Air pollution has emerged as the scourge for India’s urbanites, who continue to breathe toxic air risking their lives day in and day out. The Great Smog of Delhi is surely a wake up call for us to get our acts together to create livable and healthy cities of tomorrow.
Delhi NCR looked like a war zone on the morning of November 7 with the average air quality index (AQI) reaching as high as over 400 on a scale of 500 in many places by 10 am. Delhi Chief Minister Arvind Kejriwal termed the national capital as a “gas chamber”, even as the particulate matter levels kept on hovering way past the prescribed limit of 60 µg/m3 for PM2.5 and 100 microns per cubic metre for PM10 during the following week.
The Indian Medical Association (IMA) declared a public health emergency and asked the government to cease all outdoor activities and stop sports activities in schools. They also warned residents against venturing outdoors.
Taking note of the severity of the air pollution, the Ministry of Health and Family Welfare too issued a health advisory on November 8 asking people to “remain indoors if you have breathing difficulty and try to keep children indoors as much as possible”. “Avoid morning walk or any other strenuous outdoor activity that increases breathing rate and drink plenty of water and fluids,” the advisory said.
Dubbed the Great Smog by The Indian Express, it was the worst spell of pollution in the National Capital Region in years with huge health ramifications for the nearly 25 million people who got affected by it.
How severe was the Toxicity in the Air?
Amidst allegations and counter allegations — a game our governments have mastered over the years to shift the blame on issues pertaining to public interest (read health here) — the residents of Delhi and NCR suffered in silence. The farmers engaged in stubble burning in the adjoining states of Haryana and Punjab were blamed for poisoning the air in the city and its neighbouring areas.
Many health practitioners equated inhaling this air with smoking 50 cigarettes a day! It was a complex mixture of pollutants like carbon monoxide, nitrogen oxides, sulfur dioxide, ground level ozone and hydrocarbons, among others.
These pollutants can cause severe damage to crtical organs like lungs and heart. "In a landmark study published recently, it was observed that after analysing 16,000 heart attacks which occurred in the Salt Lake City area of Utah from 1993 to 2014, poor air quality was associated with higher incidence of heart
attacks or worse clinical situation. According to the study authors poor air quality or smog is one important reason for developing worst kind of heart attack and premature death," says Dr Arun Kochar, Senior Consultant, Cardiology, Fortis Hospital, Mohali.
But sadly, there are not too many studies undertaken in India to link smog and incidence of heart attacks. Karen Cady-Pereira, a remote sensing scientist at Atmospheric and Environmental Research, an environmental consulting firm in Lexington, Massachusetts, has been studying air pollution above 18 of the world’s megacities, metropolitan areas with 10 million or more people since 2013.
She and her team have measured levels of ammonia, formic acid, methanol, and ozone with an instrument called the Tropospheric Emission Spectrometer aboard NASA’s Aura satellite, which studies Earth’s atmosphere.
The team found that when it comes to ammonia, a gas that helps form airborne particles that can trigger lung disease, some cities like Kolkata exceeds the “harmful” threshold 47.1% of the time, while Delhi exceeds it 73.5% of the time when the satellite passes over the city.
Ammonia comes from livestock excrement and fertilizer and is more common in cities surrounded by lots of agricultural activity, as is the case with Delhi.
In terms of Ozone level, Delhi exceeds the “harmful” threshold limit 26.3% of the time.
Ramifications for Health
“It is not only important what we eat and how we manage everyday stress, but also what we breathe. It has been advised that people who have risk factors for heart disease should take adequate precautions during days of extreme air pollution. Staying away from vehicular traffic, protecting from petrol exhaust, avoiding going out in peak rush hours, checking out daily local Air pollution forecasts, avoiding cigarette smoke at all times and regular check on air filters of air conditioners are few of the important steps in preventing adverse events,” suggests Dr Kochar.
Vulnerable groups like children, senior citizens and people with low immunity become more prone to infections and diseases like pneumonia when exposed to smog.
“When fog combines with smoke, it becomes smog. In Delhi and its surrounding areas having polluted air mainly due to vehicular emissions, industrial and agricultural activities, health risks rise many fold for these vulnerable groups, especially for people with bronchial asthma, bronchitis, chronic obstructive pulmonary disease (COPD), heart disease, diabetes, HIV, cancer, etc., or a person above 55-year- olds, or young children,” says Dr Rakesh Gupta from the Internal Medicine Department of Indraprastha Apollo Hospital.
It is, therefore, important that we should recognise high risk groups — those with high blood pressure, high cholesterol levels, smokers or those with allergies or lung disease — and take adequate precautions as during increased particulate matter in the atmospheric air could lead to increased incidence of heart attacks and lung diseases.
According to Dr Shikha Sharma, Founder, Dr Shikha’s NutriHealth, it is an obvious fact and experts also opine that this haze and smog is not only dangerous for our lungs but also our overall health.
“For those with breathing problems, this air can spell disaster. Polluted air can interfere with lung function. If the lung function is harmed, the bronchi or alveoli are also going to be damaged. Lungs are responsible for oxidation and any issues there can mean trouble for the whole of your body. Pollution can cause a spectrum of health problems including allergies and respiratory conditions, malformations, growth restrictions, and even cancer,” Dr Sharma says.
How Delhi Fares in Terms of Pollution Level vis a vis Other Cities?
“According to the World Health Organization, Delhi is the most polluted city in the world. Although Beijing has been notorious for poor air quality, experts warn that it is not as dangerous as the air quality of India’s capital,” adds Dr Sharma.
