«Since autumn, we are threatened by three plagues: COVID-19, flu and smog. This mixture can be very dangerous. We will not survive the large flood of sick people »- warns dr hab. Tadeusz M. Zielonka, specialist in lung diseases and internal diseases. Why is smog in the COVID-19 era particularly dangerous? Where are the biggest threats and can we be locked down again? He told in an interview with Medonet
- Whether or not we get sick doesn’t just depend on contacting someone infected with SARS-CoV-2. We get sick when the virus enters our body. Meanwhile, smog is like a lockpick that opens the door of infection
- Smog not only opens the door to the coronavirus, but is also a means of transport for it
- Tadeusz M. Zielonka: from March we lived in one plague. From October, we are threatened by three: COVID-19, flu and smog, which not only promotes COVID-19, but also exacerbates asthma, COPD, heart failure, kidneys
- On November 14, we celebrated Clean Air Day. This article was created as part of the TvoiLokony and Airly #OddychajPolsko campaign, which aims to spread knowledge about the problem of smog in Poland
- For more up-to-date information on the coronavirus epidemic, visit the TvoiLokony home page
Dr hab. Tadeusz M. Zielonka, a specialist in lung diseases and internal diseases, works at the Chair and Department of Family Medicine at the Medical University of Warsaw. He is the Chairman of the Coalition of Doctors and Scientists for Healthy Air.
Monika Mikołajska / Medonet: Smog favors the coronavirus. As shown in the Report of Airly, the partner of the TvoiLokony campaign – Breathe Poland, where air pollution is greater, the number of SARS-CoV-2 infections is increasing. Why?
Dr hab. Tadeusz M. Zielonka: SARS-CoV-2 coronavirus infections started during the heating season. Thanks to this, it could be observed that there is a relationship between high air pollution and a higher incidence of coronavirus. It clearly happened in Italy. The dirtiest place there – the only such place – is the Po Valley in the north of the country (the concentrations of pollutants are similar to those in, for example, Upper Silesia or Małopolska). High concentrations of pollutants and a large number of cases and mortality were observed there. Similar observations were reported by the Americans – a large number of cases were in line with the map of high air pollutants (East and West Coast).
Why are more people affected by COVID-19 where there is smog?
Compounds found in smog damage the epithelium of the respiratory tract (this is the first barrier between the outside world – the air, and the inner world – organs), opening the door to various types of pathogens, including the coronavirus.
Remember – whether we get sick does not only depend on the fact that we contact a person or people infected with SARS-CoV-2. We get sick when the virus enters our body. Meanwhile, smog is like a lockpick that opens the door of infection. We are not always aware that by inhaling this odorless and not necessarily visible dust, we facilitate the entry of pathogens, including the coronavirus.
So air pollution simply makes us weaker and therefore more vulnerable to disease.
So it is. We do not get sick in winter or autumn because it is cold and the viruses are stronger. We are the weaker ones, partly because of the smog.
The high level of pollution also makes the coronavirus spread faster, he says raport Airly.
This is the second important factor. The virus is transmitted through dust, which means it stays in the air longer. Smog not only opens the door to our body for the coronavirus, but is also a means of transport for it.
We already know that in Italy and America, greater incidence of COVID-19 was noticed where the air was polluted. And what kind of observations do we have in Poland?
Similar. If we looked at the map, at the beginning of the epidemic, there were many cases in Silesia, in the south of Poland, in Mazovia, i.e. in the regions with the most polluted air.
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And then a lockdown was introduced with a surprising effect. Please tell me about it.
During the lockdown period, we noticed a drastic decrease in pollution – by 20 to 40 percent. There have been reports that nitrogen levels have dropped by 55% in some areas. (their important source is, among others, road transport, which at that time was very limited), and the amount of dust decreased by 20%. This change is on an unprecedented scale, the more so as it did not affect one day, but many weeks.
The decline in pollution has been so significant that it has led to a decline in deaths and in the incidence of non-COVID-19 diseases. I was surprised by this. I expected more deaths due to the epidemic. The fact that this did not happen shows how much smog influences our health and how healthier our lives would be without it.
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The impact of smog on our bodies is huge. We already know that it “opens” the “door” to pathogens. Please explain what exactly happens to our body under the influence of smog.
Dust kills – and we must not forget it or ignore it. People often fail to recognize that there is a close relationship between what we breathe and health and death. And the evidence is clear – as pollution in the air we breathe increases, so does the number of deaths.
In Poland, air pollution contributes to the death of almost 50 people every year. people…
For comparison, 90 to 100 die of all cancers. Meanwhile, the decrease in pollution we talked about has resulted in fewer deaths. And we’re not talking about numbers in the order of 30 or 100, but thousands per month.
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Deaths are just the tip of the smog iceberg.
Dirty air leads to exacerbations of chronic diseases (which can increase the risk of death). We see it in clinics, HEDs, and hospitals. If the situation was the same as in previous years, then during the lockdown – when hospitals were closed, access to health care was limited – we would have a huge problem with pressing sick people. Nothing like this happened.
For many years I have been dealing with patients with respiratory diseases and then I noticed a significant decrease in exacerbations of asthma or COPD. It is also of great economic importance – less money was spent on hospitalizations and visits to doctors, there were fewer leaves, we spent less on drugs. Let’s see how much could be improved in healthcare if we reduced pollution …
For whom is smog the most dangerous?
It is not age that determines this, but health, especially having chronic diseases. If a patient has, for example, atherosclerosis, then during the smog period he is more exposed to a stroke, heart attack, embolism. What we are talking about, of course, is also related to age to some extent. However, I observe that the biological age does not always coincide with the calendar age.
