Valle del Sacco – Serious environmental situation and increasing diseases, ultimatum of family doctors

(by Anna Ammanniti) A wild industrial process perpetrated since the 1960s in the Sacco Valley, without respect for the territory, has brought pollution to high levels, to the point that the overload of pollutants, especially chemicals, has contaminated the air, soils and aquifers.

Dr. Teresa Petricca

The increase in respiratory, cardiovascular and cerebral pathologies is a consequence, the killer are the fine particles. In the Sacco Valley, women fall ill with breast cancer even without risk factors, with more metastasizing forms and less responsive to chemotherapy and men experience significant reproductive damage. The Association launches an appeal Family Doctors for the Environment of Frosinone and Province against the serious environmental situation of the area. He denounces the repercussions on the health of the population, proposing a new model for detecting PM.

“In the Sacco Valley some worrying clinical pictures have emerged: an increase in respiratory, cardiovascular and cerebral pathologies; more frequent bronchitis exacerbations and asthma attacks; hypertensive, ischemic, arrhythmic cardiovascular diseases “ points out Teresa Petricca, pulmonologist specialist. Serious health risks are those that the population of the Sacco Valley, in the province of Frosinone, has been experiencing for years. An alarming situation to the point of prompting the Association of Family Doctors for the Environment of Frosinone and Province to write an open letter at the beginning of June to the Minister of Ecological Transition Roberto Cingolani and to the Minister of Health Roberto Speranza to denounce the serious environmental situation. The levels reached have catastrophic potential: the doctors’ appeal is an ultimatum to the institutions.

THE SCENERY – The pollution of the Ciociara area began in the 1960s, when the economic development of the country caused an economic conversion from agriculture to industrialization, a process which, however, in this area had a wild approach, without respect for the territory. Thus was born an important industrial district, especially chemical, but with an overload of pollutants that over the years have contaminated the air, land and aquifers. If several decades are needed for soil and water remediation, an intervention on the air by reducing emissions can be more incisive. The urgency is evident: just think of the high number of women who get breast cancer even without risk factors, in a form that is more metastasizing and less responsive to chemotherapy and the serious plague of reproductive damage of young males in the Valley. of the Sacco.

Teresa Petricca Scientific Manager of the Association of Family Physicians for the Environment of Frosinone and Province, emphasizes: “Already since 2014 we have seen more serious clinical pictures than in the past: an increase in respiratory and cardiovascular diseases; more frequent bronchitic exacerbations and asthma attacks that affected even the most advanced ages; a greater difficulty of therapeutic approach and a high representativeness of hypertensive, ischemic, arrhythmic cardiovascular diseases with cerebral stroke events. In that year, a survey of about 3500 Frosinone citizens over 14 of both sexes showed that the prevalence of asthma was double the national average; COPD was even triple. Since that time we have refined our research in order to study the harmful effects of dust on health. In 2016, the regional data showed that at the Bambin Gesù hospital the prevalence of children hospitalized for asthma was that relating to the Frosinone area. During the same period, again for the ASL of Frosinone, the deaths from COPD after 30 days from the first hospitalization represented more than double the regional average, while the percentage of mortality due to system diseases circulatory was 44.5%, compared to 36.3% in the Lazio Region. From these data we must start again. For the protection of health, primary prevention does not lie in early diagnosis, but in the intervention on the environmental causal factors of diseases, including PM for air pollution, which represent the international study marker “.

THE DETECTION PROBLEM – “The old management of ARPA – Regional Agency for the Protection of the Environment measures dust with a methodology based on an average of 24 hours. However, this approach does not allow us to know when the dust concentrates and what the most dangerous times are. ” The family doctors explain. “The first objective of the Association of Family Doctors for the Environment of Frosinone and the Province was to overcome the ARPA detection method to define
the real danger of dust in relation to peaks, during which it may be appropriate to avoid letting out the elderly, children, pregnant women, asthmatics and people with respiratory problems “. Dr. Petricca highlights:” In addition, a greater number of control units: in Frosinone there are two ARPA control units, one for PM 2.5 and PM 10 and one that records only PM10. In all of Ciociaria, for PM2.5, the most dangerous, there are only two ”.

THE EFFECTS OF POLLUTION ON HEALTH – Fine particles are particles emitted into the atmosphere that derive from combustion phenomena (car engines, chimneys, factories, etc.). The definition of PM10 and PM2.5 is based on the particle diameter (10 and 2.5 microns). These corpuscular elements once released into the atmosphere are inhaled and pass through the trachea, the pulmonary branches, until they pass the capillary alveolus barrier and spread into the bloodstream. From here they reach, within a few minutes, all the organs including the heart. The presence of fine particles inside the coronary arteries causes an inflammatory reaction with activation of coagulation factors and subsequent formation of thrombus, which can cause a heart attack. From the Escape Study, European Study of Cohorts for Air Polluction Effects, which enrolled 100,166 people from 7 European countries, with no previous history of coronary heart disease from 1997 to 2007 and followed for 11.5 years, it emerged that for every increase of 5 μg / m³ of the annual mean of PM2.5, there is a 13% increased risk of acute coronary events; for every 10 μg / m³ increase in the annual mean of PM10, there is a 12% increased risk of acute coronary events. The review of the literature unequivocally highlights an association between exposure to air pollution (both short-term and chronic) and the onset of cardiovascular diseases, with particular regard to ischemic heart disease. For this reason, the WHO has included environmental pollution among the top 10 causes of preventable mortality.

