Air pollution, winter, influenza infection-cocktail could exacerbate the severity and spread of corona virus in the coming months. Children could become super spreaders.

Virus illnesses, particularly the respiratory ones like RSV or influenza, thrive in the winter season with the most noticeable example of flu deaths in this cold season.

Even though till date there is no evidence of changing weather on the spread of corona virus, the recent surge in Delhi and other part of country strongly indicate that India might see the second peak of Corona virus cases in the coming months.

There are a few cases around the globe with corona virus and influenza coinfection. In these there has been a significant risk factor compounded by the increased shedding of viruses as well as prolonged hospital stay, according to a retrospective study from Wuhan, China.

With the resurgence of COVID-19 there may be a double epidemic of flu and the corona virus that could be further exaggerated by increased pollution. There is sufficient evidence to suggest that not just respiratory droplets, but also airborne dust and fiber particles can spread corona virus.

Corona virus has been detected on particles of air pollution that enable it to be carried over longer distances and increase the number of people infected. Air pollution particles could help corona virus travel further in the air .

We know that air pollution can cause health problems. Bronchial asthma, lung carcinoma , heart attacks, strokes, diabetes and high blood pressure, chronic lung diseases and neonatal diseases have been identified as the pre- existing medical conditions that raise the chances of death from COVID-19 infection.

According to the State of Global Air (SOGA) Report, 2020, long-term exposure to outdoor and household air pollution —contributed to 16,67,000 deaths in India in 2019.

Emerging research has now suggested that breathing more polluted air over many years may itself worsen the effects of COVID-19 (8% increase in mortality from COVID-19 infection for every 1 microgram/cubic meter increase in air pollution ) .

The Doctors For Clean Air (DFCA) has warned that compromised lung function due to air pollution could lead to serious complications in patients affected by the Covid-19.

Air pollution may also exacerbate symptoms of “long Covid”, which is a term used to describe symptoms of Covid-19 persisting weeks and months after recovery -- with symptoms of cough, fatigue, diarrhea, joint pain, muscle aches, and lungs, heart, and kidney damage. Fatigue is the most common symptom.

Now what can we do to avoid this "Triple Pandemic"?

Here are some points I would like to suggest :

1- Combination testing for both COVID-19 and influenza-- could be used to distinguish the two infections in patients presenting similar symptoms.

2- Influenza vaccination to be included in the Universal Immunization Programme.

3- Continuing social distancing / mask wearing / hand hygiene should be sufficient to suppress any twin influenza/corona epidemic.

4- Formulate long-term plans to reduce air pollution in the country -- stricter enforcement of thermal power plant emission norms, regulation of emissions from diesel and petrol vehicles and strict enforcement of construction and solid waste norms. There is a respiratory virus that kills people out there – this is not the right time to give permits to industry to pollute our air.

5- Everyone who has recovered from the corona virus disease (COVID-19) and lives in a city or region with high air pollution must get a flu shot.

Dr. Kafeel Khan is M.B.B.S,M.D (Paediatrics). He is the twice-Suspended -Assistant Professor, Dept of Paediatric, BRD Medical College,Gorakhpur, Uttar Pradesh for doing little more than trying to save the lives of little children under his care by arranging oxygen cylinders.