COVID-19 in Italy in the Context of the Pandemic Induced by SARS-Cov-2. Is There a Relationship Between COVID-19 and Atmospheric Air Pollution?

Following the outbreak of the disease in China, Italy was the first European country to be heavily involved in the pandemic defined as COVID-19 and induced by SARS-Cov-2 virus. During March 2020, many patients in the surrounding areas were diagnosed with COVID-19, often as severe cases. Another cluster was identified in the regions of Lumbardy, Veneto, and Piemonte, with an exponential increase in cases, mostly in northern Italy. Although the disease spreads throughout the whole country, it was the most prevalent in the north, reaching incidence and mortality rates among the highest in the world. Many factors explain differences from other countries, including Italy having a larger elderly population, different applications of detection tests, different prevention policies, and probably also the role of atmospheric air pollution. In Italy, the possibility of performing autopsies or post-mortem diagnostic studies on confirmed COVID-19 cases has been intensively debated; however, while post-mortem pathological analysis of COVID-19 patients in China has shown findings consistent with interstitial pneumonia and in some cases acute respiratory distress syndrome (ARDS), in Italian autopsies the involvement of endothelial, prevalently of microvascular system has been identified for the recruitment of multiple cytokine-activated inflammatory cell lineages. These anatomo-pathological and clinical observations, together with pharmacological and immunological observations, have improved the approach to the treatment of COVID-19. Of course, we hope to have in future other treatments such as anti-COVID-19 vaccines and monoclonal antibodies.