Short- and medium-term impacts of strict anti-contagion policies on non-COVID-19 mortality in China

Spillover health losses of COVID-19 in China: evidence from non-COVID-19-related mortality

OBJECTIVES

With the seeming end of the COVID-19 epidemic, international focus is rethinking its spillover consequences, such as on the routine provision and usage of healthcare. This study uses China's national death records to estimate the potential spillover effects of the COVID-19 pandemic on the mortality of non-COVID diseases in China, such as chronic diseases and mental disorders.

STUDY DESIGN

A longitudinal study.

METHODS

Using the difference-in-difference strategy, our results showed a sizeable increase in total non-COVID deaths and mortality from cardiovascular diseases, chronic kidney disease, diabetes, mental diseases, and suicide.

RESULTS

Notably, the deaths from diabetes and suicide increased by 4.60% and 7.08%, respectively, relative to the regions without pandemic cases in the first outbreak and escalated by 3.57% and 5.00%, respectively, when the control group switched to the same period in 2019.

CONCLUSIONS

These results documented adverse spillover effects of COVID-19 on mortality of non-COVID diseases, suggesting inadequate provision and utilization of regular healthcare. The government and healthcare industry should adopt expedient policies for non-epidemic diseases and reallocate health resources to mitigate future pandemics like COVID-19.

Understanding carbon resilience under public health emergencies: a synthetic difference-in-differences approach

Public health emergencies influence urban carbon emissions, yet an in-depth understanding of deviations between regional emissions under such emergencies and normal levels is lacking. Inspired by the concept of resilience, we introduce the concept of regional carbon resilience and propose four resilience indicators covering periods during and after emergencies. A synthetic difference-in-differences model is employed to compute these indicators, providing a more suitable approach than traditional methods assuming unchanged levels before and after emergencies. Using the COVID-19 pandemic in China as a case study, focusing on the power and industry sectors, we find that over 40% regions exhibit strong resilience (> 0.9). Average in-resilience (0.764 and 0.783) is higher than post-resilience (0.534 and 0.598) in both sectors, indicating lower resilience during than after emergencies. Significant differences in resilience performance exist across regions, with Hebei (0.93) and Hangzhou (0.92) as top performers, and Qinghai (0.29) and Guiyang (0.36) as the least resilient. Furthermore, a preliminary correlation analysis identifies 22 factors affecting carbon resilience; higher energy consumption, stronger industrial production, and a healthier regional economy positively contribute to resilience with coefficients over + 0.3, while pandemic severity negatively impacts resilience, with coefficients up to -0.58. These findings provide valuable references for policymaking to achieve carbon neutrality goals.

National age-specific mortality trends for cervical and breast cancers in urban-rural areas of China from 2009 to 2021: a population-based analysis

BACKGROUND

Cervical and breast cancers are among the top 4 leading causes of cancer-related mortality in women. This study aimed to examine age-specific temporal trends in mortality for cervical and breast cancers in urban and rural areas of China from 2009 to 2021.

METHODS

Age-specific mortality data for cervical and breast cancers among Chinese women aged 20-84 years were obtained from China's National Disease Surveillance Points system spanning the years 2009 to 2021. Negative binomial regression models were utilized to assess urban-rural differences in mortality rate ratios, while Joinpoint models with estimated average annual percent changes (AAPC) and slopes were employed to compare temporal trends and the acceleration of mortality rates within different age groups.

RESULTS

From 2009 to 2021, there was a relative increase in age-specific mortality associated with the two cancers observed in rural areas compared with urban areas. A rising trend in the screening age of 35-64 [AAPC: 4.0%, 95% confidence interval (CI) 0.5-7.6%, P = 0.026] for cervical cancer was noted in rural areas, while a stable trend (AAPC: - 0.7%, 95% CI - 5.8 to 4.6%, P = 0.78) was observed in urban areas. As for breast cancer, a stable trend (AAPC: 0.3%, 95% CI - 0.3 to 0.9%, P = 0.28) was observed in rural areas compared to a decreasing trend (AAPC: - 2.7%, 95% CI - 4.6 to - 0.7%, P = 0.007) in urban areas. Urban-rural differences in mortality rates increased over time for cervical cancer but decreased for breast cancer. Mortality trends for both cervical and breast cancers showed an increase with age across 4 segments, with the most significant surge in mortality observed among the 35-54 age group across urban and rural areas, periods, and regions in China.

CONCLUSIONS

Special attention should be given to women aged 35-54 years due to mortality trends and rural-urban disparities. Focusing on vulnerable age groups and addressing rural-urban differences in the delivery of cancer control programs can enhance resource efficiency and promote health equity.

Excess deaths in China during SARS-CoV-2 viral waves in 2022-2023

Background

The extent to which the Omicron variant of SARS-CoV-2 raised death rates in China during its viral wave of December 2022-January 2023 remains largely undocumented.

