2.1 Understanding the population burden and identifying populations at risk –
Harmonizing cohort studies and surveys across the EU. Many countries are basing their assessments on clinical case series and ad hoc data collection. They are also considering using available cohorts as well as new survey panels. It is critical to harmonize the studies to ensure comparability between various contexts. Large consortia or population and patient cohorts in the EU will have the potential to evaluate the effects of the environment on COVID-19, identify susceptible groups and examine the interaction between the pandemic and the response to the pandemic with health effects related to environmental exposures. Large new studies or existing cohorts may have the capacity to allow estimation of the associations between COVID-19 incidence/prevalence, underlying chronic diseases and long term exposures in previous years that may be related to cardiometabolic and/or pulmonary health including air pollution, lifestyle (e.g. smoking, diet, physical activity, mobility), indoor pollution, green/blue spaces, noise, chemicals, contaminants in drinking water, as well as policy approaches and intervention strategies chosen in various countries. The assessment of sero-prevalence and host genetics allows to study the impact of environmental exposures in modulating immune responses during the pandemic. From a larger medical perspective, an important issue to consider is the delay in prevention (including, but not only, medical prevention such as routine vaccinations, cancer screening programmes), diagnosis and therapy for other diseases during the crisis and the public health implications.
2.2 COVID-19 and Climate change impacts.
Short term studies are needed to address the possible impacts of combined COVID-19 and heat waves. It is unclear at this stage whether co-occurrence of heat waves and active COVID-19 epidemic is possible, but if this happens, the stress on the health system could be severe. The impact of spatial and temporal variation of temperature, humidity, UV radiation and COVID-19 on morbidity and mortality should be evaluated, as well as the impact of control measures during heat waves. The vulnerability of the health system is a major point.
2.3 COVID-19 and air pollution.
Rapid communications have highlighted relevant and potentially controversial aspects that need systematic scientific assessments: link between highly polluted areas and virus spread and impact; synergistic health impacts of air pollution and COVID-19 and severity of the disease; impacts of air pollutants on virus entry and pathogenesis (e.g. NO2, O3, particles); role of 3 allergens; contribution of agricultural practices. All these issues are relevant and require short term validation to support public action.
2.4 COVID-19 and toxicants.
Higher burdens of exogenous toxicants can alter immune response, metabolism during stress or shock, and adversely impact cardiometabolic and respiratory function, all of which are relevant to this pandemic. Little is known about the possible contribution of chemicals which target the immune and vascular systems to the severity of the disease. Such evidence should expedite action limiting exposure to the most relevant chemicals.
2.5 Social economic and psychological impacts of COVID-19.
There are several research needs that can be best examined through the harmonization of cohort studies described in 2.1, specifically the impact of COVID-19 and associated countermeasures and consequences (loss of movement, loss of livelihood, uncertainties and mixed messages) on anxiety and mental health, on social interactions and quality of life taking into consideration cultural differences and social and health inequalities. This includes also development and validation of strategies to mitigate these effects and build resilience in affected populations and society in general. Many of these aspects are related to disasters in general, thus the importance of drawing from the lessons and experience of other disaster situations (natural and technological) in the process.
2.6 Integrated Health and social Impact modelling and assessment
Integrated Health and social Impact modelling and assessment
of COVID-19 and related intervention strategies, confinement, improved environmental conditions (e.g. air quality), economic crisis and its social/health implications, environmental health inequalities and inequalities in access to environmental goods (such as parks, private garden, etc.). Improved assessment could guide political decisions for the post-crisis period.
2.7 Coordination of health and environmental impact prediction capacities across the EU.
A coordinated effort at the EU level would be very helpful to enable and support effectively public interventions and enhance preparedness with quantitative evidence and state-of-the-art harmonized computational capacities, methodologies and tools. This could lead in the medium/long term to a sustainable infrastructure or network, but a short term coordination is helpful to improve the methodologies and harmonize the scientific support to public decisions.