Daniel Kanofsky and Mary E. Woesner: A Fresh Air Approach to COVID-19

Written in late March 2020 in response to the Covid virus lockdown in Italy.

       In Italy, novel Corona virus deaths continue to mount and the government has instituted severe restrictions on a multitude of activities conducive to public interaction with others. Italians are confined to their homes. Even going outside alone to take "a long walk with or without a dog" is being discouraged and could result in a fine. We believe that certain social distancing measures prohibiting walking, jogging and other recreational solo outdoor activities, while preventing spread, could inadvertently contribute to the puzzling and unexpected death rate increase. We cite three reasons for believing this.

       Many Italian families are confined to a relatively small living area. Crowding and social isolation, for that matter, are well-known stressors that can have adverse effects on immune function and possibly increase vulnerability to this virus. Exercise is felt to be a good way to manage stress and is more likely to occur if an individual is allowed access to an outdoor environment.

       Smoking prevalence in Italy is somewhat higher than that of America, which has a smoking rate of 13-14% in adults. Relevant underlying conditions such as bronchitis and emphysema are more common among smokers.  COVID-19 is a respiratory disease that can lead to pneumonia and smoking is a probable risk factor for increased severity of this illness. In a 2020 online Scientific American article entitled "Smoking or Vaping May Increase the Risk of a Severe Coronavirus Infection," Tanya Lewis writes: "Another study, which has been published online in the Chinese Medical Journal, involved 78 patients with COVID-19 and found those with a history of smoking were 14 times more likely to develop pneumonia." Under stressful conditions - like crowding and other COVID-19 related stressors - people tend to smoke more.  A smoking, home-bound unidentified COVID-19 patient who may be minimally symptomatic and not mindful of the dangers of smoking, could easily increase their cigarette consumption. This could lead to a more serious illness or death.  Non-smokers living with a smoker cannot escape increased second-hand smoke exposure.  The consequences of this, with regard to the novel Corona virus infection, are unknown but probably not negligible. The World Health Organization estimates there are 880,000 second-hand smoke-related deaths each year. Even acute exposure to cigarette smoke can harm lung function.  Lung function quickly improves after the cessation of smoking. 

       Confinement indoors limits contact with sunlight and the disinfectant effect of UV radiation.  Sunshine can kill some viruses and bacteria under certain conditions. It is too early to know where coronavirus fits in this scheme. Vitamin D deficiency - a probable cause for having a more severe acute respiratory infection - is a result of sunlight deprivation. Light therapy is often given for depression. A good review of  the sunshine and fresh air treatment  or "open air treatment" can be found in Dr. Richard Hobday's 2020 internet article, "Coronavirus and the Sun: a Lesson from the 1918 Influenza Pandemic."  The 1918 influenza pandemic occurred in the pre-antibiotic, pre-flu vaccine era. There were no vital life sustaining interventions, such as intravenous hydration and sophisticated ventilatory support. Hospital mortality rates were high. Dr. Hobday cites an editorial in a 1918 issue of the American Journal of Public Health that recommended the best current treatments for the Spanish Flu. According to the editorial, "The open-air treatment of Brooks was found by the Massachusetts State Health Department to be the most valuable factor in reducing mortality. Apparently, the fatality of hospital cases was reduced from 40 per cent to about 13 per cent by the treatment.”

       There may be lessons to be learned from the Italian experience. As the situation permits, the Italian government could consider allowing solo outdoor recreational activities at a safe distance from others.  Any lifting of the ban must weigh a possible increase in the spread of the virus. This is a trade-off that cannot be dismissed and may require a more vigilant or inventive enforcement of social distancing measures.

References:

Hobday R.  Coronavirus and the Sun: a Lesson from the 1918 Influenza Pandemic. 2020. https://link.medium.com/caKnpwLjK4.

Lewis T. Smoking or Vaping May Increase the Risk of a Severe Coronavirus Infection. 2020. https://www.scientificamerican.com/.

June 3, 2021