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By Dr. Mattias Larsson, Dr. Brian McNaull*

Việt Nam has with the Covid-19 response shown an impressive determination to proactively protect community health through early detection and testing, contact tracing, quarantine, closure of schools and social distancing. This strategy has been very successful, as the pandemic has been spreading from neighbouring China to Europe, the US and globally. This effort has not been without sacrifices and costs, Prime Minister Nguyễn Xuân Phúc has stated that Việt Nam has to “accept the sacrifice of economic interests to protect people’s health.”

What if this determination could also be applied for other public health challenges in Việt Nam? We have already written about how these measures could inform the prevention of Hospital Acquired Infections with antibiotic resistant superbugs https://Việt Namnews.vn/life-style/653446/can-virus-offer-lessons-for-superbugs.html

Have you ever woken up in the morning looking out on the haze, felt an itch in the throat and eyes, with a runny nose?

This is how most people experience the arguably most urgent health disaster in Việt Nam - the effects of air pollution. Hà Nội last year ranked as the second most polluted city in Southeast Asia after Jakarta with an Air Quality Index (AQI) often hovering around 200. This means that Hanoian’s breath air that is classified as unhealthy or very unhealthy most of the time. Hồ Chí Minh City mostly has lower AQI but still commonly classified as unhealthy for sensitive groups.

As physicians in FMP we often see children and adults with allergic rhinitis, cough, runny nose, itchy eyes and asthma. These are the earliest and most common symptoms of exposure to air pollution. Allergy tests are commonly not conclusive as air pollution is a multitude of chemical compounds. For allergic reactions there is no cure, just symptomatic treatment with medicines as antihistamines.

But what are the long-term consequences of air pollution? How does it affect the individual’s health? What are the preventable morbidity and mortality as well as costs for pollution?

A lot of diseases are related to pollution. Particulate matters (PM), micro particles with a diameter of 2.5 microns or less (PM2.5), penetrate deep into the lungs and cardiovascular system, increases the risk of pneumonia, asthma, stroke, heart attack, chronic obstructive pulmonary disease, emphysema and lung cancer. Ozone in the air can cause breathing problems, trigger asthma, reduce lung function and lead to lung diseases. Exposure to nitrogen dioxide (NO2) aggravates symptoms of bronchitis in asthmatic children. Sulfur dioxide (SO2) can affect the respiratory system and causes irritation of the eyes. 

For children the health effects are especially harmful, they have more vulnerable lungs and a faster breathing rate, hence get higher exposure of pollutants than adults. The effects accumulate with time, so growing up in constant exposure in a polluted environment will increase the risk for all mentioned diseases. High level of air pollutants is clearly associated with an increased risk of hospital admissions for pneumonia and cardiovascular conditions according to studies in HCMC and seven hospitals in Northern Việt Nam.

Air pollution is “a silent killer” and according to WHO one of the major causes of mortality. In the Western Pacific Region an estimated 2.2 million deaths per year, in Việt Nam more than 60 000, more than traffic accidents with 11,000 deaths.

Air pollution cost a lot of money. The economic burden of air pollution due to disease and early deaths is huge, estimated at 5-7 per cent of Việt Nam’s GDP, US$11-16 billion per year, or about $150USD per person and year, including costs for treatments, loss of labour due to disease and death.

Air pollution comes from many sources as coal power plants providing almost half of Việt Nam electricity, heavy industries, traffic as most people have their own combustion engine, waste and agriculture burning and construction works.

Air pollution enhances Global warming where Việt Nam is one of the most effected countries. The Mekong Delta might be under the sea surface in just 30 years. Việt Nam has pledged to reduce emissions in the Paris climate accord, however there is still new coal power plants under construction.

The COVID-19 pandemic has been revealing how fast the local effects of our lifestyle can be changed when human activity is decreased though the society quarantine.  In China and northern Italy, the decrease of air pollution was clearly visualised by satellites. In New Delhi there has been a blue sky and the Himalayas have been visible for the first time in decades. 

What can we do to decrease air pollution and related diseases?

On society level air pollution can be decreased through determination of the same type as the COVID-19 response – in the short term to accept the sacrifice of economic interests to protect people’s health. Invest in clean energy as solar and wind, phase out of coal power, ban fossil fuel vehicles and/or offer tax incentives of electrical vehicles, air quality monitoring systems, measures to minimise emissions targeting the industry, transport, waste management and agricultural burning. In long term this might be economically good investment, improving health and life expectancy, for a developing economy new niches with increasing global demand can be explored.

On an individual level - what can you do to avoid air pollution and prevent associated diseases? Air purifiers indoors can decrease exposure. Face masks may filter some of the polluting particles, however few can filter the small particles. Avoid outdoor activities when AQI is high. If you show allergic and symptoms, come for check-up. You can also actively work in your community for more sustainable energy and decrease of air pollution. — Family Medical Practice

*Mattias Larsson, MD, PhD, Associate Professor, Family Medical Practice Hanoi, Department of Global Public Health, Karolinska Institutet, Stockholm, Honorary Professor, Hanoi Medical University

William Brian McNaull, MD, MPhil (Cantab), DTM&H ( London),  Medical Director, Family Medical Practice Hanoi

For more advice on any medical topics, visit Family Medical Practice Hanoi at: 298 I Kim Mã, Ba Đình. Tel: (024) 3843 0748.  E: hanoi@@vietnammedicalpractice.com.

FMP’s downtown Hồ Chí Minh location is: Diamond Plaza, 34 Lê Duẩn, District 1; 95 Thảo Điền Street, District 2. Tel: (028) 38227848. E: hcmc@@vietnammedicalpractice.com.

FMP Đà Nẵng is located at 96-98 Nguyễn Văn Linh Street, Hải Châu District, Đà Nẵng. Tel: (0236) 3582 699. E: danang@@vietnammedicalpractice.com.