The Silver Lining of COVID-19: Estimation of Short-Term Health Impacts Due to Lockdown in the Yangtze River Delta Region, China

Associations of insulin sensitivity and immune inflammatory responses with child blood lead (Pb) and PM2.5 exposure at an e-waste recycling area during the COVID-19 lockdown

Fine particular matter (PM2.5) and lead (Pb) exposure can induce insulin resistance, elevating the likelihood of diabetes onset. Nonetheless, the underlying mechanism remains ambiguous. Consequently, we assessed the association of PM2.5 and Pb exposure with insulin resistance and inflammation biomarkers in children. A total of 235 children aged 3-7 years in a kindergarten in e-waste recycling areas were enrolled before and during the Corona Virus Disease 2019 (COVID-19) lockdown. Daily PM2.5 data was collected and used to calculate the individual PM2.5 daily exposure dose (DED-PM2.5). Concentrations of whole blood Pb, fasting blood glucose, serum insulin, and high mobility group box 1 (HMGB1) in serum were measured. Compared with that before COVID-19, the COVID-19 lockdown group had lower DED-PM2.5 and blood Pb, higher serum HMGB1, and lower blood glucose and homeostasis model assessment of insulin resistance (HOMA-IR) index. Decreased DED-PM2.5 and blood Pb levels were linked to decreased levels of fasting blood glucose and increased serum HMGB1 in all children. Increased serum HMGB1 levels were linked to reduced levels of blood glucose and HOMA-IR. Due to the implementation of COVID-19 prevention and control measures, e-waste dismantling activities and exposure levels of PM2.5 and Pb declined, which probably reduced the association of PM2.5 and Pb on insulin sensitivity and diabetes risk, but a high level of risk of chronic low-grade inflammation remained. Our findings add new evidence for the associations among PM2.5 and Pb exposure, systemic inflammation and insulin resistance, which could be a possible explanation for diabetes related to environmental exposure.

Modelling variations of emergency attendances using data on community mobility, climate and air pollution

Air pollution is associated with morbidity and mortality worldwide. We investigated the impact of improved air quality during the economic lockdown during the SARS-Cov2 pandemic on emergency room (ER) admissions in Germany. Weekly aggregated clinical data from 33 hospitals were collected in 2019 and 2020. Hourly concentrations of nitrogen and sulfur dioxide (NO2, SO2), carbon and nitrogen monoxide (CO, NO), ozone (O3) and particulate matter (PM10, PM2.5) measured by ground stations and meteorological data (ERA5) were selected from a 30 km radius around the corresponding ED. Mobility was assessed using aggregated cell phone data. A linear stepwise multiple regression model was used to predict ER admissions. The average weekly emergency numbers vary from 200 to over 1600 cases (total n = 2,216,217). The mean maximum decrease in caseload was 5 standard deviations. With the enforcement of the shutdown in March, the mobility index dropped by almost 40%. Of all air pollutants, NO2 has the strongest correlation with ER visits when averaged across all departments. Using a linear stepwise multiple regression model, 63% of the variation in ER visits is explained by the mobility index, but still 6% of the variation is explained by air quality and climate change.

Evaluating cost and benefit of air pollution control policies in China: A systematic review

China has put great efforts into air pollution control over the past years and recently committed to its most ambitious climate target. Cost and benefit analysis has been widely used to evaluate the control policies in terms of past performance, future reduction potential, and direct and indirect impacts. To understand the cost and benefit analysis for air pollution control in China, we conducted a bibliometric review of more than 100 studies published over the past two decades, including the current research progress, most commonly adopted methods, and core findings. The control target in cost and benefit analysis has shifted in three stages, from individual and primary pollution control, moving to joint prevention of multiple and secondary pollutants, and then towards synergistic control of air pollution and carbon. With the expansion of the research scope, the integrated assessment model has gradually demonstrated the necessity for long-term ex-anti policy simulation, especially for dealing with complex factors. To ensure long-term air quality, climate, public health, and sustainable economic development, substantial evidence from published studies has suggested that China needs to continue its efforts in the upstream adjustment of the energy system and industrial structure with multi-regional and -sector collaboration. This cost and benefit review paper provides decision-makers with the fundamental information and knowledge gaps in air pollution control strategies in China, and direction for facing future challenges.

