key: cord-333417-edc509xr authors: Bontempi, Elza title: Commercial exchanges instead of air pollution as possible origin of COVID-19 initial diffusion phase in Italy: more efforts are necessary to address interdisciplinary research date: 2020-06-13 journal: Environ Res DOI: 10.1016/j.envres.2020.109775 sha: doc_id: 333417 cord_uid: edc509xr This communication aims to advocate a more coordinate activity mainly between medical and environmental scientists to clarify some confusing information related to airborne diffusion mechanisms of COVID-19. In this frame it is suggested that parameters other than environmental pollution (accounting for pollution-to human transmission mechanisms), as for example parameters involving commercial exchanges (accounting for human-to human transmission mechanisms), should be considered to better justify the difference in the initial diffusion of virus in Italy. At the end of 2019, COVID-19 infections were found, for the first time, in Wuhan (China). 22 At the end of February 2020, the first infection case was reported in Northern Italy 23 (Lombardy) , opening an unexpected sanitary crisis in Europe. During the continuous diffusion of the virus in Lombardy, the not complete knowledge of 25 some aspects of infection spread (for example the virus transmission due to no-symptom 26 patients), has alimented several debates and conflicting information about COVID-19 27 airborne diffusion (Zhiqiang Zhai, 2020), making evident the need of more dialogue 28 between different disciplines. 29 In particular, due to several episodes of air pollution observed in the past in China (Wang 30 et al., 2012) and in Northern Italy, especially in the Po valley (Perrino C et al., 2014) , a 31 correlation between airborne particulate matter (PM) concentration and the reported 32 infection cases was proposed by a position paper (Position paper). Based on this work, 33 several newspapers and some research articles (Frontera et al., 2020) , (Sterpetti, 2020) 34 were published reporting the possibility that airborne PM acts as a carrier in COVID-19 35 diffusion (pollution-to human transmission). 36 However, the potential influence of PM in virus diffusion was proposed as exploratory 37 evidence of potential risks, but never demonstrated so far (Qin et al, 2020) . In particular, 38 few knowledges are still available about interaction of virus and PM. 39 On the contrary, it is well documented that the exposure to high PM concentrations can 40 produce cardiovascular diseases, pulmonary oxidative stress and inflammation (Hadei, et 41 al. 2020 ). This situation can aggravate the health conditions of the infected subjects, due 42 to the pneumonia often associated with COVID-19. 43 Concerning COVID-19 diffusion in the air, some recent published papers support the idea 44 that the airborne transmission is a mechanism of virus diffusion. Moreover, these works 45 concern the small respiratory droplets with viral content, that are generated by infected 46 people (Morawska et al., 2020) , and that can be transported by air current (human-to 47 human transmission). Indeed, this eventuality primarily concerns indoor situations, then 48 different boundary conditions in comparison to transport that may be realized by outdoor 49 PM. The lack of a clear definition of the COVID-19 possibility to be transported by the air 50 has alimented several discussions and different opinions, mainly depending on the 51 experts' background. 52 The aim of this letter is to highlight some limitations due to the deficiency in 53 interdisciplinary activities focalized to study COVID-19 diffusion. This work would 54 demonstrate the need of more interdisciplinary collaborations in reporting and interpreting 55 the available data, and the possibility that other parameters, different to those already 56 proposed, should be considered. 57 The next paragraph is devoted to expanding and discussing the examples cited in the 58 introduction. The third part of this communication aims to propose a different point of view, 59 considering also economic/commercial factors and suggesting some actions addressed to 60 promote more efficacy in collaborations. Theoretical framework: some limitations of available studies may be due to the lack of 63 suitable interdisciplinary research 64 65 The need to increase the collaboration concerning COVID-19 infection, between different 66 interdisciplinary areas, can be highlighted by the lack of a suitable and shared terminology. For example, the definition of airborne has a different meaning for medical and 68 environmental scientists, with the consequence to make often confused the definition of 69 airborne virus transmission. When public health officials discuss about airborne 70 transmission, they specifically mean that virus is transported in aerosol respiratory droplets 71 (generated indoor by infected people) smaller than 5 micrometers in diameter 72 (https://www.who.int/). Compared to respiratory droplets of largest dimensions, bioaerosols 73 are expected to be able to travel meters (Morawska, et al. 2020 ). Then, this concerns 74 possible infection mechanisms mainly occurring indoor (human-to human transmission). 