COVID19 has claimed many lives, especially those who are older and infirm. If we apply the lessons learned from this pandemic, many more lives will be saved over the coming decades, especially in the aged. If our revelations lead to meaningful changes in the way we live, work and study, perhaps, we can prevent or delay those conditions such as Parkinson’s and Alzheimer’s disease which afflict many of us in the golden years.
Among the many revelations with the pandemic is that the stay-at-home order minimizes commuting, which has resulted in a precipitous drop in air pollution. If we can learn to adjust our behaviors in the future, perhaps the pollution levels will remain low. Remarkably, my neurology patients find it delightful to have video conferencing sessions rather than live in office visits.
The patients and families do not have to stagger into the office after fighting Los Angeles traffic, search the parking lot for a parking space, or endure any other unnecessary stresses just to be seen for a medication refill. Instead, they can open an app, push back their bed head hair and join me for a video conference in their pajamas. The prescriptions are electronically filled, and the medications are shipped overnight to their door. They love it. They want to keep this going after the pandemic. I would happily comply if institutions endorse this telemedicine practice in the future.
The nine or so research coordinators and programmers that work with me have also found that the stay-at-home order allows them to focus and be more productive in filing for grants, writing software and putting research materials together.
They too love this new world order. I suspect that other industries and schools will have similar experiences, if they are willing to embrace novelty and can set old behaviors aside.
Growing up in New York City, I have become comfortable with a brownish haze in the air. Naturally, being transplanted to Los Angeles, I found it comforting to be surrounded with air that I could see. When I look out my office window, I usually see a hazy brown fog that obscures the beach and Pacific Ocean only a couple of miles away. After COVID-19, the pollution levels are so low that I can see the tiny and deserted Santa Barbara Island fifty miles out in the ocean. Recently reported satellite maps show a remarkable clearing of pollution clouds from major cities around the world due to global stay at home order.
So how does this revelation regarding COVID-19 relate to degenerative disease of the brain? There are several lines of evidence suggesting that Alzheimer’s disease and Parkinson’s disease may be precipitated by exposure to air pollutants resulting form urbanization and industrialization. Both of these conditions were first recognized in the 1800’s and early 1900’s after the industrial revolution. When we go back in history, there are few references to dementia and very little that would suggest Parkinsonism. Some would say that too many people died at ages too young to manifest these conditions. Interestingly, recent observations of present day hunter gatherer societies seem to demonstrate lifespans long enough to manifest degenerative dementia. However, degenerative dementia seems to be rare in this setting.
One of the most compelling arguments comes from the work of Lilian Calderon Garciduenas and colleagues who have presented evidence that exposure to high levels of air pollution in Mexico City may be causing Alzheimer’s disease, like changes in the brains of young children who have been examined after premature deaths.
We breathe the polluted air into our nose and it gets taken up by the olfactory bulbs and carried into the brain where the destructive process starts many years before manifest dementia. We swallow some of the pollutants which get absorbed in the gut and carried by way of the vagus nerve to the brain. Rhinitis, chronic cough and asthma are well known complications as well. While we have managed to temporarily stop the assault of pollutants, the challenge will be to change our behavior in the future and come up with productive ways to minimize commuting and give humankind a much needed breath of fresh air.