Weather-Climate Anomalies and Regional Transport Contribute to Air Pollution in Northern China During the COVID-19 Lockdown

Two persistent and heavy haze episodes during the COVID-19 lockdown (from 20 Jan to 22 Feb 2020) still occur in northern China, when anthropogenic emissions, particularly from transportation sources, are greatly reduced. To investigate the underlying cause, this study comprehensively uses in-situ measurements for ambient surface pollutants, reanalysis meteorological data and the WRF-Chem model to calculate the contribution of NOx emission change and weather-climate change to the "unexpectedly heavy" haze. Results show that a substantial NOx reduction has slightly decreased PM2.5 concentration. By contrast, the weakest East Asian winter monsoon (EAWM) in the 2019-2020 winter relative to the past decade is particularly important for haze occurrence. A warmer and moister climate is also favorable. Model results suggest that climate anomalies lead to a 25-50 μg m-3 increase of PM2.5 concentration, and atmospheric transport is also an important contributor to two haze episodes. The first haze is closely related to the atmospheric transport of pollutants from NEC to the south, and fireworks emissions in NEC are a possible amplifying factor that warrants future studies. The second one is caused by the convergence of a southerly wind and a mountain wind, resulting in an intra-regional transport within BTH, with a maximal PM2.5 increment of 50-100 μg m-3. These results suggest that climate change and regional transport are of great importance to haze occurrence in China, even with significant emission reductions of pollutants.

Decrease in the chronic health effects from PM2.5 during the 13th Five-Year Plan in China: Impacts of air pollution control policies

The Chinese government implemented a series of policies to improve air quality during the Thirteenth Five-Year Plan (13^th FYP). However, the long-term health effects of the 13^th FYP air pollution control policies have not been evaluated, and the outbreak of coronavirus disease 2019 (COVID-19) has brought great uncertainty regarding the evaluation of the effects. In this study, we selected 329 cities in mainland China to study the chronic health effects due to the decrease in fine particulate matter (PM_2.5) during the 13^th FYP. The relative risk (RR) of PM_2.5 exposure was obtained from a previous study, and the total premature deaths were calculated. We also applied the grey prediction model to predict the PM_2.5 concentration in each city in 2020 to evaluate the impacts of COVID-19. The results showed that the annual PM_2.5 concentration was reduced from 49.7 μg/m³ in 2015 to 33.2 μg/m³ in 2020, and premature deaths were reduced from 1,186,201 (95% CI: 910,339-1,451,102) and 446,415 (in key regions, 95% CI: 343,426-544,813) in 2015 to 997,955 (95% CI: 762,167-1,226,652) and 368,786 (in key regions, 95% CI: 282,114-452,567) in 2020, respectively. A total of 188,246 (95% CI: 148,172-224,450) people avoided premature deaths due to the reduction in PM_2.5 concentrations from 2015 to 2020. Although the impacts of COVID-19 in 2020 brought a significant reduction of 35.3% in February (14.2 μg/m³, p < 0.0001) and in March by 17.6% (5.8 μg/m³, p = 0.001), we found that COVID-19 showed few obvious influences on China's long-term air pollution control plans. The observed data and predicted data are very close in annual mean values and showed no statistical significance both in all cities (p = 0.98) and in key regions (p = 0.56) in 2020.

