The recent epidemic of the new SARS-CoV-2 in the northern regions of Italy is putting the organization of the Italian health system under serious attack. The current emergency requires all possible efforts to stem the spread of the virus. In this context, it is clear that we have the urgent need to rely upon etiopathogenetic data, in order to do all possible efforts to block the epidemic. However, observing the trend of the infections in China and the geographic areas of the main outbreaks, it could be hypothesized that air pollution plays a role. In particular, it has been previously demonstrated, in specific populations, a role of particulate matter in worsening clinical presentation of virus infection in airways. Without prejudice to the ascertained virus spread by air droplets or contaminated surfaces, the factors that could have favored its spread remain to be investigated. Moreover, if these observations were to be confirmed, when the health emergency is resolved, it will be mandatory to redesign an economic-productive model in balance with the environment

Agostoni, P.

Badagliacca, R.

Magri, D.

Moscucci, F.

Piccirillo, G.

Sciomer, S.

English

S. Sciomer

F. Moscucci

D. Magr&#236

R. Badagliacca

G. Piccirillo

P. Agostoni

AIR Universita degli studi di Milano

SARS-CoV-2 spread in Northern Italy: what
about the pollution role?
Susanna Sciomer & Federica Moscucci & Damiano
Magrì & Roberto Badagliacca & Gianfranco Piccirillo &
Piergiuseppe Agostoni
Received: 19 March 2020 /Accepted: 21 April 2020
# Springer Nature Switzerland AG 2020
Abstract The recent epidemic of the new SARS-CoV-
2 in the northern regions of Italy is putting the organi-
zation of the Italian health system under serious attack.
The current emergency requires all possible efforts to
stem the spread of the virus. In this context, it is clear
that we have the urgent need to rely upon
etiopathogenetic data, in order to do all possible efforts
to block the epidemic. However, observing the trend of
the infections in China and the geographic areas of the
main outbreaks, it could be hypothesized that air pollu-
tion plays a role. In particular, it has been previously
demonstrated, in specific populations, a role of particu-
late matter in worsening clinical presentation of virus
infection in airways. Without prejudice to the
ascertained virus spread by air droplets or contaminated
surfaces, the factors that could have favored its spread
remain to be investigated. Moreover, if these observa-
tions were to be confirmed, when the health emergency
is resolved, it will be mandatory to redesign an
economic-productive model in balance with the
environment.
Keywords SARS-CoV-2 . COVID-19 . Pollution . PM-
10 . PM-2.5
Recent SARS-CoV2-2 outbreak in China and Italy cast
many doubts about possible mechanisms underlying its
spread and diffusion in the environment.
It is well known that the SARS-CoV-2 possesses a
high pathogenicity and transmissibility. Indeed, droplets
and inter-human contacts represent the preferred way of
this virus transmission (Han and Yang 2018, Han and
Yang 2020), and the reported high resistance of the
SARS-CoV2-2 in the air as well as on the hard surfaces
(i.e., copper or plastic) (Van Doremalen et al. 2020;
Kampf et al. 2020) enhances the virus ability to infect
a high number of subjects. However, there is a growing
interest with respect all possible factors capable to in-
crease its pathogenicity in response to the observed
difference in the outcome of the infected patients as well
as in the geographical distribution of the virus in China
and, particularly, in Italy.
Accordingly, there are well-known pre-existing
conditions which can predispose to a worse outcome.
Undoubtedly, smokers have been identified as a high-
risk category and more prone and susceptible to
Environ Monit Assess         (2020) 192:325 
https://doi.org/10.1007/s10661-020-08317-y
S. Sciomer : F. Moscucci (*) : R. Badagliacca :
