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Coronavirus: Air Pollution Might Raise Risk of Fatality

The buildings of downtown Los Angeles are partially obscured at midday on November 5, 2019 as seen from Pasadena, California. Mario Tama / Getty Images.

By Ajit Niranjan

Two main risk factors are currently known to raise the chance of dying from the novel coronavirus that has brought the world to a halt: being old and having a weak immune system.

Air pollution makes the second of those more likely.

"If you live in a polluted area, your lungs are compromised like somebody who smokes, so you're more susceptible to the coronavirus," said Kofi Amegah, an epidemiologist and air pollution expert at the University of Cape Coast in Ghana.

Dirty air, which claims more than 7 million lives a year, could make Covid-19 more deadly by contributing to chronic health conditions that leave patients weak in the face of infection.

The European Public Health Alliance said last week that air pollution is likely to cut survival chances from Covid-19.

Research on previous outbreaks has also suggested bad air makes viruses more deadly and spread further. A study of SARS-CoV-1 victims in 2003 found that patients were twice as likely to die in regions where air pollution was high rather than low. Even in regions that were only moderately polluted, the risk of dying was 84% higher.

If a similar dynamic exists for Covid-19, it could add pressure on the critical care units of hospitals in smoggy cities with rapidly rising cases, such as Madrid, London and New York. It could also spell trouble for countries in the global south where most people burn wood, dung, kerosene or coal indoors to cook and heat their homes.

Silent killer

In northern Italy and the Chinese city of Wuhan, home to high levels of pollution and some of the most severe outbreaks to date, preliminary data suggests that particulate matter may already have played a role in overwhelming health care systems.

PM2.5 — particulate matter smaller than 2.5 microns in diameter, less than the width of a human hair — can penetrate the lung barrier and enter the bloodstream, raising the risk of developing heart and lung disease.

The case fatality rate in China was nine times higher for people with cardiovascular disease and six times higher for patients with diabetes, hypertension and respiratory disease than it was for people without underlying health conditions, a joint study by the World Health Organization and China found in February.

In Italy, health officials reported in March that 99% of a sample of patients who died from Covid-19 had an underlying illness — with almost half the deceased having suffered from three or more — though the sample was not drawn randomly and may not represent the population. The most common ailments were high blood pressure, heart disease and diabetes.

The WHO says the pandemic is too recent to draw a link between air pollution and the deadliness of Covid-19, but this shouldn't stop countries from acting.

"Whether or not we have this correlation between Covid-19 and air pollution, we need to reduce air pollution no matter what," Maria Neira, director of public and environmental health at the World Health Organization, told DW.

"Stop smoking and reduce the levels of air pollution — that is a recommendation we can make even without having more evidence."

Together with ozone pollution, PM2.5 particles shave almost three years off our lives, a study in the journal Cardiovascular Research found last month. The global loss of life from outdoor air pollution is 10 times greater than that of all forms of violence put together.

Moreover, about nine in 10 premature deaths caused by air pollution — including toxic gases NO2 and SO2 — hit people in low and middle-income countries. Even within rich cities in Europe and North America, working class, black and ethnic minority communities tend to breathe the dirtiest air.

Across sub-Saharan Africa, women are particularly exposed to pollutants from indoor cooking.

"For these women, their lung systems are compromised," said Amegah from Ghana's University of Cape Coast, adding that if Covid-19 spreads they will be especially vulnerable.

"We pray and keep our fingers crossed we don't see the levels [we're seeing] in northern Italy and China."

Disease spread

As well as weakening the body, airborne pollutants could even act as a carrier of the new coronavirus and allow it to survive in the air attached to particulates, a team of Italian researchers suggested in March.

High concentrations of particulate matter in parts of northern Italy in February may have "boosted" the spread of the epidemic this way, according to a position paper published by the Italian Society of Environmental Medicine that has not yet been peer-reviewed.

Other scientists have cast doubt on this, pointing out that there are no reported cases of this coronavirus spreading in the air and that people are the main vector of transmission.

"It's good to reduce air pollution to promote health, even to help decrease preconditions that could aggravate coronavirus, such as asthma, but I cannot see [air pollution] as an important contribution to the discussion about containment of the virus," said Jos Lelieveld, director of atmospheric chemistry at the Max Planck Institute and lead author of the study on deaths from air pollution.

As coronavirus cases rise exponentially around the world, lockdowns to stop its spread have reduced pollution levels.


Satellite images of China and Italy show striking drops in NO2, a toxic gas that inflames the airways, as governments closed factories and kept cars off the streets. The drop in air pollution in China may even have saved more lives than were lost from Covid-19, a study that has not yet been peer-reviewed suggested on Friday, though this comparison does not factor in the lives that would have been lost had the coronavirus spread unchecked.

Not all of the fall in air pollution seen from space can be attributed to lockdowns, either. Air pollution is higher in colder months anyway because people heat more and drive cars more often, so it tends to fall around this time of year, said Christian Retscher of the European Space Agency.

"Certainly, we see an effect of the coronavirus on NO2 … We see an additional effect [but] we don't know the precise number."

While lockdowns have helped clean the air, it is also uncertain how long they will keep pollution levels down.

"Once the crisis is over, and we see this in China, there's a temptation to compensate for the weeks and months lost," said Zoltan Massay-Kosubek, a policy expert for clean air and sustainable transport at the European Public Health Alliance.

Nonetheless, this shows that air pollution can be reduced and lives saved, said the WHO's Neira. "Now we need to maintain that — not the fact that we'll be confined, but reducing the air pollution levels outside."

Reposted with permission from DW.

