What Impact Will Worsening Air Pollution Have on the Burden of Covid-19?

Background: Evidence suggests association between long-term exposure to air pollutants and increased risk of becoming infected with SARS-CoV- 2, the causative agent of COVID-19, and increased severity of COVID-19. However, it remains unclear whether breathing more polluted air over many years affects susceptibility to infection or only affects disease severity, with uncertainty around the intensity of these associations. It has been estimated that anthropogenic emissions have contributed to over 10% of the over 660 million cases of SARS-CoV-2 and the over 7.5 million COVID-19 deaths reported worldwide over the course of the pandemic. Furthermore, as the world continues to warm and if air pollution levels increase, then so might the burden of respiratory infectious disease, including COVID-19. Method(s): Here we explore the potential impact of long-term exposure to increasing levels of particulate matter 2.5 microns or less in diameter (PM2.5) (+1 to +5 mug/m3) assuming an association on either (1) SARS-CoV-2 susceptibility or (2) COVID-19 disease severity by projecting SARS-CoV-2 infections and COVID-19-related hospital admissions over a two-year period. Simulations were conducted using a SARS-CoV-2 transmission model in a global setting capturing age and comorbidity risk, considering seasonality, emerging variants, and vaccination and treatment options. We model linear, log, and log10 relationships between these associations. Result(s): We show that if long-term exposure to higher levels of air pollution only affects COVID-19 severity, then as expected, the projected number of COVID-19-related hospitalisations would proportionally increase. However, if exposure directly affects the susceptibility of becoming infected, then while infections would be higher, hospitalizations would also be even higher due to the potential for onward transmission. This aligns with associations between air pollution and other respiratory infections and their associated health outcomes. Conclusion(s): The anticipated additional impact air pollution is having on the public health burden of respiratory infectious disease, like COVID-19, should be considered in strategic action plans to mitigate and adapt to changing levels of air pollution. It is important to better understand at which point air pollution affects SARS-CoV-2 infection acquisition through to disease progression, to enable improved protection and to better support those most vulnerable. Modelled impact of air pollution on COVID-19. The projected cumulative impact of long-term exposure to incrementally higher PM2.5 levels (+1 to +5 mug/m3) affecting either SARS-CoV-2 susceptibility or COVID-19 disease severity on cumulative SARS-CoV-2 infections and COVID-19-related hospital admissions over a two-year period in a global setting of 100,000 people. Age and comorbidity risk are captured, seasonality considered, and it is assumed SARS-CoV-2 variants of concern (with 10% more infectious and 20% more immune-evading than the previous variant, and Omicron-level severity) emerge every six months, and COVID-19 vaccination and treatment (monoclonalantibody PrEP and antivirals) are implemented for all those eligible. While the associations between PM2.5 exposure and either SARS-CoV-2 susceptibility or COVID-19 disease severity remains unclear and there is much uncertainty around estimated assumptions, here we show a modelled log10 relationship between these two potential associations. COVID-19: coronavirus disease 2019. PM2.5: particulate matter 2.5 microns or less in diameter. PrEP: pre-exposure prophylaxis. SARS-CoV-2: severe acute respiratory syndrome coronavirus 2.

Long-term safety of 3 years of ozanimod in moderately to severely active ulcerative colitis: an interim analysis of the True North open-label extension

Background: The phase 3, randomised True North (TN) study demonstrated the efficacy and safety of ozanimod for up to 52 weeks in patients (pts) with moderately to severely active ulcerative colitis (UC). The ongoing TN open-label extension (OLE) aims to assess the long-term efficacy and safety of ozanimod in UC. This analysis evaluated the cumulative long-term safety of ozanimod in these studies, which included pts with up to ~3 years of treatment exposure. Method(s): In TN, pts were randomised to once-daily ozanimod 0.92 mg or placebo, or to open-label ozanimod for a 10-week induction period. Ozanimod clinical responders were rerandomised at Week 10 to ozanimod or placebo in the maintenance period through Week 52. TN pts were eligible to enrol in the OLE and receive ozanimod if they did not achieve clinical response at the end of induction (Week 10), lost response during maintenance, or completed maintenance at Week 52. This interim analysis of the TN OLE (data cutoff: 10 January 2022) included all pts who entered the OLE from TN (n=823). Safety was monitored from the first dose of ozanimod in TN and throughout the subsequent OLE. Exposureadjusted incidence rates per 100 patient-years (PY) were calculated. Result(s): The average age of TN OLE study participants was 41.7 years (+/-13.6), 41% were female, 62% had left-sided UC disease, and 35% had prior exposure to tumor necrosis factor inhibitors. Total PY exposure to ozanimod was 2219 years (mean [SD] exposure = 2.7 [1.6]). The most frequent treatment-emergent adverse events (TEAEs) reported through OLE Week 94 (up to 146 weeks of continuous treatment) are listed in the Table. Most TEAEs were nonserious;TEAEs leading to discontinuation were uncommon. Bradycardia was reported in 3 pts (0.4%;EAIR 0.1/100 PY;2 in TN and 1 in OLE;no pts were discontinued from treatment). Macular edema was reported in 2 (0.2%;EAIR 0.1/100 PY) pts. Reductions in ALC were common (470 [57.1%] had ALC < 500 cells/mm3), as previously described, but ALC reductions were not associated with the occurrence of TEAEs. Malignancies were uncommon (n=13 [1.6%];EAIR 0.6/100 PY), and included 6 basal cell carcinomas and 3 colorectal neoplasms. Two deaths were reported: 1 due to COVID-19 and 1 sudden death. Investigators deemed both to be unrelated to treatment. Ozanimod was not associated with an increased risk of ischemic heart disease or thromboembolic events. Conclusion(s): Long-term exposure to ozanimod for up to 3 years was well tolerated in pts with moderately to severely active UC. No new safety signals were observed with long-term ozanimod use in UC (2219 PY exposure). Safety findings are consistent with previous reports from the UC and multiple sclerosis development programs (>16,512 PY exposure). (Table Presented).

