People who hate on Miami seem to have two main complaints: It's too hot, and there's too much traffic. But in coronavirus times, those grievances might actually be fatal — record-high temperatures from global warming plus too many cars on the road have made Miami's air polluted with ozone, and new studies show there might be a link between air quality and COVID-19 deaths.

A report released this week by the American Lung Association shows the extent of South Florida's air pollution. Based on data from the Environmental Protection Agency (EPA) from 2016 to 2018, the Miami area ranked 81st of 228 metropolitan regions in terms of the number of days with high ozone pollution. That’s three spots ahead of where the region ranked last year.

And that could spell bad news for South Florida during the pandemic. Recent studies from Harvard and Aarhus University in Denmark suggest areas with the most air pollution are more likely to have higher death rates from COVID-19. The Aarhus researchers found that air pollution from ozone and fine particles in northern Italy might explain, in part, why the region had a higher death rate than other parts of the country.

"We conclude that the high level of pollution in Northern Italy should be considered an additional co-factor of the high level of lethality recorded in that area," the researchers wrote in their report.

Ozone used to be called "smog" before it was given a more scientific designation, according to Ashley Lyerly, director of advocacy for the American Lung Association. The substance is formed when gases from car exhausts and power plants react with volatile organic compounds from aerosols and insect repellents in hot urban areas.

But the gases from tailpipes and smokestacks don't automatically fuse to become ozone; they need heat to react with each other. Climate change appears to have accelerated that phenomenon in Miami, which is having one of its hottest years on record.

"Miami is showing more unhealthy days in ozone with the impact of warmer temps, which climate change is driving," Lyerly says.

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Although ozone can be a positive force in the upper atmosphere, where it blocks ultraviolet rays from the sun, on the ground it can aggressively attack lung tissue. Ozone pollution can be a health risk for people with respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD). Those diseases are also on the list of underlying conditions that the Centers for Disease Control and Prevention (CDC) say can lead to severe cases of COVID-19.

"Any type of respiratory illness will make you more susceptible to exposure to air pollution," Lyerly says. "Having asthma or some other disease and being exposed to air pollution on an annual basis is certainly going to make you more susceptible to having a medical issue."

According to the American Lung Association report, 194,215 adults in Miami-Dade County have asthma, 171,071 have COPD, and 1,541 are living with lung cancer.

As of yesterday, 10,235 people in Miami-Dade were reported as testing positive for COVID-19, and 260 of them had died from the disease, according to the Florida Department of Health.

In terms of pollution, other metro areas in Florida rank a bit better than Miami, which got a D grade from the American Lung Association. Duval County, home to Jacksonville, ranks 153rd in terms of total high ozone days and earned a grade of B. The death rate from COVID-19 in Duval as of yesterday was 1.9 percent of total cases, compared with 2.5 percent in Miami-Dade.

Broward County is closer to Miami-Dade in terms of pollution, ranking 84th on the list and earning a grade of C. Yesterday the mortality rate for Broward was 3.7 percent of the county's 4,192 confirmed cases.

Besides ozone, there's another source of pollution that might be a factor contributing to severe COVID-19 cases: particulate matter.

The Harvard study suggests pollution from particulate matter also leads to a greater risk for COVID-19 patients. Particulate matter is made up of minuscule particles of dirt, soot, smoke, sand, and other objects that gather in the air and can lead to health risks.

Areas with more pollution "will be the ones that will have higher numbers of hospitalizations, higher numbers of deaths, and where many of the resources should be concentrated," one of the researchers, Francesca Dominici, told the New York Times .

South Florida usually has low levels of particulate matter, according to the Air Quality Index, a pollution measurement scale maintained by the EPA. Over the past few weeks, however, levels have been in the "moderate" range rather than the "good" range in parts of Miami and Fort Lauderdale. But the pollution isn't from us — officials say it's coming from Cuba and Mexico.

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"It's moderate right now because there is a current condition of biomass being burned in the southwest, Mexico, and South America. Those levels are being read by our instruments," says Susana Palomino, chief of air quality of the Miami-Dade Department of Environmental Resource Management.

Officials from the Florida Department of Environmental Protection tell New Times that plumes of smoke from Cuba and Central America are wafting toward Florida and increasing particulate matter pollution. They say this is an annual event from agricultural fires that will eventually subside.

While the United States wrestles with the pandemic, Lyerly encourages residents with respiratory and chronic diseases to take extra precautions and be aware of air-quality conditions in their areas. If a link does exist between pollution and COVID-19 deaths, the recommendations to stay at home could be more important than ever.

"During the pandemic, people are facing multiple threats to health, including unhealthy air pollution," Lyerly says. "Driving less and making sure we have stronger limits on pollution emissions — these things will ultimately reduce ozone exposure and formation of ozone."