, they take examples, such as the Lombardy region, Piedmont, the Madrid region, the Benelux region, the Paris region in France and also the south of the United Kingdom.”

These are some of the most polluted regions in Europe, especially in terms of nitrogen dioxide levels. “For example, in Milan, there were 27 consecutive days in January of high pressure, and therefore pollution,” our correspondent reports. However—and this is the discovery of this study—this pollution leads to complications in the treatment of the disease. It is observed that patients who were on respirators had more inflammation, and more severe inflammation, as if their bodies, already tired of fighting pollution, now had to fight the disease.” Of  course,  this  study  needs to be reviewed…