Everything will not be all right
- The author of the article, Dr. Gian Luca Garetti is a general practitioner and psychotherapist from Tuscany. Actively involved in the environment, he is national vice president of Democratic Medicine and a member of ISDE (International Society of Doctors for the Environment).
- "Mo' ha da passà 'a nuttata" is an expression in Neapolitan dialect from a comedy of Eduardo De Filippo meaning "the night will have to be endured" as reference to a patient for whom everything possible was done and only once the night is over they will be able to say if the therapy worked.
Everything will not be all right
Even death must be staggered, like holidays
For those who desire other negative data, we might mention that in Italy every year about 90,000 deaths are caused by cigarette smoking (1-2 thousand for passive smoking); road accidents cause 3,330 deaths and 243,000 injured; in Italy, about 10,000 people die every year because of antibiotic resistance, which is among the main health emergencies. For this reason, 700,000 people die every year in the world. One of the causes is the massive use of antibiotics on animal farms. In Italy, according to the latest EMA (European Medicines Agency) data, almost 70% of antibiotics sold are intended for farm animals.
In this article focus will be on the present health emergency, more specifically on the consequences of close relationships with the animal world, due to climate change, and the perverse synergy between smog and Covid-19.
Can air pollution exacerbate Covid-19 virulence?
What will have to be assessed in the coming months is how negatively the exposure to air pollutants, such as particulates (PM2, 5, 10), nitrogen oxides (NOX), ozone (O3) has influenced the prognosis of Covid-19.
In an interesting study on SARS, an epidemic that, as we have seen, has a number of similarities with Covid-19, entitled "Air pollution and case fatality of SARS in the People's Republic of China: an ecologic study" by Yan Cui, it is shown how "air pollution is associated with increased fatality of SARS patients in Chinese population." "The biological explanation could be that long- or short-term exposure to certain air pollutants could compromise lung function, thus increasing SARS mortality". This study also linked the different mortality rate of SARS with the level of air pollution: SARS patients who lived in regions with poorer air quality had an 84% higher risk of dying. The ultrafine particulate could act as a virus carrier, transporting it into the pulmonary alveoli and exacerbating its virulence.
In another scientific paper, titled "The impact of PM2.5 on the human respiratory system" by Yu-Fei Xing, it is stated that the damage of PM2.5 for lung cells is caused by the interactions between inflammatory cells and cytokines, very similarly therefore to and synergistic with Covid-19 (see "cytokine storms").
In the scientific work of Wei Su et al. entitled "The short-term effects of six air pollutants [PM2.5, including PM10, NO2, O3, CO and SO2] on influenza-like illness (ILI)" shows that air pollutants can increase the incidence of flu-like illness, both by decreasing the immune system and by the altered production of cytokines: "Exposure to PM 2.5 not only resulted in epithelial airway damage and barrier dysfunction, but also reduced the ability of macrophages to engulf viruses, increasing an individual's susceptibility to viruses" and again, "the tissue lesions induced by PM 2.5 may be related to impaired cytokine production. PM 2.5 can compromise the phagocytic activity of alveolar macrophages".
It is therefore not too far-fetched to speculate that the perverse synergy between the SARS-COV-2 virus and air pollution could be one of the causes of the special severity and spread of the Covid-19 pandemic, in China, in the Po Valley, in South Korea, that is, in areas all with a high pollution rate. But as we know, pollution has become ubiquitous. It is essential to start taking drastic measures immediately to reduce the level of air pollutants, and not only that. Another type of economy is necessary. This pandemic is a general test of how neoliberalism, along with pollution, with climate change, with the exacerbation of inequalities, is leading us straight towards the sixth mass extinction. We cannot trust only the weather or pandemics to clean the air.
Emerging Infectious Diseases, and Species Jump
The cytokine storm
On the other hand, in the contemporary emerging infectious diseases, pneumonia is directly caused by an autoimmune mechanism, by "friendly fire". Covid-19 proceeds in a similar way as SARS, which would attack the lungs in three phases: viral replication, immune hyperactivity and lung destruction. In the second phase, the immune system comes into play, determining excess responses, the so-called "viral fires" or "cytokine storms", or "severe cytokine release syndrome" (CRS). Alarmed by the presence of a viral invasion, the immune system hurries to fight the disease by flooding the lungs with cytokines, proteins that have the task of eliminating damage and repairing lung tissue. This process, however, sometimes goes haywire and these cells kill everything they encounter, including healthy tissue (as happens with "surgical bombing"). The cytokine storm can then pour into the circulatory system and create serious systemic problems in multiple organs.
A glimpse of hope
Bats and CoVs
However, subsequent cases were not associated with this exposure mechanism and it was concluded that the virus could also be transmitted from man to man. Symptomatic people are the most frequent source of COVID-19 diffusion, though estimates suggest that 2% of the population are healthy carriers of a CoV. SARS-CoV caused a large-scale epidemic that began in China and involved two dozen countries with around 8,000 cases and 800 deaths; and the MERS-CoV which started in Saudi Arabia and caused around 2,500 cases and 800 deaths, and is still responsible for sporadic cases. Even the origins of the Nipah virus in Malaysia in 1998 and of the Ebola viruses have been traced back to bats.