Air Date: Week of April 10, 2020

New York City has been the epicenter of COVID-19 cases in the United States. It is also one of the cities in the United States with the highest levels of air pollution. (Photo: Thomas Hawk, Flickr, CC BY NC 2.0)

The novel coronavirus is deadlier to people who have years of exposure to high air pollution, emerging research finds. Dr. Aaron Bernstein of Harvard’s Center for Climate, Health and the Global Environment, speaks with Host Steve Curwood about the link between air pollution and severe cases of COVID-19, and also notes people of color are disproportionately exposed to air pollution. Dr Bernstein also discusses the lifesaving health benefits of climate solutions that also clean up polluted air.

Transcript

CURWOOD: From PRX and the Jennifer and Ted Stanley Studios at the University of Massachusetts Boston, this is Living on Earth, I’m Steve Curwood at a social distance.

The novel corona virus is more deadly in areas with many years of high air pollution, researchers are now saying. Biostatisticians at Harvard’s T.H. Chan School of Public Health compared death rates from Covid-19 in 3000 counties with air quality and found that in areas with just a small increase in long term rates of fine particle pollution, 15% more people are likely to be killed by the virus. And researchers at the University of Siena in Northern Italy also suggest there is an association between the region’s long history of high air pollution and the high pandemic death rates. For some perspectives, we turn now to Pediatrician Aaron Bernstein, who is the interim director of the Center for Climate, Health and the Global Environment at Harvard, though he did not work on the Harvard study. Since the particulates in air pollution seem to increase the lethality of the corona virus, I asked Dr. Bernstein to start our conversation by explaining just what they are.

BERNSTEIN: Particulate matter air pollution refers to anything that's suspended in the air. So that could be from burning wood, it could be from gravel that's ground up on the ground and put into the air, or even dirt or salt that gets, you know, washed up from the shores into the air or off farms into the air. But it also can come from burning fossil fuels. And it's generally treated by its size. So we say there's particulate matter of 10 microns in diameter, particulate matter of two and a half microns in diameter, and the air rules for the United States, the air quality rules, tend to focus on so-called PM2.5. That's about 1/20th the size of a human hair.

CURWOOD: So why are those particles such a health problem?

BERNSTEIN: Yeah, so lots of research has shown that the more particulate matter people breathe, the more likely they are to die, particularly if you're older. We know that they cause heart attacks and strokes, we know that they cause lung cancer. There's now strong evidence that these particles can also promote the development of type II diabetes, mental health problems, affect the developing fetus, so, may see poorer growth and maybe early birth. And there's increasing evidence that they may be damaging brains: may be a cause of dementia, may be a cause of some disorders in children we see, like autism. But the bottom line is particulate matter's just generically really bad for us. And in many places in the world including the United States, the major source is from burning fossil fuels. In other places, where people are using indoor cookstoves, for instance, and burning wood or dung or other things in their homes, that's a major source. And all told, particulate matter in the world is killing like somewhere between seven and 10 million people every year, mostly in Asia. And it's, you know, in the top 10 causes of death, maybe in the top five by some estimates.

CURWOOD: And what are those numbers here in the United States?

BERNSTEIN: So there's probably on the order of 100,000 to 200,000 people who die every year from particulate matter in the United States. That death toll is not distributed evenly across the United States population. If you're poor, if you're African American, if you're Latino, your odds of getting sick and dying from particular matter are much higher than other folks. And, you know, we know that of course, short of death, there are a lot of bad things that happen to people from air pollution. I as a pediatrician know that air pollution can be a major risk for everything from ear infections to pneumonias. And you know, in people who are older, air pollution, particulate matter air pollution can cause heart attacks and strokes.

CURWOOD: And as a pediatrician, I imagine you see a fair amount of asthma.

BERNSTEIN: Yep, we also know that particulate matter is a major both cause, meaning, it would take a child who wouldn't have had asthma and lead them to have asthma. But also, of course, children who already have asthma are more likely to have trouble breathing. And that's also true for adults, adults who have chronic lung diseases who get exposed to particulate matter are much more likely to have a hard time breathing.

CURWOOD: What's the relationship between particulates and climate disruption, climate change?

