Stop playing, running, exercising – and if possible, even stop breathing!For millions of people living in and around the capital, air is no longer an invisible backdrop to daily life. It has become a persistent health threat – an omnipresent fog that envelops lungs, corrodes hearts, overshadows classrooms and wards, and silently erodes life expectancy. Winter is the seasonal smog headline, but the underlying crisis remains year-round: persistently high levels of fine particles and other pollutants, which modern medical and public-health studies now link to adverse pregnancy outcomes ranging from respiratory disease, heart attacks, strokes, neurological damage and old age.Why isn’t it? AQI More than 500 categories?On several winter days, the city’s daily AQI reaches the ‘very poor’ to ‘severe’ categories, prompting emergency public advisories and activating the Graded Response Action Plan (GRAP) – a set of restrictions meant to limit emissions on the worst days.
| AQI category | AQI range | PM₂.₅ | associated health effects |
|---|---|---|---|
| 🟩 ok | 0-50 | 0-30 | Minimal impact. |
| 🟨Satisfactory | 51-100 | 31-60 | Sensitive people may have minor trouble breathing. |
| 🟧 Moderately polluted | 101-200 | 61-90 | People with lung disease (e.g., asthma) may have trouble breathing, and people with heart disease, children, and older adults may have trouble breathing. |
| 🟨🟧poor | 201-300 | 91-120 | Prolonged exposure can cause breathing problems and may cause problems to people with heart disease. |
| 🟥 very bad | 301-400 | 121-250 | Prolonged exposure may cause respiratory illness. The effects may be more severe for people with lung or heart disease. |
| 🟥🟥serious | 401-500 | 250+ | Respiratory effects may occur even in healthy people; Serious effects on the health of people suffering from lung/heart disease. Even mild physical activity can have an effect. |
Yashasvi Vashishtha, 6 minutes
| AQI category | AQI range | PM₂.₅ | associated health effects |
|---|---|---|---|
| Good | 0-50 | 0-30 | Minimal impact. |
| satisfactory | 51-100 | 31-60 | Sensitive people may have minor trouble breathing. |
| moderately polluted | 101-200 | 61-90 | People with lung disease (e.g., asthma) may have trouble breathing, and people with heart disease, children, and older adults may have trouble breathing. |
| Poor | 201-300 | 91-120 | Prolonged exposure can cause breathing problems and may cause problems to people with heart disease. |
| very bad | 301-400 | 121-250 | Prolonged exposure may cause respiratory illness. The effects may be more severe for people with lung or heart disease. |
| Serious | 401-500 | 250+ | Respiratory effects may occur even in healthy people; Serious effects on the health of people suffering from lung/heart disease. Even mild physical activity can have an effect. |
India’s air quality index (AQI) is not capped at 500, but values above this fall in the ‘severe’ category. The reason for this is reportedly to avoid public panic and because the government believes the health impact is similar, if not identical, at that level.International platforms such as IQAir use different models with no upper limits and may display very high values for the same pollution level. India’s official index is calculated based on reference-grade monitors, while other platforms may use lower-cost sensors whose accuracy and calculation methods may vary.Biology of harm: How polluted air attacks the bodyAir pollution is not a poison but a mixture: fine particles (PM2.5 and PM10), nitrogen oxides, sulfur dioxide, ozone, carbon monoxide and complex organic compounds. Of these, PM2.5 – particles smaller than 2.5 micrometres – is the most medically dangerous.These particles are small enough to escape the protection of the upper airway, lodge deep in the alveoli, enter the bloodstream and travel to other organs, causing inflammation, oxidative stress, and systemic damage.Over time, that damage adds up; It increases the risk of heart disease, stroke, chronic obstructive pulmonary disease (COPD), lung cancer, adverse birth outcomes, and a wide list of neurological and metabolic conditions.Dr Kuldeep Kumar Grover, head of critical care and pulmonology, CK Birla Hospital in Gurugram, explains how the current levels of air pollution in northern India significantly increases the risk of serious medical conditions such as asthma, diabetes, heart attacks, stroke and chronic obstructive pulmonary disease (COPD). “Exposure to asbestos over time increases the chance of many cancers, including lung, bladder and breast cancer, even for non-smokers.,“In the short term, people may experience headaches, more frequent respiratory infections, irritation in the eyes and throat, and difficulty breathing. The toxic air is estimated to reduce life expectancy in Delhi and the surrounding region by about eight years,” he said.
Residents are protesting the conditions in which they are being forced to live.
