A familiar scene is taking place in northern India. Vast fields burn, flames engulfing bare stalks of already-harvested crops. Billowing smoke travels across state borders. In towns and cities, the air is thick with yellow haze.
Stubble burning, the practice of intentionally setting fire to cultivated fields to prepare the land for its next crop, is one of the chief drivers of India’s so-called annual pollution season, which begins each winter.
It is especially bad in cities like the capital New Delhi, where smog from the burning crop fields, vehicular emissions, power plants, construction sites, and smoke from Diwali firecrackers combine to create a toxic cloud that lingers until spring.
Authorities have been trying for years to combat this serious public health risk – but there’s a new urgency this year, with fears that pollution could compound the danger of Covid-19.
The coronavirus outbreak in India has infected nearly 7.6 million people and killed more than 115,000, according to the country’s Health Ministry. India went into a months-long nationwide total lockdown in an attempt to contain the virus – but with little success. Presently, India has the second highest number of infections globally, after the United States, and the third highest number of deaths.
Experts and politicians now worry that the arrival of pollution season could pose a double threat, putting people at higher risk of severe infection, while increasing the strain on public health services.
“The combination of air pollution along with Covid-19, and especially as this is going to happen during the winter months, is something we need to be really concerned about and take adequate measures, so that we don’t let a huge spike occur in the number of cases,” said Dr. Randeep Guleria, director of the All India Institute of Medical Sciences (AIIMS).
India’s pollution problem
India has long faced this annual pollution problem; 21 of the 30 cities with the worst air pollution in the world are in India, according to IQAir AirVisual’s 2019 World Air Quality Report.
New Delhi has been ranked the most polluted city in the world, and the air quality last year reached levels more than 20 times what the World Health Organization (WHO) considers “safe.”
The danger lies in harmful microscopic particulate matter. Known as PM 2.5, the tiny particles are smaller than 2.5 micrometers in diameter, meaning they can lodge deep into the lungs and pass into other organs and the bloodstream. PM 2.5 can affect lung development in children, cause chronically reduced lung function, and reduce life expectancy, according to the WHO.
New Delhi residents could live an extra 10.2 years if the air was clean enough to meet WHO standards for particulate concentrations, according to the University of Chicago’s Air Quality Life Index.
During the coronavirus lockdown, which began in March, the sky in New Delhi turned blue, and people in the northern Punjab state could clearly see the Himalayan mountain range 100 miles away for the first time in decades.
Data showed that air pollutant levels dropped in the capital as factories shut down and roads emptied.
But the breath of fresh air didn’t last long, with the country reopening by early summer. This Tuesday, New Delhi’s air quality index reached its worst level since February last winter.
A double threat during Covid-19
Residents and medical workers are now bracing for the double public health threat.
“With the Covid pandemic prevailing worldwide and pollution level spiking simultaneously, there is definitely an increased risk of higher numbers and severity of Covid-19 infection increasing,” said Dr. Suranjit Chatterjee, Senior Consultant of Internal Medicine in Delhi’s Indraprastha Apollo Hospital.
New Delhi is only beginning to enter pollution season, with more crop burning and the Diwali festivities ahead in the coming months. Meanwhile, though Covid-19 infections in India are slowly on the decline, there are still anywhere from 45,000 to 70,000 new cases a day – and global health officials are warning that winter could bring another wave.
“Because of the cold air, the virus can survive in the environment for a much longer time and therefore, be more infectious,” said AIIMS’ Guleria. There are other factors that raise the danger of infection, he said – when it’s cold, people stay indoors more often and keep their windows closed, which creates poor ventilation.
A study released this spring by Harvard University examined more than 3,000 counties across the United States, and found that higher levels of air pollution were linked to higher death rates from Covid-19.
“Many of the pre-existing conditions that increase the risk of death in those with Covid-19 are the same diseases that are affected by long-term exposure to air pollution,” said the study.
Chatterjee warned of this link as well – air pollution can inflame or damage your cells, causing heart disease, stroke, asthma, diabetes and other comorbidities that can make increase the risk of death in Covid-19 patients, he said.
However, it’s not just people with pre-existing conditions at risk, he added – because air pollution in general damages your immune system, “even normal people (in India) are more predisposed to infections in the setting of higher pollution.”
There is one ray of hope: citizens may be better prepared this winter since they’re already wearing masks and taking precautions, which could better protect them from both pollution and Covid-19.
But India’s public health infrastructure, already fragile and strained, might not be able to handle the weight of two severe respiratory threats, especially in populous cities like Delhi and Mumbai.
“The last three years, we did not have enough beds in our ICUs or there weren’t enough ventilators in Delhi’s hospitals because of air pollution crisis in the month of November,” said Vimlendu Jha, an environmental and social activist based in Delhi.
“So, imagine a hospital that anyway is struggling right now because of Covid. Plus the patients, the new patients, elderly and children who are going to (hospital) because of respiratory issues or new cases of pneumonia because of air pollution. It’s going to be a huge, huge crisis,” he added.
What authorities are doing
Officials are now scrambling to respond to both dangers; in Delhi, Chief Minister of Delhi Arvind Kejriwal has announced a “battle against pollution.”
“Especially this year with corona, for our children, for our families, we have to reduce pollution,” he said on October 5. “(The) lungs are the most affected by corona, so pollution can be life-taking in such a disease.”