BERNSTEIN: Well, it's, you know, sort of the same problem. Around 70% of the carbon emissions in the world come from burning fossil fuels. And as I mentioned before, a huge amount of death is happening because of particulate matter air pollution, that also come from burning fossil fuels. And so you know, you get a win-win there. If you get off fossil fuels, you get rid of huge burdens of disease right now; I think that's critical, which is, you know, we don't wait for months or years when you stop burning coal in a power plant and convert it to renewables. The change in health happens right now, and particularly in the places where that coal plant stops burning coal. And of course, that means there's also less carbon emissions, which protects the climate moving forward.

CURWOOD: Now explain to me why air pollution then is apparently increasing a COVID patient's risk of dying from the disease, as some recent papers have indicated.

BERNSTEIN: Yeah. So had you asked me that question a couple weeks ago, I would have said, well, we have lots of evidence from other even viral infections -- including SARS, which is sort of the first cousin of COVID; it's also a coronavirus, it also came into people from bats -- that particulate pollution, particulate matter air pollution, is a major reason for people to get sick and potentially die from these infections. But in the last week, we've had evidence now specifically on COVID in the United States, showing that very small changes in the amount of air particles that people have been exposed to, over the long term, so these are not the day-to-day fluctuations, but this is over many months. So if you've lived in a place with overall worse air pollution, the death rate increases by 15% for every one microgram per meter cubed of air pollution, particulate matter air pollution. Now, to put that in context, you know, in Boston, the air quality right now, the particulate matter levels are about five micrograms per meters cubed. You know, on a bad day, it gets up 15 to 20. Many places United States are 30. But one microgram per meter cubed difference over the long haul, right, this is over extended periods, leading to a 15% increase in the death rate from COVID. And that's, by the way, doing statistics to try and account for the health status of the people who are affected, so whether you are sicker at baseline or not. They also in this study looked at people's access to health care, so were there hospitals available to you or not? They looked at people's socioeconomic status, so whether you're rich or poor, and a host of other things that of course, should matter to whether someone's likely to die. And even accounting for all those things, they still found that these small differences in air pollution matter to whether or not you're going to die from this disease.

CURWOOD: So we've seen, of course, just horrific death rates so far in places like New York City, Northern New Jersey, seems to be a question of what might be going on in Louisiana and in Michigan. In many of these places it's been tied to ethnicity, it's been tied to the African American community, it's been tied to the Hispanic community. What's going on there, do you think?

BERNSTEIN: So one of the, you know, guesses about what's going on there is that for one thing, many minority communities in this country do not have equal access to health care at baseline, meaning if they have a little bit of heart disease, they might not have the same level of care as other folks. And so it's possible that some of this is reflective of barriers to care, inequality in access to care, and other social determinants of health, that can drive whether or not people might live or die. But, you know, this new evidence, and frankly, in conjunction with the old evidence, is worrisome because we know that African Americans and Latino Americans are disproportionately exposed to air pollution. There have been many studies showing this. And so, you know, we now have the challenge to sort out whether, in fact, this signal that is emerging, which is minority communities, particularly African Americans, potentially Latinos, are at increased risk of dying because of air pollution in their communities. You know, if that turns out to be the case, it would be yet another kick in the pants around why, frankly, climate actions are so important. You know, I've been saying for the past several weeks that climate actions are pandemic prevention actions. And a lot of folks I think, understandably get rankled by that, how can you be talking about climate change when people are dying of an infectious disease right now? And my answer to that is pretty easy, which is, if someone's having a heart attack, and they're getting their, you know, heart reperfused with blood, you know, you're not talking about what they're eating and whether they're smoking and whether they're exercising when they're on the table getting their blood vessel opened. And that's probably because they're asleep, by the way. But the moment they're awake, there's someone in that room saying, you know, we've got to do better to prevent this. And what we know now about COVID, and this is true not just with the air pollution piece, but it has to also do with our diets. We know now that our health, the population health of people in this country, is a huge factor in how we deal with something like COVID. So air pollution may matter, our diets may matter; so there was an op-ed published in the New York Times a week or so ago by colleagues of mine at Boston Children's, saying, you know, we are not healthy enough to go back to work, because of our diets and the rates of obesity in this country and how we know that the rates of mortality from COVID are heavily dependent on pre-existing medical conditions, the lion's share of which are preventable through dietary changes, and we know of course, that eating, for example, more plants, less red meat is enormously helpful for our health right now. And also, of course for the climate.