75 On the other side, airborne has a different definition for scientist working in other scientific 76 areas, such as atmospheric topics. Indeed, in the air pollution studies, airborne generally 77 refers to outdoor pollution, as for example, research concerning PM. In addition, 78 bioaerosols consist of particles generated in biological processes, then they can consist of 79 flowers, trees, carbohydrates, proteins, grass, lipids, DNA, RNA, fungi, bacteria, viruses, 80 and so on (Hyde et al., 2020) , that are only a limited part of PM, that usually contains large 81 amount of inorganic components. The recent works suggesting virus diffusion in Northern 82 Italy, concerning PM acting as a carrier, is an example of a possible mechanism 83 concerning an outdoor virus diffusion possibility (pollution-to human transmission), that 84 need further investigations. The possibility that the virus can attach for example to PM, 85 which may modify the aerodynamic characteristics of these particles (Prather et al, 2020), 86 and increase the virus dispersion should be copuled with studies investigating the COVID-87 19 infectivity, also depending on its dilution (the virus may be represent in insufficient 88 amounts to produce infection) (National Academic Science, 2020 Countries, China contribution is about 75% for export and about 87% for import in Italy. Then, these data can be considered a quite good picture of economical relationships 166 occurring between different Italian areas and China. 167 Figure 1 reports trade data provided by ISTAT, concerning import and export of Italian It is very interesting to highlight that the image reported in Figure 2 is very similar to those 176 shown in Figure 1 , strongly suggesting a possible correlation. In particular, I quantified the 177 correlation between the infection cases (shown in Figure 2 ) and the trade import and 178 export data (shown in Figure 1) methodological approach, that may start in clarifying the context and define a clear and 208 recognized terminology specifically addressed to the COVID-19, select the fundamental 209 parameters to investigate, and promote interdisciplinary international research activities. 210 This goal can be obtained also with the support of political authorities, that often select 211 their scientific committees specifically devoted to COVID-19, involving only medical and 212 epidemiology specialists. This will allow not only to better address all the research efforts, 213 but also to contribute to disseminate suitable messages and information to non-specialists, 214 such as population and policymakers. 215 216 217 Figure 1 : Trade import (a) and export (b) data provided by ISTAT, concerning Italian 304 regions with East Asia in 2018. Geographical classification of Italy, provided by ISTAT is: 305 (1) North-West, (2) North-East, (3) Centre, (4) South, (5) Islands 306 307 Figure 2 : Global reported infection cases detected at the beginning of the sanitary crisis 308 (10 th March 2020), in all the Italy, reported in accord with the geographical areas provided 309 by ISTAT for trade data (see Figure 1 ) 310 Highlights -Some conflicting information can be found in literature about COVID-19 transmission mechanism -The parameters used to evaluate the virus diffusion should be expanded -The commercial exchanges with China may be considered to account initial source of contagious in Italy First data analysis about possible COVID-19 virus airborne diffusion due to 220 air particulate matter (PM): the case of Lombardy (Italy) Environmental Research (2020) 221 186, 109639 Understanding COVID-19 diffusion requires an 224 interdisciplinary, multi-dimensional approach PM10 exposure is associated 228 with increased hospitalizations for respiratory syncytial virus bronchiolitis among infants in 229 Factors determining the diffusion of COVID-19 and suggested strategy to 233 prevent future accelerated viral infectivity similar to COVID Regional air pollution persistence links to 237 covid19 infection zoning The Pollution Particulate 241 A platform to investigate the effects of particulate air pollutants on 242 viral infectivity Cardiovascular effects of airborne particulate matter: A review of 246 rodent model studies Contribution of bioaerosols to airborne particulate matter Airborne transmission of SARS-CoV-2: The world should face the 254 reality Seasonal 256 variations in the chemical composition of particulate matter: a case study in the Po Valley Part I: macro-components and mass closure Long-261 term air pollution exposure and cardiorespiratory mortality: a review Rapid Expert 265 Consultation on the Possibility of Bioaerosol Spread of SARS-CoV-2 for the COVID-19 Effect of outdoor air pollution 270 on asthma exacerbations in children and adults: systematic review and multilevel meta-271 analysis PloS One Reducing transmission of SARS-CoV-2 Genome Biology Longitudinal survey of microbiome associated 280 with particulate matter in a megacity Lessons Learned During the COVID-19 Virus Pandemic Age-specific and sex-specific mortality in 289 187 countries, 1970-2010: a systematic analysis for the Global Burden of Disease Study Facial mask: A necessity to beat COVID-19 Association between short-term exposure to air pollution 296 and COVID-19 infection: Evidence from China This paper was conceived and written by only one author. The author declares that she has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.