G. Piccirillo
Department of Clinical, Internal, Anesthesiological and
Cardiovascular Sciences, Policlinico Umberto I Hospital,
University of Rome “Sapienza”, Viale del Policlinico n.155,
00186 Rome, Italy
e-mail: federica.moscucci@uniroma1.it
D. Magrì
Department of Clinical and Experimental Medicine, “Sapienza”,
Sant’Andrea Hospital, University of Rome, Via di Grottarossa
1035-1029, 00189 Rome, Italy
P. Agostoni
Monzino Cardiology Center, IRCCS, Milan, Italy
P. Agostoni
Department of Clinical Sciences and Community Health,
Cardiovascular Section, University of Milan, Milan, Italy
MERS-CoV infection (Seys, 2018), probably due to
both dipeptidyl peptidase-4 mRNA and protein overex-
pression, inversely correlated with lung function and
diffusing capacity parameters. More recent data on
SARS-CoV-2 disease (COVID-19) pointed out that the
oxidative stress could alter the pulmonary air-blood
barrier, thus creating a substrate for a more serious acute
respiratory distress syndrome in smokers (Cai, 2020).
Besides the smoking habits, air pollutants’ exposure
might play a pivotal role. Indeed, air pollution is respon-
sible for between 3 and 7 million deaths worldwide per
year, and it still represents a serious public health issue
due to increasing industrialization and the rapid expan-
sion of urban environments. (Niemann, 2017). Particu-
larly, the urban pollution is a complex cocktail of
chemicals which is broadly characterized into gases,
semi-volatile liquids, and particles. During the last few
years, many reports dealing with this topic have been
published. In a relatively recent study, conducted in
Lombardy (Carugno, 2016), it has been shown that
some pollutants are associated to an increased risk of
complications and hospitalization for respiratory syncy-
tial virus bronchiolitis (RSV) (Carugno, 2016). The
same study found a close association between short-
and medium-term particulate matter 10 (PM-10) expo-
sures and increased risk of hospitalization due to RSV
bronchiolitis among infants. These data strengthened
another report by Ye Q. and colleagues (Ye, 2016)
where it has been demonstrated that air pollutants sig-
nificantly increase the risk of RSV infection with dos-
age, lag, and cumulative effects. Similarly, Carugno
et al. have previously demonstrated the dangerous ex-
position of the Northern Italy population to air pollutants
(Carugno, 2018); in their study, they described the short-
term effects of PM-10 and NO2 exposure in Lombardy,
where increasing concentrations of air pollution were
associated with increased mortality and hospital admis-
sions. Accordingly, it is reasonable to assume that the
prolonged cellular oxidative stress induced by the in-
haled pollutants should be considered a predisposing
condition for the severe impact of respiratory viruses
on respiratory system. In such a context, it might be
conceivable that some air pollutants, specifically of PM-
2.5 and PM-10, might favor not only the virus pathoge-
nicity but also its spread. Indeed, as it survives for
several hours, even days, on inert surfaces (Van
Doremalen, 2020), it could be hypothesized that partic-
ular atmospheric conditions constitute further facilitate
of diffusion. Supporting the abovementioned
hypothesis, the empirical observation that geographical
areas with very high levels of pollutants in the air, such
as Hubei region in China and Northern Italy, are also
those with the highest number of infected and, conse-
quently, of deaths. The rigid measures undertaken in
China have resulted in a drastic reduction of contagions
by inter-human contact; however, it is conceivable that
the reduction of pollutants, consequent to the stop of
industrial production and human activities, may have
guaranteed a further reduction in the spread of conta-
gion. In fact, during the quarantine, established by gov-
ernments, the concentrations of pollutants were mea-
