'This Diwali, say no to crackers and avoid spike in COVID-19 cases'

Doctors advise people to wear N95 masks when going out during Diwali. representation pic

This Diwali say no to fire crackers or any form of burning waste especially the dry leaves from public garden or a bonfire as any form of smoke can trigger a serious health concern amidst the covid 19 pandemic which is still active, says city allergy and medical health experts, whose advice people. Carbon particles from fumes and chemical vapours from the fire crackers, may aggrevate the pre existing allergic condition and vapour particles can stick to nostrils for a long period of time, aggravating allergic Rhinitis and tigger asthma and bronchitis attack

Speaking to MiDDAY, Dr Wiqar Shaikh, senior allergy and Astham specialist said, "Firecrackers are especially made up of four components, namely oxidizers, fuel, colouring agents and binder. Of these, the fuel component is generally charcoal, which sustains the fire and which results in the release of a large amount of air pollutants particularly, Sulphur Dioxide (SO2), Carbon Di oxide (CO2), Carbon Monoxide (CO) and particulate matter, which get lodged in the lungs. With Diwali approaching and the certainty of firecrackers being burst across the country, we can expect a drop in air quality and particularly an increase in all the incriminated air pollutants such as SPM, SO2, CO, NO, NO2, etc. All these are bound to affect the lungs and it is certain that we can expect a spike in Covid-19 cases and an increase in mortality during and after Diwali.

Dr Wiqar Shaikh

Dr Shaikh further added, "In patients with pr-existing allergic Rihnitis, Asthma or bronchitis, the inner lining of their nostrils and the lungs, go into a twitchy state, because of the pollutants which cause irritation and lead to aggravation of these conditions, which can be misdiagnosed as Covid 19 symptoms and therefore proper diagnosis of such symptoms and advice proper preventative measure are very important."

Air pollution has now been shown to have a serious impact on Covid-19 infection. People exposed to higher levels of air pollutants are found to be at a higher risk of Covid-19 infection and / or death. These are the findings of a study published in September 2020 and conducted by the Medical Research Council of the UK at their Toxicology unit at Cambridge in England. This study mainly monitored Nitrous Oxide (NO) and Nitrous Dioxide (NO2) concentrations, and concluded that death in Covid-19 is associated with increased levels of both NO and NO2 levels in England, explained Dr Shaikh.

He continued, "Another study published on October 27, 2020, in the journal "Cardiovascular Research" and published by authors from the Max Planck Institute in Germany, concluded that long term exposure to air pollution may be linked to 15 percent of Covid-19 deaths globally. However, this percentage varies from 27 percent of deaths in East Asia to 19 percent in Europe and 17 percent in North America. The researchers also noted that air pollution affects the heart, lungs and blood vessels. Increase in SPM (suspended particulate matter), particularly has been found to increase the activity of a receptor on the lung cell surface, which is known to be involved in Covid-19 infection. Indeed, Covid-19 is a respiratory virus and is documented to cause long term pulmonary fibrosis, as also aggravation of respiratory conditions such as asthma, bronchitis and pneumonia.

Yet another study published from China in the journal "The Science of The Total Environment", in July 2020, concluded that there is a significant relationship between air pollution and increase in Covid-19 infection. The authors implicated an increase in 6 air pollutants namely SPM (suspended particulate matter- PM2.5), PM10, Nitrous Oxide (NO2), Ozone (O3), Sulphur Dioxide (SO2) and Carbon Monoxide (CO), said Dr Shaikh.

Dr Subash Hira

Smoke or fine particulate matter in the air from crackers will increase transmission of COVID-19 this Diwali ! said Dr Subhash Hira, Professor of Global Health at the University of Washington-Seattle, USA and former health specialist of the World Bank HQ and WHO, and currently health advisor to several UN, Indian and African health agencies, "Scientists were worried with the ongoing celebration season in India that was bringing large crowds of people to form congregations. There is new evidence emerging that at least 45% of COVID-19 infected persons remain asymptomatic and are likely to form a disproportionately large part of these congregations; thus increasing chances of high transmission to un-infected persons. The immediate result of such crowding is seen in spurt of new cases on Wednesday, 27.10.2020 to 1,354 in Mumbai (up from 800-plus cases each day last week) and 5,673 (up from 4,000-plus cases each day last week) in New Delhi. These cities have observed that congregations are characterized by the lack of universal use of masks, breakdown of physical distancing, and poor hand sanitation and leading to first whammy; increased COVID-19 transmission."