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In early October, Britain's Prince William teamed up with conservationist David Attenborough to launch the Earthshot Prize, a new award for environmentalist innovation. The Earthshot brands itself the "most prestigious global environment prize in history."

The world-famous wildlife broadcaster and his royal sidekick appear to have played an active role in the prize's inception, and media coverage has focused largely on them as the faces of the campaign.

But the pair are only the frontmen of a much larger movement which has been in development for several years. In addition to a panel of experts who will decide on the winners, the prize's formation took advice from the World Wildlife Fund, Greenpeace and the Jack Ma Foundation.

With more and more global attention on the climate crisis, celebrity endorsement of environmental causes has become more common. But why do environmental causes recruit famous faces for their campaigns? And what difference can it make?

'Count Me In'

"We need celebrities to reach those people who we cannot reach ourselves," says Sarah Marchildon from the United Nations Climate Change secretariat (UNFCCC) in Bonn, Germany.

Marchildon is a proponent of the use of celebrities to raise awareness of environmental causes. In addition to promoting a selection of climate ambassadors who represent the UN on sustainability issues, Marchildon's team has produced videos with well-known narrators from the entertainment world: among them, Morgan Freeman and Mark Ruffalo.

"We choose celebrities who have a lifestyle where they are already talking about these issues," Marchildon explains.

"Sometimes they reach out to us themselves, as David Attenborough did recently. And then they can promote the videos on their own social channels which reach more people than we do — for example, if they have 20 million followers and we have 750,000."

Environmental groups focused on their own domestic markets are also taking this approach. One Germany-based organization that uses celebrities in campaigns is the German Zero NGO. Set up in 2019, it advocates for a climate-neutral Germany by 2035.

German Zero produced a video in March 2020 introducing the campaign with "66 celebrities" that supported the campaign, among them Deutschland 83 actor Jonas Nay and former professional footballer Andre Schürrle. They solicit support as well as financial contributions from viewers.

"Count me in," they say, pointing toward the camera. "You too?"

"We are incredibly grateful for the VIPs in our videos," says German Zero spokeswoman Eva-Maria McCormack.

Assessing Success Is Complex

But quantifying the effectiveness of celebrity endorsement of campaigns is not a straightforward process.

"In order to measure effectiveness, first of all you need to define what is meant by success," says Alegria Olmedo, a researcher at the Zoology Department at the University of Oxford.

Olmedo is the author of a study looking at a range of campaigns concerning pangolin consumption, fronted by local and Western celebrities, in Vietnam and China. But she says her biggest stumbling block was knowing how to measure a campaign's success.

"You need a clear theory of change," explains Olmedo. "Have the celebrities actually helped in achieving the campaign's goals? And how do you quantify these goals? Maybe it is increased donations or higher engagement with a cause."

A popular campaign in China in recent years saw famous chefs Zhao Danian and Shu Yi pledge to abstain from cooking endangered wildlife. While the pledge achieved widespread recognition, both Olmedo and Marchildon say it's difficult to know whether it made any difference to people's actions.

"In life we see a thousand messages every day, and it is very hard to pinpoint whether one campaign has actually made a difference in people's behavior," she explains.

Awareness Is Not Enough

Many campaigns that feature celebrities focus on raising awareness rather than on concrete action — which, for researcher Olmedo, raises a further problem in identifying effectiveness.

"Reach should never be a success outcome," she says. "Many campaigns say they reached a certain number of people on social media. But there has been a lot of research that shows that simply giving people information does not mean they are actually going to remember it or act upon it."

But anecdotal evidence from campaigns may suggest reach can make an active difference.

"Our VIP video is by far the most watched on our social media channels," McCormack from German Zero says. "People respond to it very directly. A lot of volunteers of all ages heard about us through that video."

However, some marketing studies have shown that celebrity endorsement of a cause or product can distract from the issue itself, as people only remember the person, not the content of what they were saying.

Choosing the Right Celebrity

Celebrity choice is also very important. Campaigns that use famous faces are often aiming to appeal to members of the public who do not necessarily follow green issues.

For certain campaigns with clear target audiences, choosing a climate scientist or well-known environmentalist rather than a celebrity could be more appealing — Attenborough is a classic example. For others, images and videos involving cute animals may be more likely to get a message heard than attaching a famous face.

"We choose celebrities who have a lifestyle where they are already talking about these issues," says Marchildon from the UN. "You need figures with credibility."

McCormack cites the example of Katharine Hayhoe, an environmental scientist who is also an evangelical Christian. In the southern United States, Hayhoe has become a celebrity in her own right, appealing to an audience that might not normally be interested in the messages of climate scientists.

But as soon as you get a celebrity involved, campaigns also put themselves at risk of the whims of that celebrity. Prince William and younger members of the royal family have come under fire in recent years for alleged hypocrisy for their backing of environmental campaigns while simultaneously using private jets to fly around the world.

But Does It Really Work?

While environmental campaigns hope that endorsement from well-known figures can boost a campaign, there is little research to back this up.

"The biggest finding [from my study] was that we were unable to produce any evidence that shows that celebrity endorsement of environmental causes makes any difference," says Olmedo.

This will come as a blow to many campaigns that have invested time and effort into relationships with celebrity ambassadors. But for many, the personal message that many celebrities offer in videos like that produced by German Zero and campaigns like the Earthshot Prize are what counts.

The research may not prove this conclusively — but if the public believes a person they respect deeply personally cares about an important issue, they are perhaps more likely to care too.

"I personally believe in the power this can have," says Marchildon. "And if having a celebrity involved can get a single 16-year-old future leader thinking about environmentalist issues — that is enough."

Reposted with permission from DW.