sured by the satellites of the European Space Agency,
and the results have been compared with the concentra-
tions detected in the same period of the last year and in
the period before the quarantine, finding a significant
reduction in the concentrations of pollutants
(McMahon, 2020, Bartels, 2020).
These data could be really useful to focus health
system effort on avoiding the spread of SARS-CoV-2
in specific seasons or in particular geographic areas.
All considered, when the public health emergency is
resolved, we must not waste time, and we must pursue
all the necessary health and economic policies to create
an environmental balance for maintaining health and
human activities and a more physiological air substrate
to avoid all potentially lethal consequences of a new
virus presence.
Compliance with ethical standards
Conflict of interest All authors declare that they have no con-
flict of interest.
References
Bartels M. Italy’s coronavirus response dramatically reduces air
pollution emissions, satellites show Space.com March 13,
2020.
Cai, H. (2020). Sex difference and smoking predisposition in
patients with COVID-19. The Lancet Respiratory Medicine,
11, S2213–2600(20)30117-X.
Carugno, M., Consonni, D., Randi, G., Catelan, D., Grisotto, L.,
Bertazzi, P. A., Biggeri, A., & Baccini, M. (2016 May). Air
pollution exposure, cause-specific deaths and hospitaliza-
tions in a highly polluted Italian region. Environmental
Research, 147, 415–424.
Carugno, M., Dentali, F., Mathieu, G., Fontanella, A., Mariani, J.,
Bordini, L., Milani, G. P., Consonni, D., Bonzini, M., Bollati,
  325 Page 2 of 3 Environ Monit Assess         (2020) 192:325 
V., & Pesatori, A. C. (2018). PM10 exposure is associated
with increased hospitalizations for respiratory syncytial virus
bronchiolitis among infants in Lombardy, Italy.
Environmental Research, 166, 452–457.
Han, Y., & Yang, H. (2018). The transmission and diagnosis of
2019 novel coronavirus infection disease (COVID-19): A
Chinese perspective. Clinical Infectious Diseases, 66(1),
45–53.
Han, Y., & Yang, H. (2020). The transmission and diagnosis of
2019 novel coronavirus infection disease (COVID-19): a
Chinese perspective. Journal of Medical Virology, 6.
Kampf, G., Todt, D., Pfaender, S., & Steinmann, E. (2020 Mar).
Persistence of coronaviruses on inanimate surfaces and their
inactivation with biocidal agents. The Journal of Hospital
Infection, 104(3), 246–251.
McMahon J. Study: coronavirus lockdown likely saved 77,000
lives in China just by reducing pollution Forbes EDITORS'
PICK march 16, 2020.
Niemann, B., Rohrbach, S., Miller, M. R., Newby, D. E., Fuster,
V., & Kovacic, J. C. (2017 Jul 11). Oxidative stress and
cardiovascular risk: obesity, diabetes, smoking, and pollu-
tion: part 3 of a 3-part series. Journal of the American
College of Cardiology, 70(2), 230–251.
Seys, L. J. M., Widagdo, W., Verhamme, F. M., Kleinjan, A.,
Janssens, W., Joos, G. F., Bracke, K. R., Haagmans, B. L.,
& Brusselle, G. G. (2018 Jan 6). DPP4, the Middle East
respiratory syndrome coronavirus receptor, is upregulated in
lungs of smokers and chronic obstructive pulmonary disease
patients. Clinical Infectious Diseases, 66(1), 45–53.
Van Doremalen N, Trenton Bushmaker, Dylan Morris, Myndi
Holbrook, Amandine Gamble, Brandi Williamson, Azaibi
Tamin, Jennifer Harcourt, Natalie Thornburg, Susan Gerber,
Jamie Lloyd-Smith, Emmie deWit, VincentMunster Aerosol
and surface stability of HCoV-19 (SARS-CoV-2) compared
to SARS-CoV-1 J Med Virol. 2020.
Ye, Q., Fu, J. F., Mao, J. H., & Shang, S. Q. (2016). Haze is a risk
factor contributing to the rapid spread of respiratory syncytial
virus in children. Environmental Science and Pollution
Research International, 23(20), 20178–20185 Epub 2016
Jul 20.
Publisher’s note Springer Nature remains neutral with regard to
jurisdictional claims in published maps and institutional
affiliations.
Environ Monit Assess         (2020) 192:325 Page 3 of 3   325 