Impact Short-Long Term Exposure of Air Pollution on Covid-19 Outcome

Introduction: Air pollutant exposure constitutes a serious risk factor for the emergence or aggravation of (existing) pulmonary disease. Aim(s): In this study, we wanted to investigate if recent and chronic exposures to ambient air pollution (AP) is associated with COVID-19 disease severity in a cohort of hospitalized COVID-19 patients. Method(s): 283 COVID-19 patients were recruited at the time of admission to hospital. Several clinical parameters and outcomes were collected from medical records, including the duration of stay, the early-warning score (EWS), oxygen saturation in blood at admission, admission to the intensive care unit (ICU), and clinical improvement at 30 and at 90 days after the day of admission. Daily exposure levels for PM , PM , NO and black carbon (BC) were modeled using a high-resolution spatiotemporal model. Based on daily exposure levels, average exposures 2 days and 1 week before admission and chronic exposure. Result(s): We observed a significant association between the duration of stay and exposure to PM , PM and NO (recent and chronic exposure). For BC, only chronic exposure (CP) was significantly associated with the duration of stay. On average, the duration of stay increased by 1 to 6 days for an inter-quartile range increase in average exposure to AP in the week before admission. CP was associated with 2 to 3 days increased duration of stay. An increase in PM2.5 and PM10 exposure 1 week before admission was associated with higher EWS. Conclusion(s): Exposure to AP was associated with duration of stay and EWS at the time of admission, which implies a potential link between AP exposure and COVID-19 disease severity, and a significant influence of AP exposure on the pressure of care systems.

The risk of occupational contact dermatitis in COVID-19 isolation ward setting

Background The preventive measures of coronavirus disease-19 (COVID-19) transmissions require the healthcare workers (HCWs) to be more cautious. Irritants or allergens exposure from these measures might induce adverse skin reactions and lead to the development of occupational contact dermatitis (OCD). Methods Questionnaires were distributed to HCWs in COVID-19 isolation ward of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. The questionnaire consisted of personal and work characteristics, clinical history, skin complaints, and occupational exposures. Results Fifty-three completed questionnaires were gathered from eligible subjects. History of atopic dermatitis (AD) was found on 8 subject (15.09%). Many of the subjects had complained of dry skin (28.30%), itchy skin (26.41%), and redness of skin (20.75%) on the hands in the last 12 months. As many as 50.94% of the subjects washed their hands with water and soap at least 6-10 times a day and 49.06% used hand sanitizers 6-10 times a day. The use of PPE were mostly 4 hours a day or less. There were associations between history of AD with complaints related to hand dermatitis (p=0.004) and history of AD with incidence of OCD assessed with Mathias criteria (p=0.016). It was also found that the use of gloves for 2 or more hours a day was associated with skin complaints after gloves use (p=0.021) and the use of hand sanitizer for more than 10 times a day was associated with complaints related to hand dermatitis (p=0.041). Conclusion The repeated and prolonged exposure to irritative or allergenic substances contained in PPE and hand hygiene products is related to OCD, particularly hand dermatitis, among HCWs in COVID-19 isolation ward. Copyright © 2023 Pakistan Association of Dermatologists. All rights reserved.