Methods

We worked with an established national survey organization to survey 8,004 adults in all 31 administrative areas of China to ask about deaths in families since January 2020. We examined age-specific death rates, focusing on deaths above age 60 years, and at 15-59 years. We compared these to the United Nations (UN) estimates of age-specific mortality in 2019.

Findings

The survey participants were broadly similar to the 2020 census and other national surveys in age, sex, region, and smoking status, but had lower SARS-CoV-2 vaccination rates and higher education levels. There were no differences in reporting of deaths during the Omicron period (after November 2021) versus earlier. The survey captured 456 deaths, of which 329 occurred at ages 60+ years and 212 were of women. At ages 60+ years, death rates approximately doubled during December 2022-January 2023. Deaths at ages 15-59 years did not rise appreciably. The UN estimates approximately 675,000 deaths per month at ages 60+ years in 2019. If rates doubled nationally as in our survey, China had approximately 1.35 million excess deaths from December 2022-January 2023.

Interpretation

China experienced a sharp but short increase in excess deaths among its elderly during the Omicron wave. If death registry data corroborate our estimates of substantial excess deaths in China, the worldwide estimates of excess deaths due to SARS-CoV-2 in 2022-2023 may need upward adjustment.

How does new energy demonstration city pilot policy affect carbon dioxide emissions? Evidence from a quasi-natural experiment in China

Energy transition policies are of great significance in adjusting the structure of energy supply and demand and coping with climate change. The new energy demonstration city pilot (NEDCP) policy, as an important pilot project in China's energy transition process, lacks a scientific assessment of the carbon reduction effect of the NEDCP policy and an in-depth explanation of the mechanism of the NEDCP. Based on panel data of 209 Chinese cities at the prefectural and higher levels from 2007 to 2019, this study takes the NEDCP policy as a quasi-natural experiment, using a difference-in-differences model combined with firm-level data to identify the impact of the NEDCP policy on urban carbon dioxide (CO2) emissions. This study analyzes the impact of heterogeneity of urban characteristics on the policy effect from multiple perspectives, and further investigates its mechanism. The conclusions are shown in the following aspects. (1) The implementation of the NEDCP policy decreases urban CO2 emissions significantly. Meanwhile, a series of robustness tests, including the instrumental variables method, propensity score matching difference-in-differences method, placebo test, exclusion of policy interference test, and machine learning method, support this conclusion. (2) The NEDCP policy achieves carbon reduction effects mainly through scale and structure effects. (3) The results of the heterogeneity test show that the NEDCP policy is more effective in cities with higher administrative levels, energy-demanding cities, cities in the southeast of Hu-line, and cities with a higher degree of nationalization. Therefore, the Chinese government should summarize the implementation experience of the NEDCP policy and expand its scope of application. The evaluation of the NEDCP policy in China has important reference value for the energy transition of other developing countries.

Inferring China's excess mortality during the COVID-19 pandemic using online mourning and funeral search volume

We construct a mourning and funeral index, using online search volume for "wreath and elegiac couplet", "obituary", "mortuary house", "cinerary casket", "cremation" and "pass away", to infer excess cases of mortality in China during the COVID-19 pandemic. During the 3-month period (December 2022-February 2023) after China ended its Zero-COVID policy, there were around 712 thousand excess cases of mortality. These excess cases of mortality, bench marked against the 2-year period preceding the pandemic, could be directly or indirectly related to COVID-19. During the 35-month Zero-COVID regime (January 2020-November 2022), the excess death toll was a negative 1480 thousand. Overall, by delaying the surge in infections, China might have saved 767 thousand lives. While these estimates are based on various assumptions and can be imprecise, China's COVID-19 experience could reasonably be characterized by a sharp surge in deaths after its departure from Zero-COVID and a steady pattern of lives saved during the Zero-COVID regime.

Modelling the transmission and control of COVID-19 in Yangzhou city with the implementation of Zero-COVID policy

In the fight against the COVID-19 pandemic, China has long adhered to the "Dynamic Zero COVID-19" strategy till the end of 2022. To understand the mechanism of this strategy, we used the case of the Yangzhou summer outbreak in 2021 and a multi-stage dynamical model incorporating city-wide and key area testing-trace-isolation (TTI) strategies. We defined two time-varying indexes for measuring the disease transmission risk and the public health prevention and control force, respectively, which allowed us to explore the mechanisms of TTI policies. Integrating with the historical data and literature parameter values, we first estimated the parameters and then quantified the relevant indexes over time. The findings showed that multiple rounds of rapid testing were one of the critical measures to overcome the outbreak in Yangzhou within one month. In addition, we compared the impact of the duration of the free transmission stage, tracking rate, testing interval and precise division of key areas on the epidemiological indicators, including the final sizes of infections and isolations, peak value, peak arrival time and epidemic duration and the minimum round of testing. Our results suggest that the early detection of the epidemic, an improved efficiency of tracking, and a reduced duration of each test play a positive role in restraining COVID-19; however, a considerable investment of resources was essential to achieve a significant effect quickly.