SARS-CoV-2 spread in Northern Italy: what about the pollution role?

Sciomer S.

Moscucci F.

Magri D.

Badagliacca R.

Piccirillo G.

Agostoni P.

Archivio della ricerca- Università di Roma La Sapienza

Environmental Monitoring and Assessment SARS-CoV-2 spread in northern Italy: what about the pollution role?--Manuscript Draft-- Manuscript Number: EMAS-D-20-01006R1Full Title: SARS-CoV-2 spread in northern Italy: what about the pollution role?Article Type: Short CommunicationCorresponding Author: Federica MoscucciSapienza University of RomeRome, Lazio ITALYCorresponding Author SecondaryInformation:Corresponding Author's Institution: Sapienza University of RomeCorresponding Author's SecondaryInstitution:First Author: Susanna SciomerFirst Author Secondary Information:Order of Authors: Susanna SciomerFederica MoscucciDamiano MagrìRoberto BadagliaccaGianfranco PiccirilloPiergiuseppe AgostoniOrder of Authors Secondary Information:Funding Information:Abstract: The recent epidemic of the new SARS-CoV-2 in the Northern regions of Italy is puttingthe organization of the Italian health system under serious attack. The currentemergency requires all possible efforts to stem the spread of the virus. In this context,it is clear that we have the urgent need to rely upon etiopathogenetic data, in order todo all possible efforts to block the epidemic. However, observing the trend of theinfections in China and the geographic areas of the main outbreaks, it could behypothesized that air pollution plays a role. In particular, it has been previouslydemonstrated, in specific populations, a role of particulate matter in worsening clinicalpresentation of virus infection in airways. Without prejudice to the ascertained virusspread by air droplets or contaminated surfaces, the factors that could have favored itsspread remain to be investigated. Moreover, if these observations were to beconfirmed, when the health emergency is resolved, it will be mandatory to redesign aneconomic-productive model in balance with the environment.Response to Reviewers: Dear Editorial Board of Environmental Monitoring and Assessment,We would like to thank the Editor and the Reviewer for the encouraging comments andfor the opportunity to make further changes and reconsider our paper. In the currentrevised version, we have done our best to comply with each of the reviewer’ssuggestion.Best regards,Federica Moscucci, M.D.Department of clinical, Internal, Anesthesiological and Cardiovascular Sciences,University of Rome “Sapienza”federica.moscucci@uniroma1.itPowered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation March 17, 2020  To Editor in Chief of Environmental Monitoring and Assessment  Dear Editor, we wish to submit for possible publication in Environmental Monitoring and Assessment our short communication entitled “Covid-19 spread in northern Italy: what about the pollution role?” in order to highlight a very urgent problem related to the recent SARS-CoV-19 spread in Italy. We believe that a strong relationship could be found in the virus spread and air pollutants’ concentration in Po valley. This could be a very important topic to deal with and we felt the urgent need to share our opinions with scientific community.  This paper was produced according to the principles of the Declaration of Helsinki. Each author has participated sufficiently in this work to take public responsibility for the content and gave substantial contributions. All the authors have read and approved the manuscript.  The corresponding author  is empowered by all of the authors to act on their behalf with respect to the submission of the manuscript; the article is original and does not infringe upon any copyright or other proprietary right of any third party; neither the text nor the data reported have been published previously ; the article or a substantially similar article is not under consideration by another journal at this time. There are no conflicts of interest in connection with the submitted article, nor industry relationship.  Thank you in advance for the care of your revision.  Best regards,  Federica Moscucci, MD,   Dpt Clinical, Internal, Anesthesiological and Cardiovascular Sciences. University “Sapienza”, Rome, Italy  Phone: +39 06 49970118; email: federica.moscucci@uniroma1.it    Letter to the Editor1  SARS-CoV-2 spread in northern Italy: what about the 1 pollution role? 2 Running title: Pollution and Covid-19 3  4 Susanna Sciomer1, MD, Federica Moscucci1, MD, Damiano Magrì2, MD, PhD, Roberto 5 Badagliacca, MD, PhD,1 Gianfranco Piccirillo1, MD, PhD, Piergiuseppe Agostoni3 4, MD, PhD. 6  7 1Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, University of 8 Rome “Sapienza”, Policlinico Umberto I Hospital, Viale del Policlinico n.155, 00186 Rome, Italy. 9 2 Department of Clinical and Experimental Medicine, “Sapienza”, University of Rome, Sant’Andrea 10 Hospital, Via di Grottarossa 1035-1029, 00189, Rome, Italy 11 3 Monzino Cardiology Center, IRCCS, Milan, Italy 12 4 Department of Clinical Sciences and Community Health, Cardiovascular Section, University of 13 Milan, Milan, Italy. 