The impact of air pollution on COVID-19 severity among infected individuals in a population of italian MS patients

Introduction: Studies have found associations between air pollution and pneumonia and air pollution is an established risk factors for common COVID-19 complications including pneumonia. Additionally, air pollutants have been identified as possible risk factors for MS onset and relapses. To our knowledge, only one study explored the impact of air pollution on Covid-19 severity specifically among MS patients but has only focused on PM2.5 exposures. Aim(s): We aim to evaluate the association between long-term exposure to air pollution and COVID-19 severity, described as developing pneumonia in a population of COVID-19-positive MS patients. Method(s): Data on COVID-19 infection among MS patients were extracted from an Italian web-based platform (Musc-19). A casecontrol study was designed including patients with and without pneumonia at a case-control ratio of 1:2 and 615 patients were included. The included patients were asked to provide information on the geographical area where they had spent most time in the previous 5 years. When this information was missing, the address of the MS center was used as a proxy and evaluated in sensitivity analysis. Air quality was assessed as annual average particulate matter (PM2.5 and PM10) and Nitrogen Dioxide (NO2) ground-level concentrations derived from air quality model results as provided by the 'Copernicus Atmospheric Monitoring Service', and evaluated as categorical exposures (terciles). The association between pollutants and COVID-19 pneumonia was studied using logistic regression models, also adjusting for confounders (age, sex, BMI, comorbidities, EDSS, MS type, duration and treatments). Result(s): Detailed exposure was obtained for 491 patients, of whom 34% had pneumonia. Higher concentrations of air pollutants were associated with increased odds of developing COVID-19 pneumonia in both unadjusted and adjusted models (Adjusted models estimates: PM2.5: 2nd vs 1st tercile OR(95% CI)=2.09 (1.20;3.65), 3rd vs 1st tercile OR(95% CI)=2.26(1.29;3.96);PM10: 2nd vs 1st tercile OR(95% CI)=1.83(1.05;3.20), 3rd vs 1st tercile OR(95% CI)=2.12(1.22;3.68);NO2: 3rd vs 1st tercile OR(95% CI)=2.12(1.21;3.69)). Results remained consistent in the sensitivity analysis. Conclusion(s): Higher long-term concentrations of PM2.5, PM10 and NO2 were associated with COVID-19 pneumonia among MS patients. Urgent measures to reduce air pollution should be adopted especially to protect the most vulnerable population.

ORGANIZING PNEUMONIA WITH FOREIGN BODY REACTION AS A RESULT OF SODIUM HYDROXIDE AND AMMONIUM SALT VAPOR EXPOSURE

SESSION TITLE: Occupational and Environmental Lung Disease Cases SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: Sodium hydroxide and ammonium salt vapor exposure are known to cause epithelial necrosis of the tracheobronchial tree, but no pathologic descriptions exist of subsequent inflammatory pneumonitis. CASE PRESENTATION: A 56-year-old man presented to the outpatient clinic with 2 months of progressive scant hemoptysis and dyspnea on exertion. He had a mild smoking history, a history of longstanding stable UC, and had a history significant only for recently performing multiple weeks of cleaning work on a large, enclosed HVAC system with chemicals containing sodium hydroxide and ammonium. He wore no respiratory protection at work. CXR was significant for streaky bilateral lower lobe opacities and CT Chest revealed bilateral basilar ground-glass opacities with a small left pneumothorax. His PFT demonstrated mild restriction with a diffusion defect. Infiltrates persisted after treatment with levofloxacin. A broad autoimmune panel was normal. Bronchoscopy with cryobiopsy showed organizing pneumonia with foreign body reaction. BAL showed primarily mast cells and no organisms were found. Prednisone at 60mg daily with Bactrim prophylaxis and a subsequent prolonged wean was initiated with marked improvement. DISCUSSION: Industrial HVAC cleaning agents are widely used with the proliferation of HVAC systems in the post-COVID world. Other examples exist of prolonged cleaning product use and lung function decline (Svanes et al). Our case report hypothesizes a link between inhalational exposure to sodium hydroxide and ammonium salts with organizing pneumonia with foreign body features, a previously unknown effect. Prednisone led to improvement. CONCLUSIONS: High suspicion for occult pneumonitis should exist when patients present with prolonged exposure to cleaning/noxious chemical vapors exist. Respiratory protection should be emphasized as a public health policy to prevent lung damage among any type of cleaner use including high-skilled (HVAC) cleaners. Reference #1: Advenier, A., & Grandmaison, G. (2022). PULMONARY ACUTE LESIONS AFTER CAUSTIC EXPOSURE. Retrieved 31 March 2022, from https://www.lungdiseasesjournal.com/articles/pulmonary-acute-lesions-after-caustic-exposure.html Reference #2: Svanes, Ø., Bertelsen, R. J., Lygre, S., Carsin, A. E., Antó, J. M., Forsberg, B., García-García, J. M., Gullón, J. A., Heinrich, J., Holm, M., Kogevinas, M., Urrutia, I., Leynaert, B., Moratalla, J. M., Le Moual, N., Lytras, T., Norbäck, D., Nowak, D., Olivieri, M., Pin, I., … Svanes, C. (2018). Cleaning at Home and at Work in Relation to Lung Function Decline and Airway Obstruction. American journal of respiratory and critical care medicine, 197(9), 1157–1163. https://doi.org/10.1164/rccm.201706-1311OC Reference #3: Gorguner, M., & Akgun, M. (2010). Acute inhalation injury. The Eurasian journal of medicine, 42(1), 28–35. https://doi.org/10.5152/eajm.2010.09 DISCLOSURES: no disclosure on file for Ai-Yui Maria Tan;No relevant relationships by Sudha Misra No relevant relationships by Amrik Ray