Children are also particularly exposed to smog and its consequences. They breathe the same concentrated air pollutants as adults, but it is a greater burden for them in terms of their low weight. In addition, due to the fact that the dusts fall, their highest concentration is observed close to the ground. The exhaust pipes of cars are also located at the level of the mouth and nose of young children.
Remember that smog affects babies in utero, and the health consequences of exposure to pollution before birth can be felt throughout their entire lives.
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In your opinion, by protecting ourselves against smog and the increase in incidence, we are threatened with a lockdown again?
In my opinion, it should be expected that, for social and economic reasons, we will not decide to completely close again. Unless the situation is dramatic. If we do not lockdown, and it is a cold period, air pollution will increase again (because it means an intense heating season), the respiratory tract will be damaged, which will favor infections – flu or COVID-19. Anyway, by introducing a lockdown, we will actually only reduce the level of pollution caused by transport. The question of heating-related dust pollution will remain.
Are you afraid of the upcoming “smog season”?
I am very afraid. We live in a population not vaccinated against influenza – because less than 4% of us are vaccinated, there will also be smog, which makes it easier for pathogens to access our bodies. All of this will add to the ongoing coronavirus epidemic. This mixture – flu, smog, COVID-19 can be very dangerous for us.
In addition, there is also weakened health protection.
Yes, especially in terms of human resources. We cannot distract ourselves from the health service that will fall ill with the flu, from COVID-19. It is known that more air pollution will exacerbate asthma, COPD, heart failure and there will be more infections.
So far, we have struggled with a single problem – the coronavirus. Last year’s flu was early, autumn – many cases were in October. When COVID-19 started, the flu was gone and smog was significantly reduced by a lockdown. Unfortunately, we are now facing a combination of all these threats.
Is the state able to cope with possible mass illnesses among citizens?
In my opinion, no. Our health service has the smallest staff, poorly equipped, and there are also late-developed procedures, often unimplanted into clinical practice. Do we know how the flu will differ from the coronavirus? As a doctor, I do not know what the recommended strategy is in this regard. After all, we have effective drugs for the flu, but they need to be administered immediately – within 48 hours of the first symptoms. If the patients first see a teleportation, then, when the symptoms persist – a SARS-CoV-2 test will be ordered, after four days it turns out that it is not a coronavirus …
As a result, it will be too late to treat the flu …
Unfortunately. Simultaneously, tests should be performed – for the flu and for the coronavirus. And there is something to fight for, because we are not vaccinated and we have no chance to vaccinate a large number of Poles. We will not provide vaccines to everyone who wants, let alone those who should.
The government says there will be around 2 million vaccines, and much, much more is needed. Of course, vaccine procurement doesn’t happen overnight, and I don’t blame the government for not bringing in more. But instead, a diagnostic and therapeutic procedure should be developed when we have patients with flu-like symptoms. Mistakes and delays in doing so will cost patients health – due to complications and even life.
So we are not prepared for the three dangers of smog, flu and COVID-19 overlapping each other.
In my opinion no. I work both in the clinic and in the hospital. We need to know how to proceed, what strategy to adopt.
We had been living in one plague since March. Since autumn, we are facing three threats: COVID-19, flu and smog. Smog, which not only promotes COVID-19, but results in exacerbation of asthma, COPD, heart failure, kidneys, influenza and even coronavirus co-infection (because we have mixed infections). It does not have to happen, but there are reasons for it, and I am very concerned about the situation. Because I do not feel that we are ready for it – in terms of staff, equipment, finances and in terms of procedures. It will be a big “check” for the system.
As you mentioned earlier – maybe mass flu testing should be implemented?
Do you remember how long it took to prepare laboratories for mass testing for SARS-CoV-2? About four months. In the case of flu, it would be the same – laboratories have to be equipped and prepared for this amount of research. The key is whether the government will pay for these tests as it pays for COVID-19 diagnostics. Flu diagnosis has been available for a long time, but it is performed sporadically because it is a burden on indebted medical facilities. Clinics or hospitals cannot afford influenza tests thousands of people in all people who have indications for their performance.
I am particularly concerned about the overload of the already weak health service. We will not survive a large flood of sick people. If there are outbreaks in hospitals, we will be closing the wards, but also the doctors who will have to go to quarantine or isolation.
And we have very limited reserves of medical personnel.
We have no reserves. When the French or the British had a lot of sickness, they asked retired doctors and nurses to come to work. And with us, these pensioners have been working for a long time and are on the front line. It’s like when the enemy comes and we have already thrown all our reserves into battle.
Can we ourselves do something to reduce the risk as much as possible?
The only thing is that we can limit our contacts. In Australia, where winter is now ending, there has been extremely little flu. This is explained by the fact that people have greatly limited their direct relationships due to the coronavirus. If we add hygiene, especially washing / disinfecting hands and wearing masks, we will already notice positive effects. If we forget these simple recommendations, it will be a disaster.
Remember, we will not eliminate the coronavirus or the flu with these measures, but there will be much less of these cases than if we did not comply with them. The Polish health service will not cope with too much pressure of the sick, and then a lockdown will have to be announced, which will be an economic catastrophe. I would not like us to be faced with a choice: plague or hell.
We are talking about healthy and asymptomatic people, but what about those who are already sick?
Distance, masks, hand disinfection – these activities are obligatory for everyone. However, those with symptoms should be especially vigilant. Someone who coughs, has a runny nose or a fever should not contact other people, especially children and seniors. Visiting an elderly weak person in such a state may kill him.
Therefore, let us remember that in the case of a coughing or feverish person, this sanitary regime must be strengthened.
There are no miraculous ways, the remedies that we’ve basically been talking about since spring work. The more people follow them and the tighter this regime is, the safer we are.
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