key: cord-0993688-9y9wvnv3 authors: Hashemi, Fallah; Hoepner, Lori; Hamidinejad, Farahnaz Soleimani; Abbasi, Alireza; Afrashteh, Sima; Hoseini, Mohammad title: A survey on the correlation between PM(2.5) concentration and the incidence of suspected and positive cases of COVID-19 referred to medical centers: A case study of Tehran date: 2022-04-19 journal: Chemosphere DOI: 10.1016/j.chemosphere.2022.134650 sha: 24f6b109852e4fb0c8068f46c4059ba49aac43b3 doc_id: 993688 cord_uid: 9y9wvnv3 COVID-19, one of the greatest health challenges of the present century, has infected millions of people and caused more than 6 million deaths worldwide. The causative agent of this disease is the new virus SARS-CoV-2; which continues to spread globally and sometimes with new and more complex aspects than before. The present study is an observational study aimed to investigate the role of AQI; PM(2.5) and its relationship with the incidence of suspected cases (SC) and positive cases (PC) of COVID-19 at different levels of the air quality index (AQI) in Tehran, the capital of Iran in the period from Feb 20th, 2020 to Feb 22nd, 2021. Data on AQI were collected online from the air monitoring website of Air Quality Control Company under the supervision of Tehran Municipality. The data on suspected and positive cases were obtained from the Iranian Ministry of Health. The results and statistical analysis (Pearson correlation test) showed that with the increase of AQI level, the number of suspected cases (SC) and positive cases (PC), also increased (P-value<0.01). The average daily number of suspected and positive COVID-19 cases referred to medical centers, at different levels of the AQI was as follows: level II: yellow, moderate (SC: N(ave) = 466; PC: N(ave) = 223), level III: orange, unhealthy for sensitive groups (SC: N(ave) = 564; PC: N(ave) = 275), and Level IV: red, unhealthy (SC: N(ave) = 558; PC: N(ave) = 294). The results of the GEE for seasonal comparison (winter as reference season), showed that there is an epidemiological pattern in autumn with colder weather compared to other seasons in both suspected (Cl: %95, B = 408.94) and positive (Cl: %95, B = 83.42) cases of COVID-19. The results of this study will serve policymakers as an informative tool for guidance on the importance of the role of air pollution in viral epidemics. Nowadays, COVID-19 disease, as one of the most important viral pandemics as well as a serious 48 threat to human health, has become one of the main challenges in the World Health Organization. 49 Historically, epidemics, war, natural disasters, and other health care emergencies, have had adverse According to the data obtained from Tehran Air Quality Control Company, almost all year round, 93 PM2.5 has been reported as an indicator pollutant. Therefore, in this study, the AQI in terms of 94 PM2.5 has been investigated. The present study was conducted in the form of an observational study 95 in Tehran province, Iran. This city is considered as one of the most polluted cities in the world in In this study, two hypotheses have been tested using AQI in terms of PM2.5 as well as the obtained 112 data related to suspected and positive cases. The first hypothesis: An increase in the AQI in terms of PM2.5 is associated with an increase in the 114 number of suspected cases referred to medical centers. Therefore, due to the possible presence of 115 definite cases (Positive cases based on PCR test) and hidden cases (cases that are carriers or 116 suspected cases that have hidden their disease for some reasons such as fearing losing a job, money, 117 quarantine for the whole family, etc.), there is a possibility of virus transmission in these centers. The basis for considering this hypothesis was similar studies that examined the relationship Table 4 . Because of what is called a lack of public support or non-observance of health protocols by the 218 people, several peaks were observed in the graph of the number of suspected and positive cases. The occurrence of these high-risk behaviors has intensified the number of suspected cases when 220 the AQI was in unhealthy conditions in terms of PM2.5 concentration (Fig 1 and Fig 4) . On the 221 other hand, the results showed that whenever people paid attention to the protocols announced by 222 health organizations, the number of positive cases had a constant and decreasing trend (Fig 2 and The results of statistical analysis showed that at a 95% confidence interval, the seasons as an Table 3 . Based on the results of the GEE (Table 4) the AQI was in unhealthy conditions. Therefore, the claim of the authors of this study was based 335 solely on the analysis of graphs, tables, and data. To avoid any bias in the study, it is necessary to 336 explain that the results obtained in the present study can be a clue, and to prove the accuracy of 337 the above results requires further research in the future. Among the limitations we faced were the lack of full access to information and statistics of some influenza in people who later tested positive. Therefore, it seemed logical to classify people with suspicious 344 symptoms into a group of suspected cases, apart from any prejudice. 345 The study did not receive any external funding. The authors declare that: no budget support, no economic relationship, or any other activity has 373 influenced the process of this research by any organization. J o u r n a l P r e -p r o o f J o u r n a l P r e -p r o o f cases. -The average daily incidence of suspected cases was reported in the moderate level. -The average daily incidence of positive cases was reported in the unhealthy level. -Autumn had significant effects on the incidence of suspected and positive cases. 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