14  15  16  17  18  19  20  21  22  23 Corresponding author: 24 Federica Moscucci, MD 25 Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, University of 26 Rome “Sapienza”, Policlinico Umberto I Hospital, Viale del Policlinico n.155, 00186 Rome, Italy. 27 Tel: +390649970118 28 Email: federica.moscucci@uniroma1.it 29 ORCID: 0000-0002-9385-9097  30 Manuscript Click here to download Manuscript Position paper Covid 19pollution R1 DEF.docxClick here to view linked References2  Abstract 31  32  33 The recent epidemic of the new SARS-CoV-2 in the Northern regions of Italy is putting the 34 organization of the Italian health system under serious attack. The current emergency requires all 35 possible efforts to stem the spread of the virus. In this context, it is clear that we have the urgent need 36 to rely upon etiopathogenetic data, in order to do all possible efforts to block the epidemic. However, 37 observing the trend of the infections in China and the geographic areas of the main outbreaks, it could 38 be hypothesized that air pollution plays a role. In particular, it has been previously demonstrated, in 39 specific populations, a role of particulate matter in worsening clinical presentation of virus infection 40 in airways. Without prejudice to the ascertained virus spread by air droplets or contaminated surfaces, 41 the factors that could have favored its spread remain to be investigated. Moreover, if these 42 observations were to be confirmed, when the health emergency is resolved, it will be mandatory to 43 redesign an economic-productive model in balance with the environment. 44  45  46  47  48  49  50 Key words: SARS-CoV-2, COVID-19, pollution, PM-10, PM-2.5.  51 3  Recent SARS-CoV2-2 outbreak in China and Italy cast many doubts about possible mechanisms 52 underlying its spread and diffusion in the environment. 53 It is well known that the SARS-CoV-2 possesses a high pathogenicity and transmissibility.  Indeed, 54 droplets and inter-humans contacts represent the preferred way of this virus transmission. (Han, 2018, 55 Han, 2020) and the reported high resistance of the SARS-CoV2-2 in the air as well as on the hard 56 surfaces (i.e. copper or plastic) (Van Doremalen, 2020, Kampf, 2020) enhances the virus ability to 57 infect a high number of subjects. However, there is a growing interest with respect all possible factors 58 capable to increase its pathogenicity in response to the observed difference in outcome of the infected 59 patients as well as in the geographical distribution of the virus in China and, particularly, in Italy. 60 Accordingly, there are well-known pre-existing conditions which can predispose to a worse outcome.  61 Undoubtedly, smokers patients have been identified as a high risk category, more prone and 62 susceptible to MERS-CoV infection (Seys, 2018), probably due to both dipeptidyl peptidase-4 mRNA 63 and protein over-expression, inversely correlated with lung function and diffusing capacity 64 parameters. More recent data on SARS-CoV-2 disease (COVID-19) pointed out that the oxidative 65 stress could alter the pulmonary air-blood barrier, thus creating a substrate for a more serious acute 66 respiratory distress syndrome in smokers (Cai, 2020).  67 Besides the smoking habits, air pollutants’ exposure might play a pivotal role. Indeed, air pollution 68 is responsible for between 3 and 7 million deaths worldwide per year and it still represents a serious 69 public health issue due to increasing industrialization and the rapid expansion of urban environments. 70 (Niemann, 2017). Particularly, the urban pollution is a complex cocktail of chemicals which is broadly 71 characterized into gases, semi-volatile liquids and particles. During the last few years, many reports 72 dealing with this topic have been published. In a relatively recent study, conducted in Lombardy 73 (Carugno, 2018) it has been shown that some pollutants are associated to an increased risk of 74 complications and hospitalization for respiratory syncytial virus bronchiolitis (RSV). (Carugno, 75 2018) The same study found a close association between short- and medium-term particulate matter 76 10 (PM-10) exposures and increased risk of hospitalization due to RSV bronchiolitis among infants. 77 4  These data strengthened another report by Ye Q. and colleagues (Ye, 2016) where it has been 78 demonstrated that air pollutants significantly increase the risk of RSV infection with dosage, lag and 79 cumulative effects. Similarly, Carugno et al have previously demonstrated the dangerous exposition 80 of the Northern Italy population to air pollutants (Carugno, 2018); in their study, they described the 81 short-term effects of PM-10 and NO2 exposure in Lombardy, where increasing concentrations of air 82 pollution were associated with increased mortality and hospital admissions. Accordingly, it is 83 reasonable to assume that the prolonged cellular oxidative stress induced by the inhaled pollutants 84 should be considered a predisposing condition for the severe impact of respiratory viruses on 85 respiratory system. In such a context, it might be conceivable that some air pollutants, specifically of 86 PM-2.5 and PM-10, might favor not only the virus pathogenicity but also its spread. Indeed, as it 87 survives for several hours, even days, on inert surfaces (Van Doremalen, 2020), it could be 88 hypothesized that particular atmospheric conditions constitute further facilitate of diffusion. 