Dr. Paines essay first appeared on the Good Notes blog.

Our state can be awinter wonderlandof abundant sun-drenched ski slopes. Unfortunately, Utah can also be a winterinversion-land.

Were learning more about bad health effects from bad air we breathe, especially during our annual winter temperature inversions. It may not be easy to see, but we also know that, because of changes in better human behavior, our dirty air has slowly been getting cleaner. Theres still a long way to go.

Through our research, weve recently learned about the effects of different, specific aspects of air pollution. We know more details about the effects of particulate pollution. During our wintertime inversions, we develop high levels of tiny particles in the air, called PM 2.5. These particles are just the perfect size to get down into the working part of the lung, where blood and air come close together. Higher levels of PM 2.5 over long periods of time cause all sorts of effects, such as increased rates of cardiac events, including heart attacks and deteriorating cardiac function, increased rates of asthma, and more premature births. Exposure to PM 2.5 also contributes to strokes and to deterioration in mental capacities in seniors. We know from recent research in Utah that theres an association of increased PM 2.5 levels with risk of severe pneumonia. We also know that pollution can contribute to mortality, even at lower levels than were previously considered safe.

Pollution and COVID-19

Prior to the COVID-19 pandemic, we already knew poor air quality was a risk factor for respiratory failure following a variety of insults, such as viral pneumonia or trauma. COVID-19 has expanded our understanding of this risk. A number of studies from the United States, Western Europe, and China show that people who have had greater exposure to air pollution over prior years are more likely to contract COVID-19, to have a more difficult course with the disease, and even to die from COVID-19.

So, like many aspects of health, air pollution makes COVID-19 worse. The most likely explanation is that chronic, low-level air inflammation in the lungs due to air pollution leaves a person more prone, when they become infected with the virus, to develop explosive, dysregulated inflammation that causes severe respiratory failure. These individuals require hospitalization, care in ICUs, support with ventilators, and are at great risk of death.

I spend a lot of time talking to patients about what they need to do when the air outdoors is more dangerous. I explain that they need to pay attention to air quality and should not just go outside and do their normal activity if the air quality is poor. I tell them to protect themselves and their children by staying indoors. Yes, people should still exercise, but they should try to shift to indoors rather than be exposed to high levels of pollution.

Its often important to pay attention to the time of day if going outside. Pollution is frequently not as bad in the morning, so its a better time to exercise. This is particularly true in the summer with ozone, but it can be true with particulate pollution as well, both summer and winter. So really think hard about timing and place for outdoor activity.

If its possible to find a silver lining to lockdowns during the pandemic, our air quality has improved. Remote work has been recognized for a long time as one way to improve air quality. We used to think that only a few special businesses could do it and that it would be very hard to do more broadly. The lockdowns made us discover that large numbers of people could work remotely, stop or decrease their daily commutes, and cut down on the vehicle portion of pollution.

Overall, air quality has improved in the last few years. Efforts by theEnvironmental Protection Agency (EPA)promoting cleaner fuels and more efficient, cleaner vehicles has been a huge help. The emissions per mile driven in our state has actually gotten considerably better. A little over half of the PM 2.5 pollution we see during the winter comes from mobile sources: cars, trucks, and off-road vehicles. The less we drive and the cleaner the cars, the better for our air.

A small amount of particulate PM 2.5 comes from the large smoke stacks that we worry about. We worry, because we can see them. But those big stacks at places such as Kennecott are pretty heavily regulated, and they have improved considerably in response to these regulations. That doesnt mean we shouldnt improve them further. We also need civic and state leadership to think about strict regulations for new industrial operations, such as the proposed inland port in Salt Lake City, to avoid adding to our pollution burden.

A third class of air pollution comes fromarea sources: our homes, small businesses, and such things as furnaces and hot water heaters. Weve had a lot of improvements on that front. Thanks to theState Air Quality Boardand with support from the legislature, we now have ultra-low NOx hot water heaters going into new buildings. We have improved insulation and the efficiency of heating and cooling. In these area sources, we can really push ahead even more. Anything we do now is a good investment for the future, as opposed to having to retrofit later.

Improving air qualitynowhas long-term benefits, even if it means paying a little more for a car, driving a little less, and altering life at home in terms of insulation and turning thermostats downall little things. Over the last 30 years, the EPA estimates that the cost of improving air quality has been about $60 billion, a big number. And the benefits have been about $2 trillion. There really is a huge return on investment.

Improving air quality will definitely improve our community health. But achieving better air quality will take a combination of personal behavior, political will, and economic incentives. We are far better than we used to be. Nevertheless, even with this improvement, lives are lost every day to air pollution.

It takes all of us participating to further improve the air we breathe. Lets aim for that wonderland of winter when we always see sharp outlines of the beautiful mountains that surround us.

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The air we breathe | @theU - @theU