CHLORINE GAS EXPOSURE AND OBSTRUCTIVE AIRWAY DISEASE: A CASE REPORT AND CASE-BASED DISCUSSION

SESSION TITLE: Occupational and Environmental Lung Disease Cases SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: Chlorine gas is a pulmonary irritant with pungent odor that damages the respiratory tract. Chlorine gas exposure occurs in industrial or household exposures,Chlorine gas has two forms either a liquid or gas, toxicity of chlorine gas depends on the dose and duration of exposure. Chlorine gas used in manufacturing products like paper, insecticides, Chlorine is used to treat bottled and swiming pool water. CASE PRESENTATION: A 37 Y.O Male, no PMH presents with progressive dyspnea for three days worse with activity,decreases with rest, denied cough fever or chest pain he is vaccinated for COVID,no smoking history. The patient worked at a chlorine gas factory in the Dominican Republic for 15 years. Exam: Vitals: BP 124/72 mmHg. HR 100 BPM. RR 21 BPM. SpO2 84%. General: acute distress. Heart: normal S1, S2. RRR. Lung: wheeze bilaterally. Abdomen: Soft. Musculoskeletal: no pitting edema. he was placed on 6 LPM NC saturation improved to 90%. CBC and Chemistry were unremarkable, he was started on steroid, breathing treatment with antibiotics. ABG showed hypoxemia. he was placed on Venturi mask and his saturation improved to 95%.CTA was negative for PE. EKG, troponin were unremarkable. A proBNP normal. The antibiotics were discontinued because of a negative workup. A TTE study was normal. HRCT scan of the chest, showed atelectasis and infiltrates of lower lobes. No interstitial fibrosis.A PFT showed obstructive airway disease. He was discharged on oral and inhaled steroids.Hi new onset obstructive airway could be due to chlorine gas exposure. DISCUSSION: Chlorine gas causes cellular injury through oxidative damage but further damage results from activation and recruitment of inflammatory cells with subsequent release of oxidants and proteolytic enzymes. Humans can detect chlorine gas odor at a concentration between 0.1-0.3 ppm. At 1-3 ppm,it causes irritation of oral,eye mucosal membranes. At 30-40 ppm causes cough, chest pain, and SOB. At 40-60 ppm, toxic pneumonitis and pulmonary edema and can be fatal at 430 ppm concentration or higher within thirty minutes. Chronic exposure to chlorine gas lead to chest pain, cough, sore throat, hemoptysis, recurrent asthma. Physical exam findings include tachypnea cyanosis, wheezing, intercostal retractions, decreased breath sounds. Pulmonary function tests may reveal obstructive lung function disease. Chronic exposure to a low level was found to be associated with an increased risk of asthma in swimmers. CONCLUSIONS: Chlorine exposure results in direct chemical toxicity to the airways with acute airways obstruction or airways hyperreactivity, presentation varies from acute overwhelming intoxication with acute lung injury and or death, occupational exposure increase the likelihood of chronic bronchitis or isolated wheezing attacks. Treatment for chlorine exposure is largely supportive. Reference #1: 1- Center of disease control and prevention website/emergency preparedness and response/ https://emergency.cdc.gov/agent/chlorine/basics/facts.asp Reference #2: 2- C- Morim A, Guldner GT. Chlorine Gas Toxicity. [Updated 2021 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537213/. Reference #3: A- Gummin DD, Mowry JB, Beuhler MC, et al. 2020 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 38th Annual Report. Clin Toxicol (Phila). 2021;59(12):1282-1501. doi:10.1080/15563650.2021.1989785 DISCLOSURES: No relevant relationships by Abdallah Khashan No relevant relationships by Samer Talib no disclosure on file for Matthew Yotsuya;

Long-term improvement of air quality associated with lung function benefits in Chinese young adults: A quasi-experiment cohort study.

INTRODUCTION: Long-term exposure to air pollution is associated with lung function impairment. However, whether long-term improvements in air quality could improve lung function is unclear. OBJECTIVES: To examine whether the reduction of long-term air pollution was associated with lung function improvement among Chinese young adults. METHODS: We conducted a prospective quasi-experiment cohort study with 1731 college students in Shandong, China from September 2019 to September 2020, covering COVID-19 lockdown period. Data on air pollution concentrations were obtained from China Environmental Monitoring Station. Lung function indicators included forced vital capacity (FVC), forced expiratory volume in 1st second (FEV1) and forced expiratory flow at 50 % of FVC (FEF50%). We used linear mixed-effects model to examine the associations between the change of air pollutants concentrations and the change of lung function, and additional adjustments for indoor air pollution (IAP) source. We also conducted stratified analysis by sex. RESULTS: Compared with 2019, the mean FVC, FEV1 and FEF50% were elevated by 414.4 ml, 321.5 ml, and 28.4 ml/s respectively in 2020. Every 5 µg/m3 decrease in annual average PM2.5 concentrations was associated with 36.0 ml [95 % confidence interval (CI):6.0, 66.0 ml], 46.1 ml (95 % CI:16.7, 75.5 ml), and 124.2 ml/s (95 % CI:69.5, 178.9 ml/s) increment in the FVC, FEV1, and FEF50%, respectively. Similar associations were found for PM10. The estimated impact was almost unchanged after adjusting for IAP source. There was no significant effect difference between males and females. CONCLUSION: Long-term improvement of air quality can improve lung function among young adults. Stricter policies on improving air quality are needed to protect human health.