89 Supporting the abovementioned hypothesis, the empirical observation that geographical areas with 90 very high levels of pollutants in the air, such as Hubei region in China and Northern Italy, are also 91 those with the highest number of infected and, consequently, of deaths. The rigid measures 92 undertaken in China have resulted in a drastic reduction of contagions by inter-human contact; 93 however, it is conceivable that the reduction of pollutants, consequent to the stop of industrial 94 production and human activities, may have guaranteed a further reduction in the spread of contagion. 95 In fact, during the quarantine, established by governments, the concentrations of pollutants were 96 measured by the satellites of the European Space Agency, and the results have been compared with 97 the concentrations detected in the same period of the last year and in the period before the quarantine, 98 finding a significant reduction in the concentrations of pollutants. (McMahon, 2020, Bartels, 2020) 99 These data could be really useful to focus health system effort on avoiding the spread of SARS-CoV-100 2 in specific seasons or in particular geographic areas. 101 5  All considered, when the public health emergency is resolved, we must not waste time and we must 102 pursue all the necessary health and economic policies to create an environmental balance for 103 maintaining health and human activities and a more physiological air-substrate to avoid all potentially 104 lethal consequences of a new virus presence. 105 Acknowledgment 106  107 None 108  109 Disclosures 110  111 All authors have not any potential conflict of interest with this paper. 112  113  114  115   116 6  References 117  118  119  Bartels M. Italy's coronavirus response dramatically reduces air pollution emissions, satellites 120 show Space.com March 13, 2020 121  122  Carugno M, Consonni D, Randi G, Catelan D, Grisotto L, Bertazzi PA, Biggeri A, Baccini M. 123 Air pollution exposure, cause-specific deaths and hospitalizations in a highly polluted Italian 124 region. Environ Res. 2016 May;147:415-24 125  126  Carugno M, Dentali F, Mathieu G, Fontanella A, Mariani J, Bordini L, Milani GP, Consonni D, 127 Bonzini M, Bollati V, Pesatori AC. PM10 exposure is associated with increased hospitalizations 128 for respiratory syncytial virus bronchiolitis among infants in Lombardy, Italy. Environ Res. 2018 129 Oct;166:452-457. 130  131  Han Y, Yang H.The transmission and diagnosis of 2019 novel coronavirus infection disease 132 (COVID-19): A Chinese perspective. Clin Infect Dis. 2018 Jan 6;66(1):45-53. 133  Han Y, Yang H. The transmission and diagnosis of 2019 novel coronavirus infection disease 134 (COVID-19): A Chinese perspective. J Med Virol. 2020 Mar 6 135  Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces 136 and their inactivation with biocidal agents. J Hosp Infect. 2020 Mar;104(3):246-251. 137  138  McMahon J. Study: Coronavirus Lockdown Likely Saved 77,000 Lives In China Just By 139 Reducing Pollution Forbes EDITORS' PICK March 16, 2020 140  Niemann B, Rohrbach S, Miller MR, Newby DE, Fuster V, Kovacic JC. Oxidative Stress and 141 Cardiovascular Risk: Obesity, Diabetes, Smoking, and Pollution: Part 3 of a 3-Part Series.J Am 142 Coll Cardiol. 2017 Jul 11;70(2):230-251.  143  Seys LJM, Widagdo W, Verhamme FM, Kleinjan A, Janssens W, Joos GF, Bracke 144 KR, Haagmans BL, Brusselle GG. DPP4, the Middle East Respiratory Syndrome Coronavirus 145 Receptor, is Upregulated in Lungs of Smokers and Chronic Obstructive Pulmonary Disease 146 Patients. Clin Infect Dis. 2018 Jan 6;66(1):45-53. 147  Cai H. Sex difference and smoking predisposition in patients with COVID-19. Lancet Respir 148 Med. 2020 Mar 11. pii: S2213-2600(20)30117-X. 149  Van Doremalen  N, 150 Trenton Bushmaker, Dylan Morris, Myndi Holbrook, Amandine Gamble, Brandi Williamson, A151 zaibi Tamin, Jennifer Harcourt, Natalie Thornburg, Susan Gerber, Jamie Lloyd-152 Smith, Emmie de Wit, Vincent Munster Aerosol and surface stability of HCoV-19 (SARS-CoV-2) 153 compared to SARS-CoV-1J Med Virol. 2020 Mar 6.  154  155  Ye Q, Fu JF, Mao JH, Shang SQ.Haze is a risk factor contributing to the rapid spread of 156 respiratory syncytial virus in children. Environ Sci Pollut Res Int. 2016 Oct;23(20):20178-157 20185. Epub 2016 Jul 20.  158  159  160 1  Dear Editorial Board of Environmental Monitoring and Assessment,    We would like to thank the Editor and the Reviewer for the encouraging comments and for the opportunity to make further changes and reconsider our paper. In the current revised version, we have done our best to comply with each of the reviewer’s suggestion.   Best regards,  Federica Moscucci, M.D. Department of clinical, Internal, Anesthesiological and Cardiovascular Sciences, University of Rome “Sapienza” federica.moscucci@uniroma1.it Response to reviewer's comments Click here to download Response to reviewer's commentsReply to rev.doc

SARS-CoV-2 spread in northern Italy. what about the pollution role

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