https://www.bmj.com/content/368/bmj.m627/rr-34
Covid-19: a puzzle with many missing pieces
BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m627 (Published 19 February 2020)Cite this as: BMJ 2020;368:m627Read our latest coverage of the Coronavirus outbreak
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Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2)
Rapid Response:
Re: Covid-19: a puzzle with many missing pieces. Air pollution, climate and obesity could be the COVID 19 puzzle missing pieces
Dear Editor
The features most associated with novel coronavirus disease 2019 (COVID-19) infection and its respiratory complications are male sex, older age, cardiovascular disease, diabetes and perhaps higher BMI [1-4], but assessment of obesity is rarely reported in clinical studies.
An article regarding COVID-19 fatalities In Italy didn’t mention obesity as a comorbid disease associated with death and in a recent report from ISS about comorbid conditions in SARS-CoV-2 positive deceased patients, obesity is present in only 11,8 %, whilst type 2 diabetes accounts for 32% and hypertension for 69,7% of deceased patients [5-7]: these data appear to be inexplicably in relation to the known strong association between obesity and these pathologies. In Bergamo, where the disease is particularly severe, a large portion of adult (36.2%) and young population (23.9%) is overweight or obese [8]. Patients with BMI ≥ 40 kg/m2 are at risk for flu complications [9]. Excess fat is known to be associated with several respiratory conditions [10], and the possible link between severe pulmonary manifestations of COVID-19 and obesity is conceivable.
Recent evidence indicates that accumulation of adipose tissue within the lung of obese subjects correlates with inflammatory infiltrate [11]. Air pollution may induce lung dysfunction and some studies have highlighted the possibility that adipose tissue -- namely, visceral fat -- may mediate air pollution-induced lung dysfunction [12-13]. Furthermore, it is well known the causal association between pollution and obesity and related metabolic derangements [14-15]. In fact, both air pollution and high adiposity are closely related to increased inflammation [16-17]. Most of the diseases reported in Italian deceased patients, especially respiratory and cardiovascular diseases, have also been shown to be associated with exposure to air pollution [18].
Evidence exists correlating viral infection with atmospheric particulate matter (PM) concentrations (e.g. PM10 and PM2.5) [19-21]. A recent study demonstrates that aerosol transmission of SARS-CoV-2 is possible, since the virus remains viable and infectious in aerosols for hours [22]. Atmospheric PM constitutes a carrier for both chemical pollutants and viruses and allows viruses to persist in the air in vital conditions for hours or days, depending on the relative humidity and temperature [23-24]. Wuhan and Po Valley are high polluted areas characterized by similar thermo-hygrometric conditions [25-27].
It is tempting to speculate that the spread of the infection -- as well as international travel and individual behavior -- is also linked to the local differences in total and aged population, air pollution and climate [28-29]. Accordingly these situations, and especially pollution, may explain the high virulence, the fast spread and the greater mortality of SARS-CoV-2 in Northern Italy, directly through PMs being a possible carrier of viable viral particles and indirectly through a chronic inflammatory stimulus, especially in obese subjects even if young.
Considering all the above, while we are waiting conclusive investigations, it is advisable to reinforce the importance of staying at home until the weather and pollution improve, in order to avoid breathing polluted air possibly coated by SARS-CoV-2 and to recommend not only social distancing but also individual risk factor management, limiting overeating and promoting, as far as possible, physical activity to avoid weight gain and a subsequent increase in the global prevalence of obesity.
Carla Lubrano MD PhD
Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology,
Sapienza University of Rome
Annamaria Colao MD PhD
UNESCO Chair for Health Education and Sustainable Development,
Federico II University of Naples
Conflict of interests
The authors declare no competing interest.
Bibliography
1. Bianchi F Re: Air pollution and Covid19: how to compose the puzzle BMJ 2020;368:m627
2. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395(10223): 497-506.
3. Peng YD, Meng K, Guan HQ et al. Clinical Characteristics and Outcomes of 112 Cardiovascular Disease Patients Infected by 2019-nCoV. Zhonghua Xin Xue Guan Bing Za Zhi, 48 (0), E004 2020 Mar 2
4. Liu M, He P, Liu HGet al. Clinical characteristics of 30 medical workers infected with new coronavirus pneumonia Zhonghua Jie He He Hu Xi Za Zhi. 2020 Mar 12;43(3):209-214
5. Coronavirus disease 2019 (COVID-19) pandemic: increased transmission in the EU/EEA and the UK – seventh update, 25 March 2020. Stockholm: ECDC; 2020.
6. Onder G, Rezza G, Brusaferro S. Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy [published online ahead of print, 2020 Mar 23]. JAMA. 2020; 10.1001/jama.2020.4683. doi: 10.1001/jama.2020.4683
7. https://www.epicentro.iss.it/coronavirus/bollettino/Report-COVID-2019_24...
