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Review
. 2022 Apr 5:43:271-291.
doi: 10.1146/annurev-publhealth-052120-101420. Epub 2022 Jan 4.

Environmental Factors Influencing COVID-19 Incidence and Severity

Amanda K Weaver  1 , Jennifer R Head  2 , Carlos F Gould  3   4 , Elizabeth J Carlton  5 , Justin V Remais  1
Affiliations
Review

Environmental Factors Influencing COVID-19 Incidence and Severity

Amanda K Weaver et al. Annu Rev Public Health. .

Abstract

Emerging evidence supports a link between environmental factors-including air pollution and chemical exposures, climate, and the built environment-and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission and coronavirus disease 2019 (COVID-19) susceptibility and severity. Climate, air pollution, and the built environment have long been recognized to influence viral respiratory infections, and studies have established similar associations with COVID-19 outcomes. More limited evidence links chemical exposures to COVID-19. Environmental factors were found to influence COVID-19 through four major interlinking mechanisms: increased risk of preexisting conditions associated with disease severity; immune system impairment; viral survival and transport; and behaviors that increase viral exposure. Both data and methodologic issues complicate the investigation of these relationships, including reliance on coarse COVID-19 surveillance data; gaps in mechanistic studies; and the predominance of ecological designs. We evaluate the strength of evidence for environment-COVID-19 relationships and discuss environmental actions that might simultaneously address the COVID-19 pandemic, environmental determinants of health, and health disparities.

Keywords: COVID-19; SARS-CoV-2; air pollution; built environment; chemicals; climate.

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Figures

Figure 1
Figure 1
Schematic of the mechanisms through which environmental conditions influence SARS-CoV-2 exposure and COVID-19 susceptibility and severity. Thin arrows (black) represent pathways through which environmental conditions act on COVID-19. Bold arrows (red) indicate the direction of effect of the example exposures (green text) as either promoting (upward arrow) or suppressing (downward arrow) the associated mechanism. Abbreviations: BPA, bisphenol A; COPD, chronic obstructive pulmonary disease; COVID-19, coronavirus disease 2019; NO2, nitrogen dioxide; PM, particulate matter; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
See this image and copyright information in PMC

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