Impact of COVID-19 lockdown on water quality in China during 2020 and 2022: two case surges

The COVID-19 severely affected the world in 2020. Taking the two outbreaks in China in 2020 and 2022 as examples, the spatiotemporal changes in surface water quality levels and COD_Mn and NH₃-N concentrations were analyzed, and the relationships between the variations in the two pollutants and environmental and social factors were evaluated. The results showed that during the two lockdowns, due to the total water consumption (including industrial, agricultural, and domestic water) decreased, the proportion of good water quality increased by 6.22% and 4.58%, and the proportion of polluted water decreased by 6.00% and 3.98%, the quality of water environment has been improved significantly. However, the proportion of excellent water quality decreased by 6.19% after entering the unlocking period. Before the second lockdown period, the average COD_Mn concentration exhibited a "falling, rising, and falling" trend, while the average NH₃-N concentration changed in the opposite direction. The correlation analysis revealed that the increasing trend of pollutant concentrations was positively correlated with longitude and latitude, and weakly correlated with DEM and precipitation. A slight decrease trend in NH₃-N concentration was negatively correlated with the population density variation and positively correlated with the temperature variation. The relationship between the change in the number of confirmed cases in provincial regions and the change in pollutant concentrations was uncertain, with positive and negative correlations. This study demonstrates the impact of lockdowns on water quality and the possibility of improving water quality through artificial regulation, which can provide a reference basis for water environmental management.

The shock, the coping, the resilience: smartphone application use reveals Covid-19 lockdown effects on human behaviors

Human mobility restriction policies have been widely used to contain the coronavirus disease-19 (COVID-19). However, a critical question is how these policies affect individuals' behavioral and psychological well-being during and after confinement periods. Here, we analyze China's five most stringent city-level lockdowns in 2021, treating them as natural experiments that allow for examining behavioral changes in millions of people through smartphone application use. We made three fundamental observations. First, the use of physical and economic activity-related apps experienced a steep decline, yet apps that provide daily necessities maintained normal usage. Second, apps that fulfilled lower-level human needs, such as working, socializing, information seeking, and entertainment, saw an immediate and substantial increase in screen time. Those that satisfied higher-level needs, such as education, only attracted delayed attention. Third, human behaviors demonstrated resilience as most routines resumed after the lockdowns were lifted. Nonetheless, long-term lifestyle changes were observed, as significant numbers of people chose to continue working and learning online, becoming "digital residents." This study also demonstrates the capability of smartphone screen time analytics in the study of human behaviors.

Supplementary Information

The online version contains supplementary material available at 10.1140/epjds/s13688-023-00391-9.

Changes in all-cause and cause-specific excess mortality before and after the Omicron outbreak of COVID-19 in Hong Kong

Background

While coronavirus 2019 (COVID-19) deaths were generally underestimated in many countries, Hong Kong may show a different trend of excess mortality due to stringent measures, especially for deaths related to respiratory diseases. Nevertheless, the Omicron outbreak in Hong Kong evolved into a territory-wide transmission, similar to other settings such as Singapore, South Korea, and recently, mainland China. We hypothesized that the excess mortality would differ substantially before and after the Omicron outbreak.

Methods

We conducted a time-series analysis of daily deaths stratified by age, reported causes, and epidemic wave. We determined the excess mortality from the difference between observed and expected mortality from 23 January 2020 to 1 June 2022 by fitting mortality data from 2013 to 2019.

Results

During the early phase of the pandemic, the estimated excess mortality was -19.92 (95% confidence interval (CI) = -29.09, -10.75) and -115.57 (95% CI = -161.34, -69.79) per 100 000 population overall and for the elderly, respectively. However, the overall excess mortality rate was 234.08 (95% CI = 224.66, 243.50) per 100 000 population overall and as high as 928.09 (95% CI = 885.14, 971.04) per 100 000 population for the elderly during the Omicron epidemic. We generally observed negative excess mortality rates of non-COVID-19 respiratory diseases before and after the Omicron outbreak. In contrast, increases in excess mortality were generally reported in non-respiratory diseases after the Omicron outbreak.

Conclusions

Our results highlighted the averted mortality before 2022 among the elderly and patients with non-COVID-19 respiratory diseases, due to indirect benefits from stringent non-pharmaceutical interventions. The high excess mortality during the Omicron epidemic demonstrated a significant impact from the surge of COVID-19 infections in a SARS-CoV-2 infection-naive population, particularly evident in the elderly group.

