Former AIIMS, Delhi Director Dr Randeep Guleria, now serving as chairman, the Institute of Internal, Respiratory & Sleep Medicine at Medanta Hospital, Gurugram, tells Ashish Srivastava that air pollution should be declared as a public health emergency and current air quality standards must be revised. He also urged people to influence policymakers to take sustainable measures to address the crisis. Excerpts::
What are the trends you are seeing in patients, especially after Diwali??
Unfortunately, it has become a regular affair that the pollution levels around Diwali go up and in the subsequent days, admissions in wards and influx in OPD rises. Patients with history of respiratory illness get worse. While patients without history of respiratory issues are not landing up in emergency, many are exhibiting airway irritating problem, acute bronchitis and asthma like symptoms.
Experts say that pollution is increasing death rate but is there any direct link to substantiate it?.
You can’t have direct evidence because we don’t have direct tests to ascertain whether a patient died of the air pollution. It’s always extrapolated in terms of increasing hospital admissions and based on modeling data. But these data are quite robust because they have been done in huge population abroad where they looked at number of cities and compared the mortality with the change in ambient air quality of those regions. Pollution is a silent killer. There are large number of studies which have attributed pollution as the fourth most common cause of mortality after tobacco use, high BP and cardiac issues.
Isn’t it high time we declare pollution as a public health emergency?
Indeed. Every year we see acute spurts where AQI goes in severe or very severe range causing increase in hospitalization of patients with underlying cardiac-respiratory disease. Besides, for at least 50 % the year, most cities in the country, especially from the Indo-Gangetic plain, remain in the poor range. This has long-term health impacts. In children, growth of lungs gets stunted; in elderly, risk of stroke, dementia, heart attack, and chronic respiratory diseases increases. A lot of systematic diseases are now being linked to pollution like diabetes. Some studies also suggest that risk of lung cancer goes up to some extent in people who are exposed to pollution continuously.
India had last revised its air quality standards in 2009. Do you think it needs an update?
The WHO changed its AQI standards in 2021. Now annual average concentrations of PM2.5 should not exceed 5 μg/m3. Previously, it was 10. Now, data suggests that even 10 can be harmful. But In India, the permissible range is 60. If you look at the last 5 years, except for 2020, all the other years AQI is in the good range less than 10 or 15% of the time. So we have very few good days. If we adopt current WHO standards, then we don’t have any good air days. We are not even able to meet the benchmark of current AQI standards. The guidelines should be revised.
How can the general public contribute in tackling the menace?
Public should influence policymakers to be proactive and achieve the goals through practical and sustainable manner with set timelines, rather than imposing knee-jerk reactions.
Do you think that air purifiers, smog towers or oddeven scheme work?
There is no solid evidence that suggests air purifiers work as effectively as they claim. The benefits are very mild but not very clear. Smog towers offer some degree of benefit but only upto very small area around them. Even data of previously imposed odd-even schemes suggest that they did not make any huge difference in mitigating pollution. We need to find sustainable solutions.