On Monday evening, Kathmandu Valley was found to be the most polluted city in the world.

Even before this unwelcome record was registered, the people of Kathmandu had already seen the adverse effects of air pollution on their health.

The number of people visiting Bir Hospital complaining of respiratory problems, in addition to those testing positive for the coronavirus, has increased significantly in the past five days, according to doctors at the hospital.

“The number of coronavirus infected people seeking treatment at the hospital used to be 20 to 25 every day earlier, but this has increased to 35 to 40 for the last five days,” Dr Ashesh Dhungana, a pulmonologist at the hospital, told the Post.

“Patients seeking treatment for other respiratory illnesses like chronic obstructive pulmonary disease and asthma have also risen these days.”

The worsening air quality of Kathmandu Valley could be one of the reasons behind a sharp increase in respiratory problems including the severity in patients infected with the coronavirus, according to doctors.

Kathmandu Valley’s air quality worsened to a record level on Monday.

AQ AirVisual, a Swiss group that collects real-time air-quality data from around the world, ranked Kathmandu as the most polluted city in the world with PM2.5 levels reaching 488 micrograms per cubic meter (μg/m3) at 5:45pm at Ratnapark station as per the United States Environmental Protection Agency (EPA) Air Quality Index.

PM 2.5 refers to particulate matter, or solid and liquid droplets in the air, that is less than 2.5 micrometres, or 400th of a millimetre, in diameter.

As per United States Environment Protection Agency’s air quality index, when PM2.5 reaches 151 to 200 μg/m3, air quality is considered unhealthy; everyone may experience problems, with sensitive groups feeling more severe effects. When it exceeds 300 μg/m3, it is considered “hazardous” for everyone and may prompt emergency condition alerts.

Given that the people of Kathmandu have been breathing such polluted air, around 200 patients complaining of respiratory complications have been seeking treatment at Tribhuvan University Teaching Hospital for the last few days. During the lockdown every day about 30 patients used to seek treatment for such illnesses and around 150 after authorities lifted the lockdown in July.

“Number of people suffering from respiratory complications have increased sharply in recent days,” Dr Niraj Bam, associate professor at the Institute of Medicine, told the Post. “Some of the patients are visiting the hospital in a critical stage and we have to admit them in the intensive care unit.”

According to Bam, the decline in Kathmandu’s temperature and change in the weather could be the reason for the sharp rise in respiratory cases.

Doctors say poor air quality caused short- and long-term effects on public health. Bad air quality can cause pneumonia, bronchitis, conjunctivitis , skin allergy, stroke and heart problems, among others, in the short term and ulcers and cancer of the lungs and intestine, kidney disease and heart problems in the long run.

“Children, pregnant women and elderly people are more at risk of falling ill due to the worsening air quality,” Dhungana, who is also a critical care physician at Bir Hospital, said. “Problems of those having pre-existing respiratory complications will be worsened by the polluted air.”

Doctors advise people to avoid places that are highly polluted and stay at home. But staying in a closed environment could also increase the risk of respiratory infections including the coronavirus.

“Yes, both indoors and outdoors are not safe for us,” Bam, who is also the senior chest physician, told the Post. “We should not forget to wear face masks properly, maintain social distancing and try our best to protect ourselves from possible infection.”

Air pollution level increases more than three fold in the winter season due to natural causes like lack of rainfall and temperature inversion, according to Bhupendra Das, air quality specialist at Nepal Energy and Environment Development Services.

“But Monday's air quality level is 30 times more than the World Health Organization recommended level,” Das told the Post.

When PM2.5, the most dangerous pollutant, crosses 300 μg/m3, it broadly affects everyone breathing the air irrespective of their age group.

But with the Covid-19 pandemic, the alarming rise in air pollution is an added worry.

Studies have shown that most polluted cities—including Kathmandu and New Delhi of India—had been severely affected by the coronavirus outbreak.

The study, published in Cardiovascular Research, a journal of European Society of Cardiology, estimated that about 15 percent of deaths worldwide from Covid-19 could be attributed to long-term exposure to air pollution.

Another new study by researchers at Harvard University has shown that people infected with Covid-19 who live in areas with high levels of air pollution are more likely to die from the illness than those who live in less polluted regions.

Environmentalist Bhushan Tuladhar said that deterioration of air quality to the record level is a condition of emergency, as per the Kathmandu Valley Air Quality Management Action Plan-2020, issued by the government last year.

“Public should avoid the pollution and authorities should implement the Kathmandu Valley Air Quality Management Action Plan-2020,” Tuladhar told the Post.

The government will swing into action like imposing odd-even formula for vehicles plying in Kathmandu Valley, or even stopping vehicles in some parts and shutting down schools if required in case the public health emergency would be declared due to poor air quality, according to the action plan.

The proposed action plan has objectives to get rid of the toxic quality of air by controlling air pollution emanating from the transport sector, construction sites, industries, and unhealthy means of managing solid waste. Besides, it also talks about reducing indoor air pollution, raising awareness regarding sources of air pollution, its effects and how to minimise them.

Meanwhile, the Department of Environment, issuing a statement on Tuesday, urged children and elderly people suffering from respiratory problems like asthma and cough and heart conditions to remain indoors.

“We would like to urge all not to come out of their homes, if possible and take special precaution while coming out,” Mukunda Prasad Niraula, director general at the department, said.

Apart from the Kathmandu valley, the air quality in Nepalgunj and Biratnagar is also found to have reached hazardous levels. The department has asked the city’s residents to take precaution and requested them not to burn waste materials, which increases air pollution.

“As air pollution also depends on weather and if the weather condition remains the same, the air quality may also remain the same or worsen further,” reads the statement.

Air pollution in the mornings and evenings is worse, according to the Department of Environment.

Das, the air quality specialist, said agencies under all three tiers of government—federal, provincial and local—should coordinate to lessen the source of pollution.

“It is a health emergency,” Das said. “We should take maximum precaution to avoid possible complications.”