Chronic exposure to waterpipe smoke elicits immunomodulatory and carcinogenic effects in the lung

Effects of waterpipe smoking on lung pathobiology and carcinogenesis remain sparse despite the worldwide emergence of this tobacco vector as a socially acceptable form of smoking, particularly among the youth. To address this gap, we investigated the effects of chronic waterpipe smoke (WPS) exposure on lung pathobiology, host immunity, and tumorigenesis using both an experimental animal model and an exploratory observational analysis of human waterpipe smokers and non-smokers. Mice exposed to increasing doses of WPS (once or five times per week for 20 weeks), through an exclusively devised exposure system for this study, were more prone to develop lung tumors compared to control-air exposed littermates. This effect was accompanied by various pro-tumor immune phenotypes, including increased IL-17A+ levels in T/B cells as well as elevated expression of the immune checkpoint PD-L1 and the pro-inflammatory cytokine IL-1β in myeloid cells. While flow cytometry analysis revealed increased CD4 and CD8 T cell infiltration in WPSexposed mice, gene signatures of cytotoxic and expanded immune response were, conversely, decreased in animals exposed to heavy WPS relative to control air. Interestingly, mice heavily exposed to WPS exhibited increased expression of Tmprss4, Cd55, and Ace2, cell receptors and mediators of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) entry and, thus, COVID-19 pathogenesis. We also perform RNA-sequencing analysis of bronchial airway epithelial brushings of cancer-free waterpipe smokers and non-smokers undergoing diagnostic bronchoscopy. Transcriptomes of normal airway cells in waterpipe smokers, relative to waterpipe non-smokers, harbored gene programs that were associated with poor clinical outcomes in lung adenocarcinoma (LUAD) patients, alluding to a WPS-associated molecular injury, like that established in response to cigarette smoking. Overall, our analyses demonstrate immunomodulatory and carcinogenic effects of WPS on the murine and human lung. Our study also shows that WPS exposure leads to a field of injury that may be associated with increased risk for lung cancer. This study is unique for interrogating carcinogenic effects of chronic exposure to WPS with the longest, to our knowledge, follow-up time in vivo. Our findings accentuate the need for additional studies that can guide evidence-based policies to counteract shortfalls in public health control of waterpipe smoking.

SARS-CoV-2 Antibodies in the Public Hospital Staff: The Second Report of a Seroprevalence Cohort Study from Iran

Background: SARS-CoV-2 is a novel virus that caused the recent global pandemic. Health care workers (HCWs), especially hospital staff, are at a higher risk of infection by this virus than the general population. In this study, anti-SARS-CoV-2 IgG antibodies were assessed in hospital workers. Methods: This prospective seroconversion-based cohort study assessed chronic immunity against covid-19 in the staff of two hos-pitals, the main referral hospital and a general hospital in Shiraz, south of Iran. A valid and reliable checklist was filled out for each available staff member willing to participate in this study through a face-to-face interview. Furthermore, the titer of anti-covid-19 IgG was measured by ELISA twice;in July 2020 after the second wave of COVID-19 and in February 2021 after the third wave in IRAN. Results: One hundred forty (65%) of the 214 members who participated in both stages of this consideration were from the COVID-19 referral healing center, and 74 (35%) were from the common clinic. Twelve (5.6%) of staff members had anti-SARS-CoV-2 IgG anti-bodies, including 10 (7.1%) from the referral healing center and 2 (2.7%) from the common healing center (P = 0.23). In the second measurement (second overview), 79 (36.9%) of members had IgG antibodies;58 (41.4%) from the primary hospital and 21 (28.3%) from the second healing center (P = 0.039). Cruel of the IgG titer within the first study and the referral clinic was 0.8 ± 0.3 compared to 0.15 ± 0.42 within the common clinic (P = 0.001). These figures were 3.05 ± 4.58 and 1.74 ± 3.53 in both clinics and within the second overview separately (P = 0.003). IgG levels were significantly higher in the second overview compared to the first (P < 0.0001). Conclusions: During the third wave of COVID-19, a significant proportion of hospital staff developed COVID-19 IgG, especially in the referral hospitals for COVID-19. As a result of their higher and chronic exposure to COVID-19 patients than the general hospital staff, the titer of IgG in the referral hospital staff was also higher. However, the seroconversion rate between the two waves was 1.8 times in the general hospital staff compared to the referral hospital, possibly due to less conservative precautions against covid-19 among them. Even after receiving the anti-covid-19 vaccination, it is important to monitor the immunity of hospital staff to covid-19 and to adhere strictly to standard precautions.

