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The under-reported role of toxic substance exposures in the COVID-19 pandemic.

  • Kostoff, Ronald N1
  • Briggs, Michael B2
  • Porter, Alan L3
  • Hernández, Antonio F4
  • Abdollahi, Mohammad5
  • Aschner, Michael6
  • Tsatsakis, Aristidis7
  • 1 Research Affiliate, School of Public Policy, Georgia Institute of Technology, Gainesville, VA, USA. Electronic address: [email protected] , (Georgia)
  • 2 Roscommon, MI, USA.
  • 3 School of Public Policy, Georgia Institute of Technology, Atlanta, GA, USA; Search Technology, Peachtree Corners, GA, USA. , (Georgia)
  • 4 Department of Legal Medicine and Toxicology, University of Granada School of Medicine, Health Sciences Technological Park, Granada, Spain. , (Spain)
  • 5 Department of Toxicology and Pharmacology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. , (Iran)
  • 6 Department of Molecular Pharmacology, Albert Einstein College of Medicine, New York, NY, USA; IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
  • 7 IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; Laboratory of Toxicolgy and Forensic Sciences, Faculty of Medicine, University of Crete, 71003, Heraklion, Greece. , (Greece)
Published Article
Food and chemical toxicology : an international journal published for the British Industrial Biological Research Association
Publication Date
Nov 01, 2020
DOI: 10.1016/j.fct.2020.111687
PMID: 32805343


Coronavirus disease 2019 (COVID-19) and previous pandemics have been viewed almost exclusively as virology problems, with toxicology problems mostly being ignored. This perspective is not supported by the evolution of COVID-19, where the impact of real-life exposures to multiple toxic stressors degrading the immune system is followed by the SARS-CoV-2 virus exploiting the degraded immune system to trigger a chain of events ultimately leading to COVID-19. This immune system degradation from multiple toxic stressors (chemical, physical, biological, psychosocial stressors) means that attribution of serious consequences from COVID-19 should be made to the virus-toxic stressors nexus, not to any of the nexus constituents in isolation. The leading toxic stressors (identified in this study as contributing to COVID-19) are pervasive, contributing to myriad chronic diseases as well as immune system degradation. They increase the likelihood for comorbidities and mortality associated with COVID-19. For the short-term, tactical/reactive virology-focused treatments are of higher priority than strategic/proactive toxicology-focused treatments, although both could be implemented in parallel to reinforce each other. However, for long-term pandemic prevention, toxicology-based approaches should be given higher priority than virology-based approaches. Since current COVID-19 treatments globally ignore the toxicology component almost completely, only limited benefits can be expected from these treatments. Copyright © 2020 Elsevier Ltd. All rights reserved.

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