<div>To the Editor,</div><div>We appreciate the interest and comments of Soriano and Ancochea<sup>1</sup> regarding our papers <sup>2</sup>. Further to
the suggestion that “it would be of interest to repeat their statistics
conducted during the first wave of COVID-19, again with the current
estimates during the ongoing second wave, or later ones”, we would like
to emphasize that our geographical observation was a type of anecdotal
evidence that contributed to formulating a hypothesis. In a previous
paper, we found that after adjusting for potentially relevant
country-level confounders, there was a negative ecological association
between COVID-19 mortality and the consumption of cabbage and cucumber
in European countries <sup>3</sup>. In this study, we
acknowledged that “As in any ecological study, any inference from the
observed association should be made at the country level, as the
possibility of ecological fallacy precludes inferences at the individual
level; and that further testing in properly designed individual studies
would be of interest”. Indeed, what would be useful is testing the
hypothesis in robust observational studies and/or clinical trials.</div><div>Regarding our observation that COVID-19 could be considered as a disease
of the Anthropocene <sup>4</sup> , other authors have recently
provided a more complete description of the links between the disruption
of the natural ecosystems that characterize the Anthropocene and the
occurrence of zoonosis <sup>5</sup> <sup>6</sup>.</div><div>1. Soriano J and Ancochea J. Saved by cabbage, killed by cabbage, and
COVID-19. <i>Allergy</i> 2020; in press.</div><div>2. Bousquet J, Anto JM, Czarlewski W, et al. Cabbage and fermented
vegetables: from death rate heterogeneity in countries to candidates for
mitigation strategies of severe COVID-19. <i>Allergy</i> 2020. DOI:
10.1111/all.14549.</div><div>3. Fonseca S, Rivas I, Romaguera D, et al. Association between
consumption of vegetables and COVID-19 mortality at a country level in
Europe. <i>MedRix</i> 2020; 10.1101/2020.07.17.20155846</div><div>4. O’Callaghan C and Anto J. COVID-19: The Disease of the Anthropocene.<i>Env Res</i> 2020; 187: 109683.doi:
109610.101016/j.envres.102020.109683. Epub 102020 May 109615.</div><div>5. Morens DM and Fauci AS. Emerging Pandemic Diseases: How We Got to
COVID-19. <i>Cell</i> 2020; 182: 1077-1092. 2020/08/28. DOI:
10.1016/j.cell.2020.08.021.</div><div>6. Roche B, Garchitorena A, Guegan JF, et al. Was the COVID-19 pandemic
avoidable? A call for a ”solution-oriented” approach in pathogen
evolutionary ecology to prevent future outbreaks. <i>Ecol Lett</i> 2020
2020/09/02. DOI: 10.1111/ele.13586.</div><div>JM Anto</div><div><div>ISGlobAL, Centre for Research in Environmental Epidemiology (CREAL),
Barcelona, Spain.


IMIM (Hospital del Mar Research Institute), Barcelona, Spain.


Universitat Pompeu Fabra (UPF), Barcelona, Spain.


CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.</div></div><div>J Bousquet</div><div><div>Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and
Berlin Institute of Health, Comprehensive Allergy Center, Department of
Dermatology and Allergy, Berlin, Germany.


MACVIA-France, Montpellier, France.</div></div>