Assessing nitrogen dioxide (NO2) levels as a contributing factor to coronavirus (COVID-19) fatality

2020 Elsevier B.V.

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Nitrogen dioxide (NO2) is an ambient trace-gas result of both natural and anthropogenic processes. Long-termexposure to NO2 may cause awide spectrumof severe health problems such as hypertension, diabetes, heart and cardiovascular diseases and even death. The objective of this study is to examine the relationship between long-term exposure to NO2 and coronavirus fatality. The Sentinel-5P is used for mapping the tropospheric NO2 distribution and theNCEP/NCAR reanalysis for evaluating the atmospheric capability to disperse the pollution. The spatial analysis has been conducted on a regional scale and combined with the number of death cases taken from 66 administrative regions in Italy, Spain, France and Germany. Results show that out of the 4443 fatality cases, 3487 (78%)
were in five regions located in north Italy and central Spain. Additionally, the same five regions show the highest NO2 concentrations combined with downwards airflow which prevent an efficient dispersion of air pollution.
These results indicate that the long-termexposure to this pollutantmay be one of themost important contributors to fatality caused by the COVID-19 virus in these regions and maybe across the whole world. © 2020 Elsevier B.V.

  1. Introduction
    The outbreak of the novel coronavirus (COVID-19) is an ongoing global epidemic event which started in the city of Wuhan, China in late 2019. ByMarch 2020 the virus has spread globally andwas declared as pandemic by the World Health Organization (World Health Organization, 2020). COVID-19 is an acute respiratory disease which may lead to pneumonia with symptoms such as fever, cough and dyspnea (Jiang et al., 2020) and has an approximate fatality rate of 2–3% (Rodriguez-Morales et al., 2020). As of March 19, 2020, there have Science of the Total Environment 726 (2020) 138605 E-mail address: 0048-9697/© 2020 Elsevier B.V. All rights reserved. Contents lists available at ScienceDirect Science of the Total Environment journal homepage:
    been 209,839 confirmed cases and 8788 deaths reported globally. Early
    studies concluded that the risk factors associatedwith the development
    of the disease are older age (Wu et al., 2020), history of smoking (Liu et al., 2020), hypertension and heart disease (Chen et al., 2020). The Italian institute of health (Istituto Superiore di Sanità) reported background diseases of 481 patients in Italy who passed away due to COVID-19 infection. Table 1 shows the information about themost common background diseases which are evident in over 20% of the cases. Furthermore, recent studies suggest that the cause of death of many COVID- 19 patients was related to cytokine storm syndrome (Guo et al., 2020;
    Mehta et al., 2020). This syndrome, also known as hypercytokinemia is an uncontrolled release of proinflammatory cytokines (Tisoncik et al., 2012) and it is a severe reaction of the immune system, leading to a chain of destructive processes in the body that can end in death. Many studies have shown that the incidence of these diseases can also be caused by a long exposure to air pollution, especially nitrogen dioxide (NO2), a toxic component. NO2 enters the atmosphere as a result of anthropogenic activity (mostly fossil fuel combustion from vehicles and power plants) and natural processes (lightning and soil processes). Elevated exposure to NO2 has been associatedwith hypertension (Saeha et al., 2020), heart and cardiovascular diseases (Gan et al., 2012; Mann
    Jennifer et al., 2002; Arden et al., 2004), increased rate of hospitalization
    (Mann Jennifer et al., 2002), chronic obstructive pulmonary disease (COPD) (De et al., 1993; Euler et al., 1988), significant deficits in growth of lung function in children (Avol et al., 2001; James Gauderman et al., 2000), poor lung function in adults or lung injury (Bowatte et al., 2017; Rubenfeld et al., 2005) and diabetes (Saeha et al., 2020). In addition to these, other studies have focused on the immune system’s response to NO2 exposure. Blomberg et al., 1999, found that exposure to NO2 causes an inflammatory response in the airways and Devalia et al., 1993, showed that these exposures may induce the synthesis of roinflammatory cytokines from airway epithelial cells which consequently
    play an important role in the etiology (cause) of airway disease. Moreover,
    the epithelial cells in the lung may be uniquely susceptible to
    death when exposed to NO2 (Persinger et al., 2002).
    High NO2 concentration is significantly associated with respiratory
    mortality (Beelen et al., 2008; Chen et al., 2007; Hoek et al., 2013) and
    is also responsible for generating some harmful secondary pollutants
    such as nitric acid (HNO3) and ozone (O3) (Khoder, 2002). As a result,
    the WHO has stated that the health risks may potentially occur due to
    the presence of NO2 or its secondary products (World Health Organization, 2003). Accordingly, the WHO understands the health issues arising from NO2 and suggests that the world population should be protected from exposure to this pollutant. The objective of this work is to assess the contribution of a long-term exposure to NO2 on coronavirus fatality. This is achieved by combining three databases: the tropospheric concentration of NO2, the atmospheric condition as expressed by the vertical airflow, and the number of fatality cases. The data is processed at the administrative level for each country to obtain high spatial resolution.


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