Delhi resident Ashish Saxena is facing constant trouble in breathing due to toxic substances. He says, “I am sure I have lost at least 10 years of my life due to Delhi’s toxic air. Apart from a persistent cough, I have permanent headaches in winters due to pollution. Since offices refuse to entertain the WFH option, we are forced to travel amidst the deadly smog, which has a serious impact on our health.”Clinically, short-term effects are seen in emergency rooms and outpatient clinics: increased asthma attacks, bronchitis, laryngitis, allergic conjunctivitis, and chest pain. Long-term, sustained exposure reduces life expectancy and increases the prevalence of chronic disease in all groups – especially children, the elderly, pregnant women, and people with pre-existing conditions.Air pollution is as much a cardiovascular risk as it is a respiratory risk. Fine particles and gaseous pollutants impair blood clotting ability, increase blood pressure and accelerate atherosclerosis, which clinically translates into more heart attacks and strokes on high pollution days and higher baseline cardiovascular mortality rates overall.Big concern for pregnant mothers, babies and childrenWhat happens when expectant mothers breathe polluted air?“High pollution levels during pregnancy are linked to complications such as low birth weight, premature delivery and stunted fetal growth. These effects can have adverse effects on the long-term health of the mother and child,” Dr Grover said.Children suffer immense harm. They breathe faster than adults, inhale more air per body weight, and their lungs and immune systems are still developing – which makes the same pollution dose more harmful. “Because their lungs and immune systems are still developing, young children and infants are especially sensitive to the adverse effects of polluted air. “Worsening of asthma, frequent infections, slowed lung development and even brain development can be affected,” he said. Pediatric clinics in Delhi have reported children being frequently hospitalized for cough, wheezing, decreased exercise tolerance and severe lower respiratory infections. Lifelong consequences may include reduced peak lung function, higher lifetime risk of chronic respiratory disease, and neurodevelopmental harms that affect learning and behavior.No dystopian movie scene, no Chernobyl – this is Delhi
Delhi breathes very poor air for 16 out of 21 days in November.
NCR resident Manya Jain has difficulty in breathing. She said, “Having lived in Delhi for 21 years, I have lived through post-Diwali pollution every year, but it never felt like it was directly attacking my body. This year is different – I am really struggling to breathe. I don’t go out without a mask, and yet, the air feels poisonous. I really wish I could leave Delhi for a few weeks.”Hospitals across the capital have reported a rise in cases linked to pollution. According to recent hospital and academic alerts, the number of outpatient visits for respiratory and related conditions increases rapidly in the weeks following severe pollution episodes.Intensive care units report greater ventilator use and complicated recoveries from routine viral illnesses – when there is a background of persistent particle and chemical insults, the body’s ability to recover is diminished.Who is most at risk – and why the poor suffer the mostVulnerability is both biological and socio-economic. The elderly, infants, people with chronic illness, and pregnant women are physically more vulnerable. But social factors increase the risk: low-income households often live in areas with high traffic congestion or informal industries, have less access to mitigation (sealed houses, purifiers), and often use biomass or polluting fuels for cooking and heating.As a result, the poorest people bear the greatest health burden – even though wealthier people also suffer (through private costs such as sanitation, health care, lost productivity, or migration). Unequal burden also makes clean air policy an issue of equity and justice.Personal security: what can we do?
At the individual level, N-95/FFP2 masks (when worn properly) reduce exposure to inhaled particles, air purifiers reduce indoor PM levels, and limiting outdoor activities on high-AQI days reduces exposure.Here are doctor’s recommendations during high AQI readings:• Monitor local air quality index (AQI) daily and avoid outdoor activities if levels are high • Stay indoors with windows closed during peak pollution hours • Use an air purifier, especially in bedrooms and living spaces. • Avoid indoor sources of pollution such as tobacco smoke and sunlight • Maintain good indoor ventilation as outdoor air quality improves • Ensure that children, the elderly and people with chronic diseases take special precautions during high pollution periods But these measures have their own challenges:– Mask fit and compliance varies– Purifiers work only in sealed rooms– Many workers (construction, street vendors, drivers) cannot avoid outdoor exposureExperts stress that while individual safety measures are sensible prevention, only systemic emissions controls reduce the risk to the entire population.Delhi’s smog season has become an annual indictment: years of clear causes, predictable weather patterns and policy choices have been known, yet action has been partial and often ad hoc. The science is clear, the clinics are ringing the bell, and the data is clear: breathing in Delhi, for too many people, is now a risk that starts before birth and looms over the last years of life.