CURWOOD: What kind of impact on public health do you think the Trump administration's decisions to indefinitely relax the enforcement of certain environmental regulations, including air pollution, what could this have right now in the midst of the coronavirus, do you think?

BERNSTEIN: Yeah, it's hard to know, it's a good question. A lot of people have been really concerned about the EPA decision to essentially allow polluters to not really pay so much attention to their pollution. In light of the research that came out this week, I think there's heightened concern here, because if even small increments in air pollution occur, especially in communities that we know are at risk, that decision now looks a little less wise. You know, I do my best to operate in good faith that the folks who are trying to steer us right now are doing the best job they can. But I think that what we, we, we owe it to everybody to do is to try and use science as best we can to make the case as to why certain decisions might be changed or why certain decisions should stand. And I think this is a very good example, which is, we now have evidence people may be much more sensitive to air pollution with disease than we previously understood. Does that matter to the decision of the EPA? I would say it absolutely does. I should note that for the last three years, air pollution in the United States has gotten worse, for the first time in decades. Not clear why that is, but you know, this is concerning because from a regulatory standpoint, there's no reason for that to happen. So we already have this uptick in air pollution; now we have evidence that air pollution may be more risky; and we potentially have an EPA that's saying, Let's not pay as much attention to air pollution. That would certainly give me pause, particularly for those folks in our communities that are most at risk.

CURWOOD: Ari, before you go, what advice do you have as a physician to people going through this COVID pandemic -- ways beyond the usual things we hear to enhance our own health and that of our children and our elders, people that we care about.

BERNSTEIN: Yeah, it's a great question, Steve. Let me try and answer it in the domain that's closest to my own, which is, you know, what do you tell children, who've been kept out of school and kept away from friends and it may be hard to understand what's going on, in some ways. Because all children sort of get infections, many of them had ear infections, throat infections, and they're sort of, you know, they get over them. And this is just so wildly different. So for children out there, and you know, for their parents and grownups who are listening, you know, I think there's a couple of important things to know. One is that it's important to take care of ourselves right now. That doesn't mean bingeing on french fries. [LAUGHS]

What, what it does mean is keeping with the routines as much as we can, that, that happened, you know, before we were asked to stay home. And to the extent we can engage with our friends through computers and the Internet, to the extent that we can continue our schoolwork, to the extent we can maintain those routines, that's great. I also think that, you know, the things that we're being asked to do, washing our hands all the time, keeping our physical distance from others, are good for protecting ourselves and our families. But they're also, of course, done primarily to protect people most at risk, right? So most children are not affected as severely and they may not have symptoms. And so one might reasonably have said, Well, I'm not really protecting myself, if I'm a child. The real reason is we're protecting people who are more at risk. And you know, there aren't a lot of silver linings in this mess. But one of them could be that we cultivate a cohort of children here, who really get that we do things not always for ourselves. That sometimes, the right thing to do, which may not be something that we would do for ourselves otherwise, is important to do because it saves lives. It keeps the people in our communities healthy. That we make decisions that matter beyond ourselves. And there's been no experience in recent memory that has made it clearer than this one, that our health is absolutely tied to the communities we live in and to the living world, and that we simply must move forward on that basis if we want to make sure that our children grow up to have the opportunities and health that so many of us have enjoyed. And so that's the kind of thing I think is really important to talk to our children about these days.

CURWOOD: Aaron Bernstein is the Interim Director of the Center for Climate, Health, and the Global Environment at the Harvard T.H. Chan School of Public Health and a pediatrician at Boston Children's Hospital. Ari, thanks so much for taking the time with us today.

BERNSTEIN: Thanks for having me, Steve.

 

Links

NYTimes | "New Research Links Air Pollution to Higher Coronavirus Death Rates"

New England Journal of Medicine | "Exposure to Air Pollution and COVID-19 Mortality in the United States"

Environmental Pollution | "Can Atmospheric Pollution be Considered a Co-Factor in Extremely High Level of SARS-COV-2 Lethality in Northern Italy?"

CNN | "Los Angeles Has Notoriously Polluted Air. But Right Now It Has Some of the Cleanest of Any Major City"

The Atlantic: A new report from the Environmental Protection Agency finds that people of color are much more likely to live near polluters and breathe polluted air—even as the agency seeks to roll back regulations on pollution.

Harvard Center for Climate, Health and the Global Environment (C-CHANGE)

About Aaron Bernstein, MD