8. Press release 61/2019 8/11/2019 ATS Bergamo Lombardy Region
9. Ryan DH, Ravussin E, Heymsfield S. COVID 19 and the Patient With Obesity - The Editors Speak Out Obesity (Silver Spring). 2020 Apr 1. doi: 10.1002/oby.22808.
10. Mancuso P. Obesity and lung inflammation. J Appl Physiol (1985) 2010; 108(3): 722-8.4.
11. Elliot JG, Donovan GM, Wang KCW, Green FHY, James AL, Noble PB. Fatty airways: implications for obstructive disease. Eur Respir J 2019; 54(6).
12. Conti S, Harari S, Caminati A, et al. The association between air pollution and the incidence of idiopathic pulmonary fibrosis in Northern Italy. Eur Respir J 2018; 51: 1700397 [https://doi.org/10.1183/13993003.00397-2017
13. Kim H-J, Park J-H, Min J-Y et al., Abdominal adiposity intensifies the negative effects of ambient air pollution on lung function in Korean men Int J Obes (2017) 41, 1218–1223
14. Yang Z, Song Q, Li J et al Air Pollution as a Cause of Obesity: Micro-Level Evidence from Chinese Cities Int. J. Environ. Res. Public Health 2019, 16, 4296
15. Lubrano C, Genovesi G, Specchia P et al Obesity and metabolic comorbidities: environmental diseases? Oxid Med Cell Longev. 2013; 2013:640673
16. Wei Y, Zhang JJ, Li Z, et al. Chronic exposure to air pollution particles increases the risk of obesity and metabolic syndrome: findings from a natural experiment in Beijing. FASEB J. 2016;30(6):2115–2122. doi: 10.1096/fj.201500142
17. WHO. Noncommunicable Diseases and Air Pollution. WHO European High-Level Conference on Noncommunicable Diseases. Time to Deliver: meeting NCD targets to achieve Sustainable Development Goals in Europe 9-10 April 2019, Ashgabat, Turkmenistan. Available at: http://www.euro.who.int/__data/assets/pdf_file/0005/397787/Air-Pollution...).
18. Bastard JP, Jardel C, Bruckert E, et al. Elevated Levels of Interleukin 6 Are Reduced in Serum and Subcutaneous Adipose Tissue of Obese Women after Weight Loss J Clin Endocrinol Metab 2000, 85: 3338–3342,
19. Ciencewicki J et al.,. “Air Pollution and Respiratory Viral Infection” Inhalation Toxicology, (2007) 19: 1135-1146
20. Carugno M, Dentali F, Mathieu G et al PM10 exposure is associated with increased hospitalizations for respiratory syncytial virus bronchiolitis among infants in Lombardy, Italy. Environ Res. 2018 Oct; 166:452-457. doi: 10.1016/j.envres.2018.06.016.
21. Nenna R, Evangelisti M, Frassanito A, Respiratory Syncytial Virus Bronchiolitis, Weather Conditions and Air Pollution in an Italian Urban Area: An Observational Study Environ Res. 2017 Oct; 158:188-193
22. Cui Y, Zhang Z-F, Froines Jet al. Air pollution and case fatality of SARS in the People's Republic of China: an ecologic study. Environmental Health 2003, 2:15
23. Van Doremalen, Morris DH, HolbrookMG et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1 N Engl J Med. 2020 Mar 17
24. Despres V.R., et al., “Primary biological aerosol particles in the atmosphere: a review” Tellus B: Chemical and Physical Meteorology, 2012 - Issue 1 Tellus B, 64, 15598
25. Liu F, Lai S, Reinmuth-Selzle K, Scheel JF Metaproteomic Analysis of Atmospheric Aerosol Samples Anal Bioanal Chem. 2016 Sep;408(23):6337-48
26. World Air Quality Index https://aqicn.org/city/wuhan/, https://aqicn.org/city/italy/lombardia/bergamo-via-meucci/
27. Sajadi, M M. Habibzadeh, P, Vintzileos, A et al Temperature, Humidity and Latitude Analysis to Predict Potential Spread and Seasonality for COVID-19 (March 5, 2020). Available at SSRN: https://ssrn.com/abstract=3550308 or http://dx.doi.org/10.2139/ssrn.3550308
28. Setti L, Passarini F, de Gennaro G et al. POSITION PAPER: Relazione circa l’effetto dell’inquinamento da particolato atmosferico e la diffusione di virus nella popolazione 2020 http://www.simaonlus.it/wpsima/wp-content/uploads/2020/03/COVID19_Positi...
29. Pluchino A. , Inturri G, Rapisarda A. et al. A Novel Methodology for Epidemic Risk Assessment: the case of COVID-19 outbreak in Italy arXiv:2004.02739 [physics.soc-ph]
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