Association between long-term exposure to particulate air pollution with SARS-CoV-2 infections and COVID-19 deaths in California, U.S.A.

Previous studies have reported associations between air pollution and COVID-19 morbidity and mortality, but most have limited their exposure assessment to a large area, have not used individual-level variables, nor studied infections. We examined 3.1 million SARS-CoV-2 infections and 49,691 COVID-19 deaths that occurred in California from February 2020 to February 2021 to evaluate risks associated with long-term neighborhood concentrations of particulate matter less than 2.5 µm in diameter (PM2.5). We obtained individual address data on SARS-CoV-2 infections and COVID-19 deaths and assigned 2000-2018 1km-1km gridded PM2.5 surfaces to census block groups. We included individual covariate data on age and sex, and census block data on race/ethnicity, air basin, Area Deprivation Index, and relevant comorbidities. Our analyses were based on generalized linear mixed models utilizing a Poisson distribution. Those living in the highest quintile of long-term PM2.5 exposure had risks of SARS-CoV-2 infections 20% higher and risks of COVID-19 mortality 51% higher, compared to those living in the lowest quintile of long-term PM2.5 exposure. Those living in the areas of highest long-term PM2.5 exposure were more likely to be Hispanic and more vulnerable, based on the Area Deprivation Index. The increased risks for SARS-CoV-2 Infections and COVID-19 mortality associated with highest long-term PM2.5 concentrations at the neighborhood-level in California were consistent with a growing body of literature from studies worldwide, and further highlight the importance of reducing levels of air pollution to protect public health.

Spatial Analysis of COVID 19 in KSA Related to Air Pollution Factor

The pathogen of the disease COVID-19 is the extreme acute respiratory syndrome COVID-19 especially in the elderly and asthmatics. In our study, we examine if long-term exposure to air pollution raises the infection situations of COVID-19 in kingdom of Saudi Arabia (KSA). Through our studies, we proved that there is an associative relationship among the air pollution factor besides, the spread of COVID-19. As the results showed that compounds of air pollution such as Carbon monoxide (CO), Ozone (O3), Sulphur dioxide (SO2), Nitrogen dioxide (NO2), and PARTICLES (PM10), are severely related to the occurrence of COVID-19 due to the rate of the ratio of these areas more in the areas with the most prevalence of cases of COVID-19, so we used in our study the SIR model. It is considered one of the easiest, most reliable tools, consisting of three compartments;prone, contaminated, and removed. Besides, we utilized the Runge-Kutta method. © 2022, ICST Institute for Computer Sciences, Social Informatics and Telecommunications Engineering.

Does air pollution explain COVID-19 fatality and mortality rates? A multi-city study in São Paulo state, Brazil.

Since air pollution compromise the respiratory system and COVID-19 disease is caused by a respiratory virus, it is expected that air pollution plays an important role in the current COVID-19 pandemic. Exploratory studies have observed positive associations between air pollution and COVID-19 cases, deaths, fatality, and mortality rate. However, no study focused on Brazil, one of the most affected countries by the pandemic. Thus, this study aimed to understand how long-term exposure to PM10, PM2.5, and NO2 contributed to COVID-19 fatality and mortality rates in São Paulo state in 2020. Air quality data between 2015 and 2019 in 64 monitoring stations within 36 municipalities were considered. The COVID-19 fatality was calculated considering cases and deaths from the government's official data and the mortality rate was calculated considering the 2020 population. Linear regression models were well-fitted for PM2.5 concentration and fatality (R2 = 0.416; p = 0.003), NO2 concentration and fatality (R2 = 0.232; p = 0.005), and NO2 concentration and mortality (R2 = 0.273; p = 0.002). This study corroborates other authors' findings and enriches the discussion for having considered a longer time series to represent long-term exposure to the pollutants and for having considered one of the regions with the highest incidence of COVID-19 in the world. Thus, it reinforces measures to reduce the concentration of air pollutants which are essential for public health and will increase the chance to survive in future respiratory disease epidemics.

