The COVID-19 pandemic highlights the vital link between public health and the environment.

Since 1970, April 22 has been designated Earth Day. The theme of this year’s observations, held digitally due to the pandemic, is climate action, with the organizers calling climate change “the biggest challenge to the future of humanity.”

The biggest immediate challenge facing humanity is coronavirus. Yet, just as the pandemic’s economic fallout highlights the interconnectedness of health and the economy, this crisis underscores the ongoing environmental emergency and its link to public health.

Air pollution and COVID-19 deaths.

Since coronavirus first emerged, there’s been speculation about a link between air pollution and severe illness or death. Early this month, a nationwide study conducted by researchers at the Harvard T.H. Chan School of Public Health offered evidence of a connection: even a small increase in long-term exposure to fine particulate matter—dangerous inhalable solids or liquid droplets in the air—is associated with a large increase in the COVID-19 death rate.

The inhalation of fine particulate matter is known to cause inflammation and damage to the lungs, making a person more susceptible to asthma, heart conditions, and other health problems. Fuel combustion—for example, automobile and industrial emissions—is one of the main sources of these microscopic pollutants.

Communities with higher percentages of minorities and those with higher levels of poverty are more likely to be located near sources of such hazardous emissions and thus face greater health risks, particularly with respiratory illnesses like COVID-19. Recent reports highlight disparities in COVID-19 death rates, particularly in dense, urban areas with higher levels of air pollution: black and Latino residents have been twice as likely to die of the illness in New York City, and more than 70% of COVID-19 deaths in Chicago—and a similar percentage in Wisconsin’s Milwaukee County—have been among residents who are black.

Environmental protections rolled back.

The authors of the Harvard study point out the importance of enforcing air pollution protections during this public health crisis, noting that “. . . a failure to do so can potentially increase the COVID-19 death toll and hospitalizations, further burdening our healthcare system.”

Yet in late March, the Environmental Protection Agency (EPA) instituted widespread relaxation of environmental rules, citing the impact of the pandemic on businesses. For the foreseeable future, the EPA is allowing power plants, factories, and other businesses to monitor themselves. They won’t be penalized if they don’t meet legal requirements for reporting air, water, and waste pollution.

In recent weeks, while much of the country has been locked down and some areas are being devastated by a respiratory illness pandemic, the Trump administration made several other moves to weaken air pollution protections:

  • On March 31, the administration finalized a rollback of automobile emission standards intended to reduce a major U.S. source of greenhouse gas emissions.
  • Last week, EPA administrator Andrew Wheeler announced national air quality standards would not be strengthened. This decision goes against the recommendations of EPA staff scientists, who had advised that the annual particulate matter standard be lowered, citing estimates that doing so could save more than 12,000 lives a year.
  • The administration also announced last week that it changed the way it assesses air pollutant emissions (like mercury) from power plants, effectively rolling back a rule that reduced emissions by an estimated 80% in the past decade.

Climate change: the other public health emergency.

These changes to environmental protections are expected to increase levels of pollution and greenhouse gases in the atmosphere. Such pollution is a major cause of the other ongoing public health emergency: climate change.

In addition, there is growing recognition that the COVID-19 pandemic may undermine our readiness for upcoming climate change impacts, such as the storms and natural disasters that occur more frequently and with greater severity each year. Federal and local emergency response agencies and health care providers, already stressed due to the coronavirus crisis, will be underresourced and more easily overwhelmed by extreme weather events. In turn, these events are expected to compound the harm—including loss of employment, property, and life—caused by the current public health emergency.

The multitude of ways this may occur was evident last week, when tornadoes crossed a large swath of the South. Over the course of hours, 105 tornadoes left a trail of damage almost 800 miles in length across 10 states. Dozens of people were killed. Some storm shelters, concerned about the spread of coronavirus, required residents to wear masks. According to local news reports, an Alabama family that had only one mask was refused entry, leaving them outside in the rain as a tornado approached.

Physical distancing recommendations complicated recovery efforts. Neighbors trying to rescue the injured and comfort one another couldn’t maintain recommended distances. People who had recently lost their jobs have few resources to rebuild and require extended stays in shelters. Challenged with not becoming vectors of illness, recovery shelters reduced capacity in order to be able to meet physical distancing recommendations and scrambled to institute new safety precautions, including health screenings and the provision of masks.

Variations of this scenario are likely to play out repeatedly in the next few months:

  • Wildfire season in the West now lasts for much of the year and is expected to be negatively affected by low levels of snowpack and rainfall in California.
  • Hurricane season stretches from June through November and is predicted to be more active than usual.
  • Springtime flooding is possible across one-third of the United States.

‘Beyond clinically based parameters of health.’

The increased urgency of the environmental crisis during the coronavirus pandemic highlights the need for greater recognition of the myriad connections between human health and the environment. As William E. Rosa, the author of this month’s Viewpoint, points out:

We must think beyond clinically based parameters of health. Cholesterol levels mean little to civilizations that, quite literally, face extinction because of sea level rise, weather emergencies, and lack of access to clean water.

For additional information about the many ways nurses are essential to environmental efforts in all health care settings, see this month’s Environments and Health column by Julie Kleber and Bevin Cohen. In it, they highlight the vital and innovative role nurses can play in managing the large amount of plastic medical waste produced by the health care industry.