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Review
. 2021 Feb 9;30(159):200242.
doi: 10.1183/16000617.0242-2020. Print 2021 Mar 31.

The impact of outdoor air pollution on COVID-19: a review of evidence from in vitro, animal, and human studies

Affiliations
Review

The impact of outdoor air pollution on COVID-19: a review of evidence from in vitro, animal, and human studies

Thomas Bourdrel et al. Eur Respir Rev..

Abstract

Studies have pointed out that air pollution may be a contributing factor to the coronavirus disease 2019 (COVID-19) pandemic. However, the specific links between air pollution and severe acute respiratory syndrome-coronavirus-2 infection remain unclear. Here we provide evidence from in vitro, animal and human studies from the existing literature. Epidemiological investigations have related various air pollutants to COVID-19 morbidity and mortality at the population level, however, those studies suffer from several limitations. Air pollution may be linked to an increase in COVID-19 severity and lethality through its impact on chronic diseases, such as cardiopulmonary diseases and diabetes. Experimental studies have shown that exposure to air pollution leads to a decreased immune response, thus facilitating viral penetration and replication. Viruses may persist in air through complex interactions with particles and gases depending on: 1) chemical composition; 2) electric charges of particles; and 3) meteorological conditions such as relative humidity, ultraviolet (UV) radiation and temperature. In addition, by reducing UV radiation, air pollutants may promote viral persistence in air and reduce vitamin D synthesis. Further epidemiological studies are needed to better estimate the impact of air pollution on COVID-19. In vitro and in vivo studies are also strongly needed, in particular to more precisely explore the particle-virus interaction in air.

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Conflict of interest statement

Conflict of interest: T. Bourdrel has nothing to disclose. Conflict of interest: I. Annesi-Maesano has nothing to disclose. Conflict of interest: B. Alahmad has nothing to disclose. Conflict of interest: C.N. Maesano has nothing to disclose. Conflict of interest: M-A. Bind has nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Target organs and the main diseases that coronavirus disease 2019 (blue) and air pollution (green) share. ARDS: acute respiratory distress syndrome.
FIGURE 2
FIGURE 2
Air pollutants/virus interaction according to atmospheric conditions. Relative humidity plays a role in the desiccation or hydration of viral droplet and, thus, influences the size of the droplet and the persistence of respiratory viruses in the air. Solar ultraviolet (UV) radiations have in vitro antiviral activity and lead to an increase in vitamin D synthesis. Atmospheric air pollutants may lead to decreased UV penetration leading to reduced vitamin D synthesis. Temperature influences the size of the viral droplet. In addition, low temperatures decrease the functioning of airways ciliated cells, while high temperatures may have antiviral activity. Droplet nuclei refers to viral droplets ≤5μm, it is also called viral airborne or viral aerosol. In addition to the common effect of air pollutants, which lead to a decrease in immune respiratory defence, particulate matter (PM) may be involved in respiratory virus transport. AMP: antimicrobial proteins and peptides; ELF: epithelial lining fluid; RASS: renin-angiotensin-aldosterone system; AT1R: angiotensin 2 receptor type 1.

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