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In Italy and further afield, pollution and poverty have played a part in worsening COVID-19 ǀ View

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The global shutdown intended to control the novel coronavirus has given many scientists and policymakers pause. Lockdowns are predicated on the idea that the only thing to be avoided is contact with the virus itself. Yet, there are some important clues in the patterns the disease is leaving that tell us quite a bit about what conditions can hasten its spread and even worsen its lethality.

So far, the areas of the world where the most people are dying of the disease – called the case-fatality rate – have been densely populated urban zones in China, Iran and northern Italy.

Recent studies confirm that air pollution has been blindingly severe in those regions of northern Italy where the coronavirus has been most virulent. Lombardy and the Po Valley, for instance, rank among the most air polluted areas of Europe, and also have a very high rate of smoking among men.

As the centre of steel-making and coking ovens, Wuhan, the first epicentre of the disease, has the worst air pollution in China and one of the highest rates of cigarette smoking. In addition to China and Iran having some of the highest concentrations of human beings on the planet, there are a number of other important environmental factors in both regions that could explain why the disease seems more deadly in those locales. Residents of Tehran or China’s Hebei province sometimes inhale the equivalent of a pack or more of cigarettes every day.

But while China has instituted national standards for air pollutants and taken the modern step of banning fireworks – one of the most severe forms of air pollution ever measured – monitoring is limited to cities. In fact, air pollution in major Chinese cities is declining. In Iran, conditions are worsening. The United Nations Environment Programme ranks Iran 117 out of 133 countries with respect to overall environmental quality.

Especially in the wintertime, air in these areas regularly can contain levels of ultra-fine particulate air pollution from coal-burning and diesel engine products of incomplete combustion that would be illegal in most modern cities. The high levels of diesel pollutants around the world today are due to the millions of trucks and cars on the roads that rely on diesel engines that were fraudulently manufactured to pass emissions tests. These vehicles came with their own defeater devices on all of the diesel engines produced in the 1980s. Whenever hooked up to a computer test, the engine would lower its emissions.