This study sets out the effect of scientific research on humanitarian interventions during the respiratory -coronavirus disease 2019 (COVID-19) pandemic. Amid the outbreak of this pandemic, the elders were severely affected by COVID-19. In addition to that effect, long-term PM2.5 (particulate matter with aerodynamic diameter ≤ 2.5 μm) exposure is associated strongly with respiratory diseases among the same age group. COVID-19 caused death and tested positive cases in all prefectures of Japan during the study period from Feb. 18 to Apr. 16, 2020, are analyzed. Also, PM2.5 caused deaths from 2010 to 2017 are calculated based on PM2.5-relative risk (RR) of 1.04 (95% CI: 1.01 – 1.08) from the World Health Organization-Air Quality Guidelines (WHO–AQG). The findings of this study show that elders living in prefectures with high levels of PM2.5 could be the most vulnerable to COVID-19. The estimated death cases from 2010 to 2017 are about 115,532 (95% CI: 28,883 - 231,064) cases. Thus, humanitarian actors could consider PM2.5 data for the localization of the efforts to minimize the spread of COVID-19.
Research Article
The effect of research on COVID-19 and PM 2.5 on the localization of humanitarian aid
https://doi.org/10.21203/rs.3.rs-2230116/v1
This work is licensed under a CC BY 4.0 License
Journal Publication
published 30 May, 2023
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humanitarian aid
PM2.5
COVID-19
localization
respiratory deaths
Humanitarian interventions during the COVID-19 pandemic faced enormous challenges due to restrictions on movement and social gatherings. Careful attention is to be paid in the affected areas to ensure safety and prevent any loss of life among humanitarian aid actors (Lau et al., 2020). During the COVID-19 pandemic, the United Nations Office for the Coordination of Humanitarian Affairs (UN-OCHA) allocated a large amount of funding as an emergency response from the Country-based Pooled Funds (CBPFs) (UNOCHA, 2020). Employing pandemic response and recovery plans is crucial (Fakhruddin et al., 2020), however, it is necessary to consider emerging scientific research on COVID-19.
A study from Wuhan in China (Zhou et al., 2020) indicated that elders were vulnerable to the adverse health effects of COVID-19. Another study from the United States (Wu et al., 2020) found a strong association between elevated PM2.5 concentrations and increased COVID-19-caused death cases. In Japan, the information issued by the Ministry of Health, Labor and Welfare (MoHLW) indicated that, up to April 16, 2020, there were 4,168 tested positive and 81 death cases caused by COVID-19 (Ministry of Health Labour and Welfare, 2022). Long-term exposure to high levels of PM2.5 (particulate matter with aerodynamic diameter ≤ 2.5μm) is also associated positively with respiratory deaths (Jerrett et al., 2009; Lippmann, 2008; Pope et al., 2002; Pope & Dockery, 2006). Additionally, there were many published studies about the effects of PM2.5 on human health in Japan listed in (Nawahda, 2013; Nawahda et al., 2012). Thus, the distribution of PM2.5 levels and COVID-19 caused death and tested positive cases, February - April 2020, in all prefectures were analyzed. Additionally, the deaths caused by long-term exposure to PM2.5 were calculated for the period from 2010 - 2017. They are estimated based on the relative risk (RR) of 1.04 (95% CI: 1.01 – 1.08). This RR value is associated with a 10 μg m−3 change in PM2.5 mean annual concentration (Pope et al., 2002). The findings of this study show that elders living in prefectures with high levels of PM2.5 are the most vulnerable to COVID-19. Thus, this study provides not only a better understanding of the possible association between air quality management and COVID-19 but also decision-support information for the humanitarian actors for the localization of efforts to minimize the spread of COVID-19.
PM2.5 monitoring data
Daily PM2.5 data for an 8-year period (2010–2017) from 1,064 Air Quality Monitoring Systems (AQMSs) in Japan are made available by the Ministry of the Environment (MoE) (Ministry of the Environment, 2022). These AQMSs (Fig. 1) are deployed by MoE and local governments. The mean annual concentrations of PM2.5 from 2011 to 2017 are shown in Fig. 2.
COVID-19 cases in Japan
MoLHW provides the following information related to COVID-19 cases in Japan; tested positive, with symptoms, discharged, PCR tested, serious, deaths, and by ages for all prefectures in Japan (Ministry of Health Labour and Welfare, 2022). Fig. 3, shows the number of reported death cases up to April 16th , 2020, most cases of COVID-19 belong to 60+ age group.
Effect of long-term exposure to PM2.5
The annual deaths caused by long-term exposure to high levels of PM2.5 are calculated as follows,
where x is the prefecture index, t is the year of simulation, pop is the exposed population, i is the index of age group, △PM2.5 is the change in the annual mean levels, Mb is the annual mean baseline death rate, and βPM2.5 equals 0.004 (Nawahda, 2013). An increase of 10 μg m-3 annual mean of PM2.5 caused a 4% (95% CI: 1.01–1.08) increase in death rate for the age group of 30+ (Pope et al., 2002).
