University of California San Francisco
Helen Diller Family Comprehensive Cancer Center

Air Pollution and Smoking May Increase Coronavirus Risks, Worsen Outcomes

By Jeffrey Norris | | April 9, 2020

Air Pollution and Smoking May Increase Coronavirus Risks, Worsen Outcomes

Lung damage is the cause of most COVID-19 deaths, and lung damage also is a public health concern for smokers and anybody living under polluted skies. The assault to the lungs in COVID-19 and due to inhaled smoke and chemicals has led researchers to suspect that there is a synergy at work for many with the disease.

For more resources and information see our Coronavirus COVID-19 Links for the UCSF Cancer Community.

Diabetes, high blood pressure and heart or chronic respiratory disease put those infected with SAR-CoV-2, the newly pandemic coronavirus that causes COVID-19, at risk for worse outcomes. But beyond these pre-existing health conditions, there’s good reason to believe that smoking and long-term exposure to air pollution also are likely to shift the odds.

Researchers, including pulmonologists at UC San Francisco, are working to find out more about the links between smoking, air pollution and infection, including fatal coronavirus infection. For instance, Michael Matthay, MD, along with UCSF intensive care physician Jeffrey Gotts, MD, PhD, and postdoctoral fellow Shotaro Matsumoto, MD, are investigating how lung injury and susceptibility to infection may be affected not only by smoking, but also by vaping.

Acute Respiratory Distress Syndrome

The leading cause of death in COVID-19 patients is acute respiratory distress syndrome (ARDS), a form of oxygen starvation associated with the flooding of the tiny air sacs within the lungs called the alveoli.

Although treatment has greatly improved over the past two decades, ARDS arising from influenza infections still kills thousands of patients each year in the United States, notes UCSF pulmonologist and critical care specialist Matthay. The number of COVID-19 deaths due to ARDS is expected to be much greater.

“Most of the mortality in COVID-19 is due to severe ARDS,” Matthay said. “Somewhere between about 17 percent to 30 percent of hospitalized COVID-19 patients are ending up with ARDS, and about 40 to 50 percent who develop ARDS are dying, based on data from China and some regions of the U.S.”