Dr Hira further added "with Diwali celebrations that will peak in mid-November, adding the second whammy, namely, cracker bursting that will raise smoke and fine particulate matter in the air. These air pollutants stimulate the ACE-2 receptors on respiratory and nasal cells, thus increasing permeability to SARS-COV-2 virus to easily enter these cells and establish infection in the nose, throat and lungs. An estimate of 30-40% additional new cases will arise in cities and towns due to second whammy. This will be followed on by the third whammy, namely, the winter temperatures. With puffs and aerosols of SARS-COV-2 virus produced by an infected person will remain afloat in the air for longer periods than 10-20 minutes due to low temperatures and air pollutants, and are inhaled and get presented to activate ACE-2 receptors of uninfected persons, thus adding another 30% new cases! That is a synergistic action of three whammies coming our way in November."

Said Dr. Hira, "Triple whammy can be prevented or at least truncated by populace being responsible this season; avoid bursting crackers and generating smoke, elderly to stay indoor to avoid winter temperatures outside, and all ages should avoid physical congregations, and instead meet families and friends on the virtual space! Stay well with 'better normal'!"

Dr Swati Maheshwari from Delhi

Dr Swati Maheshwari, internal medicine specialist from South Delhi, said, "Delhi is witnessing a third wave, with a surge in COVID-19 cases, and it is now proven that 15 per cent of COVID-19 deaths is linked to air pollution."

"It has been observed that children are now stepping out of their homes without following safety protocol of masks and hand sanitisation. Parents must ensure children don't go to crowded spaces," said Dr Maheshwari.

Dr Swati Maheshwari, internal medicine specialist from South Delhi, echoed similar concern and said, "Delhi is at present witnessing a third wave, with surge in Covid 19 cases and it is now proven fact that fifteen percent of covid 19 death is due to pollution. With winter already setting and covid existing, it will be a double whammy. Say No to Fire Cracker this Diwali and with air pollution, the situation will be more challenging."

"It is observed that many children have now started stepping out of their houses and are spotted at public places without following the basic social distancing and even wearing face masks. Covid will continue to be here, and we need to live with it, and therefore kids should not be taken to public places, though they may be taken for a scroll to nearby parks or for a walk, but maintaining social distancing, cleaning hands with hand sanitizer and face mask, will continue to be our weapon to fight covid 19," said Dr Maheshwari.

She further added, "We have now come across study which stay that regular flu shot do work to some extend in safeguarding with complexity emerging out of Covid 19, so when there is a nib in weather, prevention is the better than cure."

Also Read: India crosses 80 lakh-mark with spike of 49,881 COVID-19 cases

Is there a solution? Yes, say Dr Wiqar Shaikh, who has listed some of the easily doable acts, which would help to fight the pandemic and have a fire cracker less festivity -

• Ideally, we should all stop bursting firecrackers during Diwali. Although this is easier said than done, it would require the government and the law enforcers to act strictly. Of course, with knowledge about air pollution and its effects on Covid-19, it would be wonderful if the Indian population voluntarily avoids firecrackers completely during Diwali.
• Since it is inevitable that people are going to burst firecrackers, we should strictly ask the susceptible population, such as children, the elderly, pregnant women and sick people to stay indoors and keep their doors and windows closed.
• People suffering from asthma or bronchitis should ensure that they use their medicines regularly during this period to keep the symptoms under control and to prevent acute exacerbations. They should also ensure that their medicines are handy at all times.
• Wearing an appropriate mask becomes even more important during the Diwali and post Diwali season. Ideally, an N95 mask should be recommended.
• Avoid exercising outdoors (due to the air pollution), instead exercise indoors.

Seek immediate medical help in case of aggravation of symptoms.

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