Prolonged Exposure to Remdesivir Inhibits the Human Ether-a-go-go-related Gene Potassium Current

Introduction: Remdesivir is indicated for the treatment of COVID-19 in patients requiring hospitalization. However, cases of QTc interval prolongation and torsade de pointes (TdP) have been reported to the FDA Adverse Event Reporting System. Drug-induced QTc prolongation and TdP is the single most common cause of withdrawal, relabeling and use restriction of marketed drugs. Most drugs that prolong the QTc inhibit a potassium current (IKr), which is encoded by the human ether-a-go-go-related gene (hERG) and is crucial for ventricular repolarization and action potential duration. Research Question or Hypothesis: To assess the potential for remdesivir and its metabolite, GS441524, to inhibit hERG-related currents. Study Design: Cell-based hERG Assay Methods: Whole-cell, voltage-clamp experiments were performed in HEK-293 cells stably expressing hERG. Borosilicate glass electrodes (resistance: 2-4 MW) filled with internal solution were used to record tail currents at depolarizing and repolarizing voltages tail current. To assess acute effects, drugs were added to the internal pipette solution, and for prolonged exposure;cells were incubated with remdesivir for 24 hours prior to recording. Results: Acute exposure to remdesivir and GS-441524 did not significantly inhibit peak activation or maximum tail current density. However, prolonged exposure to remdesivir 100 nM and 1 mM, but not 10 nM, inhibited peak activation currents by 32% (19±2 pA/pF, p = 0.03) and 36% (18±2 pA/pF, p = 0.02) respectively. Remdesivir 100 nM and 1 mM, also inhibited the maximum tail current density by 40% (18±2 pA/pF, p = 0.02) and 37% (19±2 pA/pF, p = 0.03), respectively. Conclusion: Prolonged exposure to physiological concentrations of remdesivir inhibits hERG-related currents. These results, coupled with clinical reports of QTc prolongation and TdP, highlight the need for a rigorous assessment of the effect of remdesivir on ventricular repolarization and risk of proarrhythmia.

Knowledge & Usage of Personal Protective Equipment for Prevention of Infection among Frontline Health Care Workers during Covid - 19 Pandemic

Background: The risk of transmission of novel SARS CoronaVirus-2 among health care workers can be reduced using personal protective equipment. It is critical to follow guidelines for appropriate use of protective gear to avoid its wastage. This study aimed to evaluate frontline healthcare workers' understanding of effective donning and doffing of protective equipment in the wake of recent emergence of corona virus disease.Physical impacts due to its prolonged usage were also identified. Material and Methods: A cross sectional survey was conducted targeting frontline health care workers from June till July 2021. Data was analyzed using SPSS version 24. Descriptive analysis was performed for qualitative variables.Chi-square test was utilized to determine association between qualitative variables and p <0.05 was considered to be statistically significant. Results: A total of 204 responses were received. Surgical masks (53.9%), gloves (51.5%), gowns (46.1%) and N95 respirator (40.7%) were most frequently used. Physicians had better knowledge on correct utilization of protective equipment as compared to non-physicians, p<0.001.Only 55.9% and 47.1% participants knew correct donning and doffing sequence respectively.The most prevalent mistakes while doffingwere touching front of mask and potentially contaminated surfaces followed by incorrect doffing sequence.Mostrespondentsmentioned scarcity of protective gear. Around 53% participants did not attend any training session on utilization of personal protective equipment. Prolonged exposure to masks and gloves led to acne, facial marks and itching. Frequent practice of hand hygiene was linked with skin dryness and cracking, p<0.001. Conclusion: We observed lack of expertise in donning and doffing technique. Mostly mistakes occurred during doffing, so interactive workshops are required to train health care workers.Most common dermatological manifestationsdue to use of masks and gloves included acne, facial markings, and itching. Adverse effects of prolonged use of PPE can be avoided by having shorter duration of working hours and giving rest during the shifts.

Particulate matter and COVID-19 excess deaths: Decomposing long-term exposure and short-term effects.

We investigate the time-varying effect of particulate matter (PM) on COVID-19 deaths in Italian municipalities. We find that the lagged moving averages of PM2.5 and PM10 are significantly related to higher excess deceases during the first wave of the disease, after controlling, among other factors, for time-varying mobility, regional and municipality fixed effects, the nonlinear contagion trend, and lockdown effects. Our findings are confirmed after accounting for potential endogeneity, heterogeneous pandemic dynamics, and spatial correlation through pooled and fixed-effect instrumental variable estimates using municipal and provincial data. In addition, we decompose the overall PM effect and find that both pre-COVID long-term exposure and short-term variation during the pandemic matter. In terms of magnitude, we observe that a 1 µg/m3 increase in PM2.5 can lead to up to 20% more deaths in Italian municipalities, which is equivalent to a 5.9% increase in mortality rate.