Spatio-temporal modelling of changes in air pollution exposure associated to the COVID-19 lockdown measures across Europe

The lockdown and related measures implemented by many European countries to stop the spread of the SARS-CoV-2 virus (COVID-19) pandemic have altered the economic activities and road transport in many cities. To rigorously evaluate how these measures have affected air quality in Europe, we developed Bayesian spatio-temporal (BST) models that assess changes in the surface nitrogen dioxide (NO₂) and fine particulate matter (PM_2.5) concentration across the continent. We fitted BST models to measurements of the two pollutants in 2020 using a lockdown indicator covariate, while accounting for the spatial and temporal correlation present in the data. Since other factors, such as weather conditions, local combustion sources and/or land surface characteristics may contribute to the variation of pollutant concentrations, we proposed two model formulations that allowed the differentiation between the variations in pollutant concentrations due to seasonality from the variations associated to the lockdown policies. The first model compares the changes in 2020, with the ones during the same period in the previous five years, by introducing an offset term, which controls for the long-term average concentrations of each pollutant during 2014–2019. The second approach models only the 2020 data, but adjusts for confounding factors. The results indicated that the latter can better capture the lockdown effect. The measures taken to tackle the virus in Europe reduced the average surface concentrations of NO₂ and PM_2.5 by 29.5% (95% Bayesian credible interval: 28.1%, 30.9%) and 25.9% (23.6%, 28.1%), respectively. To our knowledge, this research is the first to account for the spatio-temporal correlation present in the monitoring data during the pandemic and to assess how it affects estimation of the lockdown effect while accounting for confounding. The proposed methodology improves our understanding of the effect of COVID-19 lockdown policies on the air pollution burden across the continent.

The Impact of COVID-19 Lockdowns on Air Quality—A Global Review

The outbreak of the COVID-19 pandemic has emerged as a serious public health threat and has had a tremendous impact on all spheres of the environment. The air quality across the world improved because of COVID-19 lockdowns. Since the outbreak of COVID-19, large numbers of studies have been carried out on the impact of lockdowns on air quality around the world, but no studies have been carried out on the systematic review on the impact of lockdowns on air quality. This study aims to systematically assess the bibliographic review on the impact of lockdowns on air quality around the globe. A total of 237 studies were identified after rigorous review, and 144 studies met the criteria for the review. The literature was surveyed from Scopus, Google Scholar, PubMed, Web of Science, and the Google search engine. The results reveal that (i) most of the studies were carried out on Asia (about 65%), followed by Europe (18%), North America (6%), South America (5%), and Africa (3%); (ii) in the case of countries, the highest number of studies was performed on India (29%), followed by China (23%), the U.S. (5%), the UK (4%), and Italy; (iii) more than 60% of the studies included NO2 for study, followed by PM2.5 (about 50%), PM10, SO2, and CO; (iv) most of the studies were published by Science of the Total Environment (29%), followed by Aerosol and Air Quality Research (23%), Air Quality, Atmosphere & Health (9%), and Environmental Pollution (5%); (v) the studies reveal that there were significant improvements in air quality during lockdowns in comparison with previous time periods. Thus, this diversified study conducted on the impact of lockdowns on air quality will surely assist in identifying any gaps, as it outlines the insights of the current scientific research.

Reduction of air pollutants and associated mortality during and after the COVID-19 lockdown in China: Impacts and implications