FROSINONE THREATENED BY POLLUTION – The city of Frosinone has been known for years for its particulate concentrations above the legal limits, reaching, in winter, even daily values ​​5 times higher than those allowed by the law (PM10: 50 μg / m³ in the Italian state – 25 μg / m³ WHO; PM2.5: 25 μg / m³ Italian state – 10 μg / m³ WHO). Moreover, the same capital is located in the Valle del Sacco, a territory that extends between the province of Rome and Frosinone, declared SIN (Site of National Interest) to represent, like the Terra dei Fuochi or Taranto, a highly dangerous area for health. To aggravate the already compromised situation of air pollution, moreover, the orogeographic characteristic of “basin” which does not allow the dispersion of pollutants present in the air, also favoring stagnation. The Association studied the incidence of Acute Ischemic Heart Disease events in the city of Frosinone relating to two periods subsequently compared: 1st period: 1st October 2019 – 30th November 2019 and then 2nd period: 1st October 2020 – 30th November 2020. The acute ischemic pathology studied involved IMA (Acute Myocardial Infarction, stemi and n-stemi) and unstable Angina (intermediate coronary syndrome). The data relating to the daily averages and the peaks of PM2.5 detected by the ANCLER control units, located in different areas of the capital, during the observation period were acquired. Frosinone was therefore ideally divided into 11 observation areas (number of ANCLER stations present in the area) of which 6 belong to the “Lower zone” and 5 to the “Upper zone” of the city. The entrants to the emergency room were in turn placed according to the distance, calculated as the crow flies, from the home address with respect to the nearest ANCLER control unit. Dr. Petricca explains: “What we found at the conclusion of the study is that in the observation period 1 October – 30 November 2020, acute ischemic heart disease events increased by 67% compared to the same period referring to the year 2019. . The year 2020 recorded a lowering of the average age of onset of acute ischemic events compared to the year 2019, passing from 70 years to 63 years. In 2020, acute events mainly affected the lower part of the city: 50% in 2019, 70% in 2020 as indicated by the control units. “

THE PROJECT OF THE ASSOCIATION FOR THE PROTECTION OF HEALTH – The Association of Family Doctors for the Environment of Frosinone and the Province gathers various indigenous technical and scientific professionals such as doctors, engineers, computer scientists, patient associations, local administrations. It represents a concrete commitment of civil society with the primary objective of health protection. A first result has already been achieved: the creation of an effective dust monitoring model, the “ANCLER” system. “Thanks to the Association it was possible to apply multiple detection units for PM10, PM2.5 and for the first time PM1. These are optical reading control units, low cost, limited weight, connected to a digital platform, usable anywhere and by anyone who wants to use them, including personal ones. They represent a practical, simple and immediate tool to access the data of the air condition through applications that can be consulted from the mobile phone, for a better usability of the air according to daily activities. Knowledge of the environmental condition becomes democratic and free. Many damage to health can be avoided by knowing the most critical moments of high concentrations of fine particles. For the first time it is possible to multiply the territorial surveys, allowing to map in a capillary way the concentration of dust in many different areas of the same city to study cardiovascular and respiratory diseases in these micro-areas and relate them to the concentration of the dust itself. The urban areas are thus identified according to the different concentration of PMs, to the point of forming an observational network that has no equal on the national territory. Thanks to multiple recordings that are repeated every 5 minutes, the sensors are able to automatically and continuously determine and describe a curve over the entire 24-hour period. This tool allows you to measure the PM of each city area, going well beyond traditional methods. All this allows for
understand the intimate relationship between PM and natural phenomena that determine the concentration of dust and their changes in certain places and times, between PM and anthropogenic phenomena as well as between PM, diseases and deaths. The unparalleled wealth of information makes it possible to evaluate different choices that may impact on the environment: the knowledge of the different concentrations of PM in the different areas can constitute the starting point for the redistribution of city traffic, for example, or the method for identifying areas to be use as playgrounds or the social life of the elderly. The project was primarily shared by the municipal administrations of Frosinone and Anagni. The hope is that it will be a starting point for a turnaround involving the whole territory. Now we need a wider dissemination and awareness of the situation ”.

Anna Ammanniti

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