The interplay between environmental exposures and COVID-19 risks in the health of children

• Published in: Environmental health 2021-03, Vol.20 (1), p.34-10, Article 34
• Main Authors: Sly, Peter D, Trottier, Brittany A, Bulka, Catherine M, Cormier, Stephania A, Fobil, Julius, Fry, Rebecca C, Kim, Kyoung-Woong, Kleeberger, Steven, Kumar, Pushpam, Landrigan, Philip J, Lodrop Carlsen, Karin C, Pascale, Antonio, Polack, Fernando, Ruchirawat, Mathuros, Zar, Heather J, Suk, William A
• Format: Article
• Language: English
• Subjects: Adult; Adults; Age Factors; Air pollution; Air Pollution - adverse effects; Air Pollution - prevention & control; Air quality; Child; Child Health; Children; Children’s environmental health; Combined exposures; Coronaviruses; COVID-19; COVID-19 - epidemiology; COVID-19 - immunology; COVID-19 - pathology; COVID-19 - prevention & control; Cytokine storm; Disease Susceptibility - epidemiology; Disease Susceptibility - immunology; Disease Susceptibility - pathology; Disease transmission; Environmental Exposure - adverse effects; Environmental Exposure - prevention & control; Environmental factors; Environmental Health; Environmental impact; Epidemiology; Epithelium; Exposure; Fetal Development; Fetuses; Health aspects; Health risks; Human capital; Humans; Hygiene; Hygiene Hypothesis; Immune response; Immune system; Immunity, Innate; Infections; Infectious diseases; Innate immunity; Lungs; Pandemics; Pediatric research; Public health; Questions; Research methods; Respiratory System - pathology; Respiratory System - virology; Respiratory tract; SARS-CoV-2; Septic shock; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Signs and symptoms; Viral diseases; Viral infections; Viruses; Womens health
• ISSN: 1476-069X; 1476-069X
• DOI: 10.1186/s12940-021-00716-z

An unusual feature of SARS-Cov-2 infection and the COVID-19 pandemic is that children are less severely affected than adults. This is especially paradoxical given the epidemiological links between poor air quality and increased COVID-19 severity in adults and that children are generally more vulnerable than adults to the adverse consequences of air pollution. To identify gaps in knowledge about the factors that protect children from severe SARS-Cov-2 infection even in the face of air pollution, and to develop a transdisciplinary research strategy to address these gaps. An international group of researchers interested in children's environmental health was invited to identify knowledge gaps and to develop research questions to close these gaps. Key research questions identified include: what are the effects of SAR-Cov-2 infection during pregnancy on the developing fetus and child; what is the impact of age at infection and genetic susceptibility on disease severity; why do some children with COVID-19 infection develop toxic shock and Kawasaki-like symptoms; what are the impacts of toxic environmental exposures including poor air quality, chemical and metal exposures on innate immunity, especially in the respiratory epithelium; what is the possible role of a "dirty" environment in conveying protection - an example of the "hygiene hypothesis"; and what are the long term health effects of SARS-Cov-2 infection in early life. A concerted research effort by a multidisciplinary team of scientists is needed to understand the links between environmental exposures, especially air pollution and COVID-19. We call for specific research funding to encourage basic and clinical research to understand if/why exposure to environmental factors is associated with more severe disease, why children appear to be protected, and how innate immune responses may be involved. Lessons learned about SARS-Cov-2 infection in our children will help us to understand and reduce disease severity in adults, the opposite of the usual scenario.