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Since the rise of the Covid-19 pandemic, several researchers stated the possibility of a positive relationship between Covid-19 spread and climatic parameters. An ecological study in 12 Iranian cities using the report of daily deaths from Covid-19 (March to August 2020) and validated data on air pollutants, considering average concentrations in each city in the last year used to analyze the association between chronic exposure to air pollutants and the death rate from Covid-19 in Iran. Poisson regression models were used, with generalized additive models and adjustment variables. A significant increase of 2.7% (IC(95%) 2.6–4.4) was found in the mortality rate due to Covid-19 due to an increase of 1 μg/m3 of NO 2. The results suggest an association between Covid-19 mortality and NO 2 exposure. As a risk approximation associated with air pollution, more precise analysis is done. The results also show a good consistency with studies from other regions; this paper's results can be useful for the public health policymakers and decision-making to control the Covid-19 spread. • A reliable Covid-19 data from Iran was used in this paper. • 12 cities were considered from all of the minor climate conditions of the country to minimize the climate bias. • Correlation of the air pollution and the other most effective diseases on the Covid-19 is also studied. • Nox was the most effective particle and had a significant impact on the Covid-19 mortality rate. • For a 1% increase in the NO 2 concentration, there will be a 2.7% increase in the Covid-19 mortality rate. [ABSTRACT FROM AUTHOR]

One of the problems hardly clarified in Coronavirus Disease 2019 (COVID-19) pandemic crisis is to identify factors associated with a lower mortality of COVID-19 between countries to design strategies to cope with future pandemics in society. The study here confronts this problem by developing a global analysis based on more than 160 countries. This paper proposes that Gross Domestic Product (GDP) per capita, healthcare spending and air pollution of nations are critical factors associated with fatality rate of COVID-19. The statistical evidence seems in general to support that countries with a low average COVID-19 fatality rate have high expenditures in health sector >7.5% of GDP, high health expenditures per capita >$2,300 and a lower exposure of population to days exceeding safe levels of particulate matter (PM 2.5). Another relevant finding here is that these countries have lower case fatality rates (CFRs) of COVID-19, regardless a higher percentage of population aged more than 65 years. Overall, then, this study finds that an effective and proactive strategy to reduce the negative impact of future pandemics, driven by novel viral agents, has to be based on a planning of enhancement of healthcare sector and of environmental sustainability that can reduce fatality rate of infectious diseases in society. • Expenditures in health sector >7.5% of GDP can reduce COVID-19 mortality between countries. • Health expenditures >$2,300 per capita can lessen COVID-19 mortality between countries. • Lower exposure of population to days having high levels of air pollution reduces COVID-19 mortality. • High health expenditures reduce COVID-19 mortality, though a high share of older population. • Efficient healthcare sector and environmental sustainability minimize case fatality rates of COVID-19. [ABSTRACT FROM AUTHOR]