The primary cause of climate change comes from the combustion of fossil fuels, which produces an enormous amount of carbon dioxide and atmospheric pollution, primarily in the form of particulate matter, nitrogen dioxide, and ozone. Globally, outdoor air pollution caused 4.2 million deaths in 2015, which are attributable to the following illnesses, as indicated in thousands (Cohen 2017):

  • Ischaemic heart disease: 1521
  • Cerebrovascular disease: 898
  • Chronic obstructive pulmonary disease: 876
  • Lower respiratory infection:675
  • Lung cancer: 283
  • World total: 4244

Now we are beginning to have more published data on the nature of the deaths of Coronavirus in Italy; we may compare the pollution data with that of the Coronavirus. In Italy, the virus strikes mostly elderly persons with the average age of death of 79 years and 71 percent being males. The most common pathology is preexisting diseases. Those with no disease represent only 1.1 percent of the deaths; 26.1 percent have one disease, 25.7 percent have two, and 47 percent have three. Thus preexisting sicknesses play an enormous role in Italian Coronavirus mortality. The diseases associated with the Coronavirus are presented here in order of importance in terms of number of deaths for a sample analyzed March 15, 2020 (Infodata 2020):

  • Cerebrovascular disease: 164
  • Other heart diseases: 150
  • Diseases of Circulatory System: 137
  • Ischaemic heart disease: 124
  • Cancer of trachea, bronchi & lungs: 93
  • Other Chronic Respiratory Diseases: 70

The five diseases resulting from outdoor atmospheric pollution caused by fossil fuels, in turn, the primary cause of global warming, coincide with four of the six most important diseases associated with the Coronavirus in Italy in the given analysis, as shown above. In other words, the use of fossil fuels with its related air pollution adds diseases and deaths of many (4 out of 6) of the same kind of illnesses presented with Coronavirus1.

The numbers of premature deaths in Italy resulting from outdoor air pollution, attributable to small particulates (PM 2.5), nitrogen dioxide, and ozone, are presented in the Air Quality in Europe-2019 report, for year 2016 (EEA 2020). These three pollutants result in a total of 76.200 premature deaths in Italy. Small particulate matter is the most deadly with 58,600 or 77 percent of the total, followed by nitrogen dioxide with 19 percent and ozone with four percent. Total Italian deaths that year were 615 thousand; thus, the air pollution deaths were a significant amount,12.4 percent of the total.

From the same report, the geographic distribution2 of the most critical pollutant small particulate matter (PM 2.5) is illustrated for 2016.

Northern Italy has the largest average values; this same area has had the highest incidence of the Coronavirus. The urban centers of Rome and Naples are also relevant.

Cohen estimates premature deaths attributable to pollution of ambient particulate matter in the United States to be 88,400 in the year 2015 (Cohen, 2017), hopefully much less than that due to Coronavirus, currently around 1,000, but certainly growing.

In conclusion, Italian deaths due to local air pollution contribute to a profile of diseases that are highly overlapping with those accompanying Coronavirus diseases. This type of relationship will differ from country to country due to the varying importance of air pollution (for example, the US has fewer pollution-related deaths per capita than Italy, probably due to more open spaces) and a different profile of those dying from the virus.

The chief cause of climate warming, the combustion of fossil fuels, results in emissions of carbon dioxide together with particulate matter, nitrogen dioxide, and ozone that cause premature deaths, much more frequently than that of the Coronavirus; and these repeat annually because the pollution repeats. As such, programs to lower atmospheric pollution and the related deaths are highly recommended. In Europe, the EEA has estimated that lowering all concentrations equal to or below the WHO standard AQG for small particulates would decrease premature deaths by 27 percent or 101,000 deaths in the EU-27 (EEA 2019).

The “climate change virus” is also invisible and upon us. We cannot risk acting late. Now, this means phasing out coal-fired plants, building photovoltaic and wind turbine systems, making massive improvements in energy efficiency, going electric in transport, heating and cooling, creating a sustainable society. We are one planet in environment and health.


1 Since the sample reported on March 15, The Italian Institute of Health released on March 30, a much broader analysis, including 10,026 patients, of the most common comorbidities observed in COVID-19 positive diseased patients in Italy. With the larger sample: again the ischemic heart disease is the number one in both groups; cerebrovascular disease includes strokes and is also associated with hypertension on the new comorbidities sample; the chronic obstructive pulmonary disease is in both groups; lung cancer would be included among active cancer. Only lower respiratory infection does not appear in the list of comorbidities. Comparing the most common five di diseases of local air pollution with the larger sample of comorbidities confirms the result of a significant overlap between the two. Four out of five of the related air pollution diseases appear in the top eight COVID-19 comorbidities reported.
2 See Air quality in Europe — 2019 report, p. 62.


Cohen, A. J., et al., "Estimates and 25-year trends of the global burden of disease attributable to ambient air pollution: an analysis of data from the Global Burden of Diseases Study 2015", The Lancet, Volume 389, Issue 10082, 13–19 May 2017, pages 1907-1918.
EEA, Air quality in Europe - 2019 Report, European Environmental Agency, N° 10/2010.
Infodata, “Le cause di morte in Italia e il Coronavirus. L’analisi sui decessi e le proiezioni”, March 22, 2020, Il Sole 24 Ore.