Although strict lockdown measurements implemented during the COVID-19 pandemic have dramatically reduced the anthropogenic-based emissions, changes in air quality and its health impacts remain unclear in China. We comprehensively described air pollution during and after the lockdown periods in 2020 compared with 2018-2019, and estimated the mortality burden indicated by the number of deaths and years of life lost (YLL) related to the air pollution changes. The mean air quality index (AQI), PM10, PM2.5, NO2, SO2 and CO concentrations during the lockdown across China declined by 18.2 (21.2%), 27.0 μg/m3 (28.9%), 10.5 μg/m3 (18.3%), 8.4 μg/m3 (44.2%), 13.1 μg/m3 (38.8%), and 0.3 mg/m3 (27.3%) respectively, when compared to the same periods during 2018-2019. We observed an increase in O3 concentration during the lockdown by 5.5 μg/m3 (10.4%), and a slight decrease after the lockdown by 3.4 μg/m3 (4.4%). As a result, there were 51.3 (95%CI: 32.2, 70.1) thousand fewer premature deaths (16.2 thousand during and 35.1 thousand after the lockdown), and 1066.8 (95%CI: 668.7, 1456.8) thousand fewer YLLs (343.3 thousand during and 723.5 thousand after the lockdown) than these in 2018-2019. Our findings suggest that the COVID-19 lockdown has caused substantial decreases in air pollutants except for O3, and that substantial human health benefits can be achieved when strict control measures for air pollution are taken to reduce emissions from vehicles and industries. Stricter tailored policy solutions of air pollution are urgently needed in China and other countries, especially in well-developed industrial regions, such as upgrading industry structure and promoting green transportation.

Impacts of COVID-19 on aircraft usage and fuel consumption: A case study on four Chinese international airports

COVID-19 pandemic starting in early 2020 has greatly impacted human and industrial activities. Air transport in China shrank abruptly in February 2020, following a year-long gradual recovery. The airline companies reacted to this unprecedented event by dramatically reducing the flight volume and rearranging the aircraft types. As the first major economy that successfully controls the spread of COVID-19, China can provide a unique opportunity to quantify the medium-long impacts on the air transport industry. To quantify the corresponding changes and to elucidate the effects of COVID-19 in the wake of two major outbreaks centered in Wuhan and Beijing, we analyze twelve flight routes formed by four selected airports, using the Automatic Dependent Surveillance-Broadcast (ADS-B) data in 2019 and 2020. Our results show that the total flight volume in 2020 reduced to 67.8% of 2019 in China. The recovering time of flight volume was about 2-6 months, dependent on the severity. In order to unwind the severe challenge, airlines mainly relied on aircraft B738 and A321 between February and June in 2020 because the fuel consumption per seat of these two aircraft types is the lowest. Besides, fuel consumption and aircraft emissions are calculated according to the Base of Aircraft Data (BADA) and the International Civil Aviation Organization's Engine Emissions Databank (ICAO's EEDB). At the end of 2020, the ratios of daily fuel consumption and aircraft emissions of 2020 to 2019 rebounded to about 0.875, suggesting the domestic commercial flights were nearly fully recovered. Our results may provide practical guidance and meaningful expectation for commercial aircraft management for other countries.

Ambient air pollution and the risk of ischaemic and haemorrhagic stroke

Stroke is a leading cause of disability and the second most common cause of death worldwide. Increasing evidence suggests that air pollution is an emerging risk factor for stroke. Over the past decades, air pollution levels have continuously increased and are now estimated to be responsible for 14% of all stroke-associated deaths. Interpretation of previous literature is difficult because stroke was usually not distinguished as ischaemic or haemorrhagic, nor by cause. This Review summarises the evidence on the association between air pollution and the different causes of ischaemic stroke and haemorrhagic stroke, to clarify which people are most at risk. The risk for ischaemic stroke is increased after short-term or long-term exposure to air pollution. This effect is most pronounced in people with cardiovascular burden and stroke due to large artery disease or small vessel disease. Short-term exposure to air pollution increases the risk of intracerebral haemorrhage, a subtype of haemorrhagic stroke, whereas the effects of long-term exposure are less clear. Limitations of the current evidence are that studies are prone to misclassification of exposure, often rely on administrative data, and have insufficient clinical detail. In this Review, we provide an outlook on new research opportunities, such as those provided by the decreased levels of air pollution due to the current COVID-19 pandemic.

