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. 2021 Mar 26;20(1):34.
doi: 10.1186/s12940-021-00716-z.

The interplay between environmental exposures and COVID-19 risks in the health of children

Peter D Sly  1 , Brittany A Trottier  2 , Catherine M Bulka  3 , Stephania A Cormier  4 , Julius Fobil  5 , Rebecca C Fry  3 , Kyoung-Woong Kim  6 , Steven Kleeberger  7 , Pushpam Kumar  8 , Philip J Landrigan  9 , Karin C Lodrop Carlsen  10 , Antonio Pascale  11 , Fernando Polack  12 , Mathuros Ruchirawat  13 , Heather J Zar  14 , William A Suk  15
Affiliations

The interplay between environmental exposures and COVID-19 risks in the health of children

Peter D Sly et al. Environ Health. .

Abstract

Background: An unusual feature of SARS-Cov-2 infection and the COVID-19 pandemic is that children are less severely affected than adults. This is especially paradoxical given the epidemiological links between poor air quality and increased COVID-19 severity in adults and that children are generally more vulnerable than adults to the adverse consequences of air pollution.

Objectives: To identify gaps in knowledge about the factors that protect children from severe SARS-Cov-2 infection even in the face of air pollution, and to develop a transdisciplinary research strategy to address these gaps.

Methods: An international group of researchers interested in children's environmental health was invited to identify knowledge gaps and to develop research questions to close these gaps.

Discussion: Key research questions identified include: what are the effects of SAR-Cov-2 infection during pregnancy on the developing fetus and child; what is the impact of age at infection and genetic susceptibility on disease severity; why do some children with COVID-19 infection develop toxic shock and Kawasaki-like symptoms; what are the impacts of toxic environmental exposures including poor air quality, chemical and metal exposures on innate immunity, especially in the respiratory epithelium; what is the possible role of a "dirty" environment in conveying protection - an example of the "hygiene hypothesis"; and what are the long term health effects of SARS-Cov-2 infection in early life.

Conclusion: A concerted research effort by a multidisciplinary team of scientists is needed to understand the links between environmental exposures, especially air pollution and COVID-19. We call for specific research funding to encourage basic and clinical research to understand if/why exposure to environmental factors is associated with more severe disease, why children appear to be protected, and how innate immune responses may be involved. Lessons learned about SARS-Cov-2 infection in our children will help us to understand and reduce disease severity in adults, the opposite of the usual scenario.

Keywords: COVID-19; Children’s environmental health; Combined exposures; SARS-Cov-2.

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Conflict of interest statement

Authors declare they have no competing interests.

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