The population of Japan in 2015 is obtained from the datasets of the Official Statistics of Japan (Japanese Government Statistics, 2022). The population by age is divided into the following categories: 0-14, 15–64, 65–74, and 75+. The corresponding percentage of each age group is as follows, 13.76%; 66.08%; 11.05%; and 9.11%, respectively. The corresponding baseline mortality (per one thousand) of each group is as follows, 0.3; 2.25; 14.28; and 59.01, respectively (Nawahda, 2013). The first two age groups are ignored due to the limitation of Eq. (1) that is valid for 30+ age groups.
The calculated annual deaths in all prefectures in Japan from 2010 to 2017 caused by exposure to PM2.5 > 10 μg m-3 for the 65+ age groups are listed in Table 1.
Table 1. Total death cases caused by exposure to PM2.5in Japan from 2010 to 2017.
|
Year |
Death cases |
95% CI |
|
|
2010 |
20,469 |
5,117 |
40,938 |
|
2011 |
18,826 |
4,707 |
37,652 |
|
2012 |
18,044 |
4,511 |
36,087 |
|
2013 |
17,776 |
4,444 |
35,552 |
|
2014 |
15,728 |
3,932 |
31,455 |
|
2015 |
10,957 |
2,739 |
21,914 |
|
2016 |
7,063 |
1,766 |
14,126 |
|
2017 |
6,669 |
1,667 |
13,339 |
The calculated death cases due to exposure to PM2.5 > 10 μg m-3 during the study period from 2010 to 2017 are shown in Fig. 4. The death cases among the 75+ age group are around 3.4 times as much as the third age group. Better air quality of the year 2017, compared to 2010, could save the lives of around 13,600 inhabitants. Fig. 5 shows that elders living in prefectures with high PM2.5 levels could be the most vulnerable to COVID-19.
The calculated death cases due to exposure to PM2.5 in all prefectures in Japan are estimations based on RR value of 1.04. These estimations are conservative; if a higher value of RR is considered, e.g. 1.08 (Jerrett et al., 2009) for PM2.5 levels > 10 μg m-3, the estimated deaths will increase accordingly. In 2009 Japan Ministry of Environment (MoE) adopted the following air quality standards of PM2.5; 15 μg m-3 / 35 μg m-3 (mean annual standard / 24 hours standard). These standards are similar to the U.S.EPA PM2.5-guidelines (U.S. EPA, 2022) but different from the World Health Organization-Air quality Guidelines (WHO-AQG), which are; 10 μg m-3 / 20 μg m-3 (World Health Organization. Occupational and Environmental Health Team, 2006). According to Figs. 2 and 6 the mean annual standard is met almost in all prefectures in Japan. This indicates a yearly improving air quality. However; during the study period the 24 hours standard is exceeded mainly in the southern prefectures in Japan. This could be due to the yellow dust storms.
There is uncertainty in the method of estimating the effects of long-term exposure to high levels of PM2.5 as discussed in (Nawahda, 2013). This uncertainty is mainly caused by using a non-Asian CR function and population data (e.g. counts, percentage of each age group, and the corresponding baseline mortality) of the 8-year study period. The findings in this study are conservative and could be improved by considering confounding factors such as; stage of pandemic, deprivation, occupation, age structure, health conditions, and ethnic mixture.
COVID-19 caused death and tested positive cases in all prefectures during the study period from Feb. 18 up to Apr. 16, 2020, are analyzed. The prefectures with high levels of PM2.5 have the highest COVID-19 death and tested positive cases. Accordingly; old people living in places with high concentrations of PM2.5 could be the most vulnerable to COVID-19. The findings of this study are a step towards a better understanding of the association between PM2.5 and COVID-19. PM2.5 caused deaths from 2010 to 2017 are calculated based on PM2.5-relative risk (RR) of 1.04 (95% CI: 1.01 – 1.08) from the World Health Organization-Air Quality Guidelines (WHO–AQG). The estimated death cases from 2010 to 2017 are about 115,532 (95% CI: 28,883 - 231,064) cases. Thus, humanitarian actors could consider PM2.5 data for the localization of the efforts to minimize the spread of COVID-19.
Ethics approval and consent to participate: Not applicable
Consent for publication: Not applicable
Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Competing interests: Not applicable
Funding: Not applicable
Authors' contributions: Not applicable
Acknowledgement
Thanks to Palestine Technical University-Kadoorie (PTUK) and Japan Ministry of Environment for providing PM2.5 data.
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No competing interests reported.