Background The questioned link between air pollution and coronavirus disease 2019 (COVID-19) spreading or related mortality represents a hot topic that has immediately been regarded in the light of divergent views. A first “school of thought” advocates that what matters are only standard epidemiological variables (i.e. frequency of interactions in proportion of the viral charge). A second school of thought argues that co-factors such as quality of air play an important role too. Methods We analyzed available literature concerning the link between air quality, as measured by different pollutants and a number of COVID-19 outcomes, such as number of positive cases, deaths, and excess mortality rates. We reviewed several studies conducted worldwide and discussing many different methodological approaches aimed at investigating causality associations. Results Our paper reviewed the most recent empirical researches documenting the existence of a huge evidence produced worldwide concerning the role played by air pollution on health in general and on COVID-19 outcomes in particular. These results support both research hypotheses, i.e. long-term exposure effects and short-term consequences (including the hypothesis of particulate matter acting as viral “carrier”) according to the two schools of thought, respectively. Conclusions The link between air pollution and COVID-19 outcomes is strong and robust as resulting from many different research methodologies. Policy implications should be drawn from a “rational” assessment of these findings as “not taking any action” represents an action itself.

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