Long term exposure to air pollution and COVID-19 incidence in the city of Varese, Northern Italy: A complete-year, individual-level analysis

Introduction Studies on air pollution and COVID-19 are limited to the first pandemic wave (April/June 2020) and by their ecological design. Objectives To investigate the association between airborne pollutants and SARS-CoV-2 incidence up to March 2021 in the Varese city (Lombardy region), with individual-level data on exposures, disease and confounders. Methods Varese citizens aged 18+ years as of Dec31st,2019 were linked by residential address to 2018 average annual exposure to outdoor concentrations of PM2.5, PM10, NO2, NO and O3 modelled using FARM chemical-transport model (linkage coverage: 97.4%). Citizens were linked to Regional datasets for COVID-19 case ascertainment (positive nasophar-yngeal swab specimens) and to define age, sex, residential care home living, population density and comorbidities. We estimated rate ratios and additional number of COVID-19 cases for 1 mg/m3 increase in air pollutants, from single-and bi-pol-lutant Poisson regression models. Results Among the 62.848 residents, we observed 4408 COVID-19 cases. Yearly average PM2.5 exposure was 12.5 mg/m3. Cumulative incidence curves suggest an increased risk for PM2.5>13.5 mg/m3 in correspondence of downtrend periods in the pandemic curve. Age, residential care home living, history of stroke, medications for diabetes, hypertension and obstructive airway disease were independently associated with COVID-19 rate. In single-pollutant multivariate model, 1 mg/m3 increase in PM2.5 was associated with 5.1% increase in COVID-19 rate (95%CI: 2.7%-7.5%), corresponding to 294 additional cases per 100.000 person-years. These figures were confirmed in bi-pollutant models and after excluding subjects in residential care homes. Similar findings were observed for PM10, NO2 and NO. O3 was associated with a 2% decrease in disease rate, the association being reversed in bi-pollutant models. Conclusions In our study, long term exposure to low-levels of air pollutants, especially PM2.5, positively affected COVID-19 incidence. Causality warrants confirmation in future studies;meanwhile, governmental efforts to further reduce air pollution should continue.

Long-term exposure to ambient air pollution and incidence of depression: A population-based cohort study in China.

BACKGROUND: Long-term exposure to ambient air pollution was linked to depression incidence, although the results were limited and inconsistent. OBJECTIVES: To investigate the effects of long-term air pollution exposure on depression risk prospectively in China. METHODS: The present study used data from Yinzhou Cohort on adults without depression at baseline, and followed up until April 2020. Two-year moving average concentrations of particulate matter with a diameter ≤ 2.5 µm (PM2.5), ≤10 µm (PM10) and nitrogen dioxide (NO2) were measured using land-use regression (LUR) models for each participant. Depression cases were ascertained using the Health Information System (HIS) of the local health administration by linking the unique identifiers. We conducted Cox regression models with time-varying exposures to estimate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) of depression with each pollutant, after adjusting for a sequence of individual covariates as demographic characteristics, lifestyles, and comorbidity. Besides, physical activity, baseline potential depressive symptoms, cancer status, COVID-19 pandemic, different outcome definitions and air pollution exposure windows were considered in sensitivity analyses. RESULTS: Among the 30,712 adults with a mean age of 62.22 ± 11.25, 1024 incident depression cases were identified over totaling 98,619 person-years of observation. Interquartile range increments of the air pollutants were associated with increased risks of depression, and the corresponding HRs were 1.59 (95%CI: 1.46, 1.72) for PM2.5, 1.49 (95%CI: 1.35, 1.64) for PM10 and 1.58 (95%CI: 1.42, 1.77) for NO2. Subgroup analyses suggested that participants without taking any protective measures towards air pollution were more susceptible. The results remained robust in all sensitivity analyses. CONCLUSIONS: Long-term exposure to ambient air pollution was identified as a risk factor for depression onset. Strategies to reduce air pollution are necessary to decrease the disease burden of depression.

Long-Term Exposure to Ambient PM2.5 and Increased Risk of CKD Prevalence in China.

BACKGROUND: Fine particulate matter (PM2.5) is an important environmental risk factor for cardiopulmonary diseases. However, the association between PM2.5 and risk of CKD remains under-recognized, especially in regions with high levels of PM2.5, such as China. METHODS: To explore the association between long-term exposure to ambient PM2.5 and CKD prevalence in China, we used data from the China National Survey of CKD, which included a representative sample of 47,204 adults. We estimated annual exposure to PM2.5 before the survey date at each participant's address, using a validated, satellite-based, spatiotemporal model with a 10 km×10 km resolution. Participants with eGFR <60 ml/min per 1.73 m2 or albuminuria were defined as having CKD. We used a logistic regression model to estimate the association and analyzed the influence of potential modifiers. RESULTS: The 2-year mean PM2.5 concentration was 57.4 µg/m3, with a range from 31.3 to 87.5 µg/m3. An increase of 10 µg/m3 in PM2.5 was positively associated with CKD prevalence (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.22 to 1.35) and albuminuria (OR, 1.39; 95% CI, 1.32 to 1.47). Effect modification indicated these associations were significantly stronger in urban areas compared with rural areas, in males compared with females, in participants aged <65 years compared with participants aged ≥65 years, and in participants without comorbid diseases compared with those with comorbidities. CONCLUSIONS: These findings regarding the relationship between long-term exposure to high ambient PM2.5 levels and CKD in the general Chinese population provide important evidence for policy makers and public health practices to reduce the CKD risk posed by this pollutant.