The Real-time Air Quality Index (AQI), which uses the traditional 0-500 AQI scale based on the US EPA standard for indexing the pollution, frequently rates Delhi’s air as “Unhealthy for Sensitive Groups”. An AQI of 0-50 means the air quality is considered satisfactory, and air pollution poses little or no risk; the air quality in 50-100 range is considered acceptable, however, for some pollutants there may be a moderate health concern for a very small number of people who are unusually sensitive to air pollution.
However, the AQI in the range 100-150 is considered as unhealthy for sensitive groups as members in these groups may experience health effects, though the general public is not likely to be affected.
The AQI range from 150 to 200 and beyond that is unhealthy for everyone as they may begin to experience health effects, while members of sensitive groups may experience more serious health effects.
The WHO database of 2016 contains results of outdoor air pollution monitoring from almost 3,000 towns and cities in 103 countries. The database has as many as 34 Indian towns and cities in the top 100 most polluted cities with Gwalior and Allahabad acquiring the number 2 and three spots, while the national capital Delhi comes in at number 11 position when it comes to quality of air.
The WHO database is represented by the annual mean concentration of particulate matter (PM10 and PM2.5).
Preventive Care — The Indian Way
“Avoid smoking, tobacco, and the use of sprays and room fresheners as these can aggravate the effects of pollution further. Make sure to eat warm, home cooked food incorporating turmeric, cayenne pepper, carom seeds, ginger, and basil leaves. Practicing simple yoga techniques like pranayam, kapalbhaati, and jal neeti can also help tackle the ill effects of pollution,” says Dr Sharma.
There are many preventive care tips which one can take to manage and tackle pollution in our cities. Many of these can be done in the comfort of our homes. The Indian kitchen is also a storehouse of medicinal herbs and plants which can help tackle pollution and its effects very well.
1) Neem
Many herbal preparations can be made with Neem. These adsorb pollutants and have detoxification properties. It is good to put some neem leaves in hot water before taking a bath. This will help in clearing the pollutants that are stuck to our skin and mucosal membrane. Eating three to four neem leaves twice a week can also help in purifying the blood and lymphatic tissue.
2) Tulsi
Tulsi (basil) is the most revered of all plants in India. Every household has a tulsi plant, and if not, should take care to plant one. It helps in absorbing harmful pollutants. Drinking tulsi juice every day helps in clearing pollutants from the respiratory tract.
3) Water
It may sound very basic but the effectiveness of drinking water to get rid of pollution in the body cannot be underestimated. Water helps in diluting the pollutants in the body which get easily excreted by the kidneys.
4) Ghee
Putting two drops of cow ghee in each nostril daily, once in the morning and once at night helps in clearing the pollutants. Consuming ghee every day also helps to chelate the toxic effects of lead and mercury, which are the byproducts of air pollution. Ghee prevents the accumulation of these chemicals in the bones, kidneys, and liver.
5) Pippali
Known as a super herb, Pippali helps in purifying the lungs and in easy breathing. It has rejuvenating properties which can help during a lung infection. Consume 1/8 teaspoon Pippali powder with ¼ teaspoon Ginger and ¼ teaspoon turmeric, mixed in 1 tbsp honey, accompanied by warm water.
6) Triphala
One of the main reasons for an imbalance in tridosha is pollution. This can be restored with the help of Triphala. It also boosts immunity. The ideal dosage is one tablespoon of Triphala with 1 teaspoon of honey at night.
7) Pomegranate Juice
It purifies blood and protects the heart.
8) Massage
Abhayangam or a daily full-body warm oil massage is a powerful way to recharge the body and mind.
9) Steam
You can take steam for about five minutes twice a day. Add 5 to 10 drops of eucalyptus oil or a drop of peppermint oil for better effect.
“As recommended, all vulnerable groups along with normal populace should take ‘Blue Vaccine’ or an ‘Influenza Vaccine’ once-and-every year to prevent infections such as pneumonia. Although various medicines are available for an already pneumonia-infected person, however, if the vaccination is taken on time—usually before the disaster like the current smog strikes—one can be safe from the infection. The government should also promote the use of this vaccination on a larger scale,” suggests Dr Rakesh Gupta of Apollo.
Air Purifiers as Effective Solutions
Although doctors are divided on the efficacy of air purifiers in controlling air pollution, these products definitely help in helping you breathe easy in the comfort of one’s homes. Their usefulness within the walls of our homes can’t be denied.
According to some media reports, the sharp decline in the air quality of Delhi has spurred the demand for air purifiers in the city. In fact, players like Philips, Blueair, Atlanta Healthcare, Honeywell, NatéoSanté and SHARP are already in the market to help people take on the health challenges posed by air pollution, although in a limited way.
Lessons from China
Much like Indian cities, Chinese cities too are grappling with the problem of air pollution. According to Chinese news agency Xinhua, China has introduced a four-tier warning system for severe weather with red being the most serious, followed by orange, yellow and blue.
A red alert is issued under two different circumstances – if a city’s Air Quality Index (AQI) reaches 500 and if there are four consecutive days of heavy air pollution with AQI over 200. Two days of severe air pollution (AQI over 300) can also call for a red alert, according to Xinhua.
A red alert means that production at factories and industrial sites, including steel and cement plants, as well as mines are halted. Vehicles with low emission standards and trucks transporting construction waste are also banned from the capital’s roads till the situation improves. China has also experimented with building matrials that can absorb pollutants.
