Pollution impact: After Diwali, Delhi doctors report spike in breathing trouble

With Delhi’s air quality plummeting to hazardous levels after Diwali, doctors in the city have reported a 20% increase in the number of patients complaining of respiratory trouble such as shortness of breath, wheezing, and incessant coughing. To complicate matters, the prevalent air pollution levels may adversely impact people who have recovered from Covid-19, said doctors.

“There has been a 20% increase in the number of patients with chronic lung conditions reporting exacerbated symptoms over the past 15 to 20 days because of the changing weather – there were rainy days, hot days, and cold days. However, the pollution levels shot up after Diwali – whether due to firecrackers, crop burning, or vehicular pollution – and we saw an additional 10% increase in the number of patients in the last couple of days,” said Dr Sandeep Nayar, head of the department of respiratory medicine at BLK-Max hospital.

Dr Rajesh Chawla, senior consultant of pulmonary and critical care at Indraprastha Apollo hospital, said, “There has been nearly 20% increase in the number of patients coming in with exacerbations of their chronic respiratory conditions since Diwali.”

A study by the All India Institute of Medical Science (AIIMS), for which data was collected between 2017 and 2019, shows that even on “good” air days, small increases in pollution levels sends more people to the emergency department. The study found that there is a nearly 20% increase in the number of patients who need emergency care when PM2.5 level is recorded between 50 and 100µg/m³. At its peak – between October and January –hospitalisations go up by 40%.

The high pollution levels are likely to impact more people this year as a significant proportion of people who recovered from Covid-19 might not have completely healthy lungs, Dr Chawla added.

“People who had severe Covid-19, especially those who were admitted to the intensive care unit (ICU), will definitely suffer more due to the pollution. Some are likely to see asthma-like bronchial hyper reactivity. Nearly 20 to 30% of the post-Covid-19 patients will suffer the effects. And this will not just be limited to this year but in the time to come as well. The impact [of pollution] will be more in patients with low lung efficiency,” he said.

Dr Nayar said, “The lungs of several Covid-19 patients might not have recovered fully. Exposing them to high levels of pollution is like hitting someone on an existing wound. In fact, I have seen several Covid-19 recovered patients who were fine till last month but have started experiencing some symptoms since.”

Over 1.4 million people have had the infection in Delhi so far, according to official data.

Several global studies have already shown that people living in areas with high levels of pollution are more likely to die of Covid-19 – such as the study that reported 12% mortality in Northern Italy where pollution levels are higher in comparison to 4.5% from other parts of the country. A study from the Harvard University has also shown that with every 1 μg increase in PM 2.5 long term exposure, Covid-19 mortality went up by 8%.

“Both Covid-19 and pollution primarily affects the lungs. High levels of pollution may result in chronic conditions that predispose people to severe Covid-19; lungs damaged by severe Covid-19 are more likely to be affected by pollution. Just like every year, we have started seeing an increase in patients coming in with shortness of breath, cough, wheezing, chest pain, and sputum as soon as the pollution levels went up,” said Dr BK Tripathi, professor in the department of medicine at Safdarjung hospital.

Senior officials of Delhi’s environment department said that the government started issuing regular health advisories in 2016 after the National Green Tribunal (NGT) in a 2015 order asked the Delhi government to identify pollution hot spots and define the health impact that residents of those areas could face because of prolonged exposure to toxic air.

“The health impacts are definitely critical and for a healthy human being these impacts might not be seen immediately, but for the more vulnerable sections such as people with chronic ailments, children and senior citizens exposure to such high levels of poisonous air can be a problem. With Covid-19, these risks are much higher,” a senior environment department official said.

According to the Central Pollution Control Board’s daily health advisories, only ‘good’ air days as per Indian air quality standards (AQI in 0-50 range) results in “minimal health impact” in people. As the AQI levels start rising to the ‘satisfactory’ (AQI in 51-100 range), “minor breathing discomfort” could be visible among “sensitive people. In the ‘moderate’ AQI range, the air quality monitoring body warns that signs of “breathing difficulty could be seen among people with lung problems, asthma and heart diseases”, with prolonged exposure to ‘poor’ air (AQI between 101 and 150), breathing discomfort might be experienced among “most people”.

The CPCB advisories also say that in ‘very poor’ and ‘severe’ AQI range — usually recorded in the national capital during winter, when frigid conditions coupled with external and local pollution start worsening the city’s air quality — residents can experience respiratory illnesses and serious health impacts to those with existing diseases.

Before the NGT order, CPCB conducted a comprehensive study in 2008, which identified a significant association of pollution with adverse health outcomes. It was found that residents in Delhi had a 1.7 times higher prevalence of respiratory symptoms as compared to someone living in a rural area. The findings also showed that lung function was reduced in 40.3% of individuals in Delhi as compared to those in rural areas.

Bhavreen Kandhari, environmental activist and co-founder of Warrior Moms, a group of women fighting air pollution in India, said, “My daughters live with a very high risk of developing respiratory infections that stem from Delhi’s excessively polluted air. For children to have the lungs of a smoker by their teens, through no fault of their own, just by breathing air is absolutely unacceptable. We need governments to listen to us. Keep our children safe.”