Association of COVID-19 transmission with high levels of ambient pollutants: Initiation and impact of the inflammatory response on cardiopulmonary disease

Ambient air pollution contributes to 7 million premature deaths annually. Concurrently, the ongoing coronavirus disease 2019 (COVID-19) pandemic, complicated with S-protein mutations and other variants, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in over 2.5 million deaths globally. Chronic air pollution-mediated cardiopulmonary diseases have been associated with an increased incidence of hospitalization and mechanical ventilation following COVID-19 transmission. While the underlying mechanisms responsible for this association remain elusive, air pollutant-induced vascular oxidative stress and inflammatory responses have been implicated in amplifying COVID-19-mediated cytokine release and vascular thrombosis. In addition, prolonged exposure to certain types of particulate matter (PM2.5, d < 2.5 μm) has also been correlated with increased lung epithelial and vascular endothelial expression of the angiotensin-converting enzyme-2 (ACE2) receptors to which the SARS-CoV-2 spike glycoproteins (S) bind for fusion and internalization into host cells. Emerging literature has linked high rates of SARS-CoV-2 infection to regions with elevated levels of PM2.5, suggesting that COVID-19 lockdowns have been implicated in regional reductions in air pollutant-mediated cardiopulmonary effects. Taken together, an increased incidence of SARS-CoV-2-mediated cardiopulmonary diseases seems to overlap with highly polluted regions. To this end, we will review the redox-active components of air pollutants, the pathophysiology of SARS-CoV-2 transmission, and the key oxidative mechanisms and ACE2 overexpression underlying air pollution-exacerbated SARS-CoV-2 transmission.

Interplay between COVID-19, pollution, and weather features on changes in the incidence of acute coronary syndromes in early 2020

BACKGROUND

Coronavirus disease 2019 (COVID-19) has caused an unprecedented change in the apparent epidemiology of acute coronary syndromes (ACS). However, the interplay between this disease, changes in pollution, climate, and aversion to activation of emergency medical services represents a challenging conundrum. We aimed at appraising the impact of COVID-19, weather, and environment features on the occurrence of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) in a large Italian region and metropolitan area.

METHODS AND RESULTS

Italy was hit early on by COVID-19, such that state of emergency was declared on January 31, 2020, and national lockdown implemented on March 9, 2020, mainly because the accrual of cases in Northern Italy. In order to appraise the independent contribution on changes in STEMI and NSTEMI daily rates of COVID-19, climate and pollution, we collected data on these clinical events from tertiary care cardiovascular centers in the Lazio region and Rome metropolitan area. Multilevel Poisson modeling was used to appraise unadjusted and adjusted effect estimates for the daily incidence of STEMI and NSTEMI cases. The sample included 1448 STEMI and 2040 NSTEMI, with a total of 2882 PCI spanning 6 months. Significant reductions in STEMI and NSTEMI were evident already in early February 2020 (all p<0.05), concomitantly with COVID-19 spread and institution of national countermeasures. Changes in STEMI and NSTEMI were inversely associated with daily COVID-19 tests, cases, and/or death (p<0.05). In addition, STEMI and NSTEMI incidences were associated with daily NO2, PM10, and O3 concentrations, as well as temperature (p<0.05). Multi-stage and multiply adjusted models highlighted that reductions in STEMI were significantly associated with COVID-19 data (p<0.001), whereas changes in NSTEMI were significantly associated with both NO2 and COVID-19 data (both p<0.001).

CONCLUSIONS

Reductions in STEMI and NSTEMI in the COVID-19 pandemic may depend on different concomitant epidemiologic and pathophysiologic mechanisms. In particular, recent changes in STEMI may depend on COVID-19 scare, leading to excess all-cause mortality, or effective reduced incidence, whereas reductions in NSTEMI may also be due to beneficial reductions in NO2 emissions in the lockdown phase.

Changes of air quality and its associated health and economic burden in 31 provincial capital cities in China during COVID-19 pandemic

With outbreak of the novel coronavirus disease (COVID-19), immediate prevention and control actions were imposed in China. Here, we conducted a timely investigation on the changes of air quality, associated health burden and economic loss during the COVID-19 pandemic (January 1 to May 2, 2020). We found an overall improvement of air quality by analyzing data from 31 provincial cities, due to varying degrees of NO2, PM2.5, PM10 and CO reductions outweighing the significant O3 increase. Such improvement corresponds to a total avoided premature mortality of 9410 (7273-11,144) in the 31 cities by comparing the health burdens between 2019 and 2020. NO2 reduction was the largest contributor (55%) to this health benefit, far exceeding PM2.5 (10.9%) and PM10 (23.9%). O3 instead was the only negative factor among six pollutants. The period with the largest daily avoided deaths was rather not the period with strict lockdown but that during February 25 to March 31, due to largest reduction of NO2 and smallest increase of O3. Southwest, Central and East China were regions with relatively high daily avoided deaths, while for some cities in Northeast China, the air pollution was even worse, therefore could cause more deaths than 2019. Correspondingly, the avoided health economic loss attributable to air quality improvement was 19.4 (15.0-23.0) billion. Its distribution was generally similar to results of health burden, except that due to regional differences in willingness to pay to reduce risks of premature deaths, East China became the region with largest daily avoided economic loss. Our results here quantitatively assess the effects of short-term control measures on changes of air quality as well as its associated health and economic burden, and such information is beneficial to future air pollution control.

Chemistry of Atmospheric Fine Particles During the COVID-19 Pandemic in a Megacity of Eastern China

Air pollution in megacities represents one of the greatest environmental challenges. Our observed results show that the dramatic NOx decrease (77%) led to significant O3 increases (a factor of 2) during the COVID-19 lockdown in megacity Hangzhou, China. Model simulations further demonstrate large increases of daytime OH and HO2 radicals and nighttime NO3 radical, which can promote the gas-phase reaction and nocturnal multiphase chemistry. Therefore, enhanced NO3 - and SO4 2- formation was observed during the COVID-19 lockdown because of the enhanced oxidizing capacity. The PM2.5 decrease was only partially offset by enhanced aerosol formation with its reduction reaching 50%. In particular, NO3 - decreased largely by 68%. PM2.5 chemical analysis reveals that vehicular emissions mainly contributed to PM2.5 under normal conditions in Hangzhou. Whereas, stationary sources dominated the residual PM2.5 during the COVID-19 lockdown. This study provides evidence that large reductions in vehicular emissions can effectively mitigate air pollution in megacities.

Subtle Changes or Dramatic Perceptions of Air Pollution in Sydney during COVID-19

The COVID-19 pandemic made it critical to limit the spread of the disease by enforcing human isolation, restricting travel and reducing social activities. Dramatic improvements to air quality, especially NO2, have often characterised places under COVID-19 restrictions. Air pollution measurements in Sydney in April 2019 and during the lockdown period in April 2020 show reduced daily averaged NO2 concentrations: 8.52 ± 1.92 and 7.85 ± 2.92 ppb, though not significantly so (p1~0.15) and PM2.5 8.91 ± 4.94 and 7.95 ± 2.64 µg m−3, again a non-significant difference (p1~0.18). Satellite imagery suggests changes that parallel those at ground level, but the column densities averaged over space and time, in false-colour, are more dramatic. Changed human mobility could be traced in increasing times spent at home, assessed from Google Mobility Reports and mirrored in decreased traffic flow on a major road, suggesting compliance with the restrictions. Electricity demand for the State of New South Wales was low under lockdown in early April 2020, but it recovered rapidly. Analysis of the uses of search terms: bushfires, air quality, haze and air pollution using Google Trends showed strong links between bushfires and pollution-related terms. The smoke from bushfires in late 2019 may well have added to the general impression of improved air quality during lockdown, despite only modest changes in the ground level measurements. This gives hints that successful regulation of air quality requires maintaining a delicate balance between our social perceptions and the physical reality.