The COVID-19 pandemic in various restriction policy scenarios based on the dynamic social contact rate

The social contact rate has influenced the transmission of COVID-19, with more social contact resulting in more contagion cases. We chose 18 countries with the most confirmed cases in the first 200 days after the Wuhan lockdown. This was the first study using the dynamic social contact rate to simulate the epidemic under diverse restriction policies over 500 days since the COVID-19 outbreak. The developed General Dynamic Model suggested that the probability of contagion ranged from 12.52% to 39.39% in the epidemic. The geometric mean of the social contact rates differed from 18.21% to 96.00% between countries. The restriction policies in developed economies were 3.5 times more efficient than in developing economies. We compare the effectiveness of different policies for disease prevention and discuss the influence of policy adjustment frequency for each country. Maintaining the tightest restriction or alternate tightening and loosening restrictions was recommended, with each having an average 72.45% and 79.78% reduction in maximum active cases, respectively.

Risk Perception, Perceived Government Coping Validity, and Individual Response in the Early Stage of the COVID-19 Pandemic in China

As a major crisis event, the COVID-19 pandemic has affected the global economy, threatened the lives of the public, and caused varying degrees of impact on the public. Previous studies have shown that risk perception and government response had different impacts on the public, but they revealed more about the independent impact of risk perception and government response on the public. This study will comprehensively consider the impacts of these two factors on the behavior of the public in the early stage of the epidemic. We analyzed data from an online survey in the early days of the COVID-19 pandemic in China and categorized individual behaviors into three dimensions: entertainment and travel, work, and the stockpile of supplies. In addition, we defined the risk perception variables by two dimensions: knowledge of the epidemic itself and knowledge of the consequences of the epidemic. At the same time, we used an exploratory factor analysis to construct the variable of perceived government coping validity and then adopted the ordinal logit model for analysis. The results showed that in terms of entertainment and travel, people would not be affected even if they fully understood the epidemic itself; once they were aware of the negative social consequences of the epidemic, people would suspend entertainment and travel to prevent the spread of the virus. As for work or employment, people would not stop working or employment even if they realized the infectivity and harmfulness of the disease and its social consequences. Furthermore, fear of COVID-19 and the perception of uncontrolled COVID-19 significantly positively affected people's material stockpiling behavior. These results indicate that different risk perceptions had different effects on individual responses, and individual behaviors reflected different coping logics. In addition, the government's effective response to the epidemic would significantly reduce the negative impacts of the epidemic on the three dimensions of people's responses. These conclusions have certain policy implications for preventing and responding to outbreaks in other countries.

JUE Insight: COVID-19 and household preference for urban density in China

This paper investigates the effect of COVID-19 on both housing prices and housing price gradients in China using transaction level data from 60 Chinese cities. After using a difference-in-differences (DID) specification to disentangle the confounding effects of China's annual Spring Festival, we find that housing prices decreased by two percent immediately after the COVID-19 outbreak but gradually recovered by September 2020. Moreover, our findings suggest that COVID-19 flattens the horizontal housing price gradient, reduces the price premium for living in tall buildings, and changes the vertical gradient within residential buildings. This is likely explained by the changing household preferences towards low-density areas associated with lower infection risk.

Changes in Chinese early adolescents' group orientation and mental health from before to during the COVID-19 pandemic

Adolescence is a critical period for formulating and developing value orientations. The COVID-19 pandemic has dramatically restricted people's lives, potentially leading adolescents to reevaluate what they prioritize in life (i.e., their values) and affecting their mental health. Previous studies suggest that Chinese early adolescents' group orientation is negatively associated with mental health more strongly in rural than in urban, whereas this rural-urban differs may vary after the outbreak of the pandemic. To examine potential changes in group orientation, mental health, and their associations during the pandemic, two cross-sectional surveys of ninth-grade students in the same three school were conducted in rural and urban China in 2019 and 2021. The results showed that compared with students before the pandemic (2019, N = 516, 48.8% girls, M_age = 14.87 years), students during the pandemic (2021, N = 655, 48.1% girls, M_age = 14.80 years) displayed lower group orientation such as group responsibility and rule abiding of rural students, and higher loneliness and depressive symptoms. Social equality, group responsibility and rule abiding were all significantly negatively associated with loneliness and depressive symptoms. Those negative associations were stronger in the urban regions than in the rural region. Follow-up invariance analysis revealed that this rural-urban difference in the relations between social equality, group responsibility, and rule abiding and mental health problems was only significant during (and not before) the pandemic. The protective effect of group orientation on mental health seems to be weakened only in rural contexts. The results suggest that significant changes in macrolevel contexts may play an important role in shaping adolescents' value orientation and mental health.

Experience of the COVID-19 pandemic in Wuhan leads to a lasting increase in social distancing

On 11th Jan 2020, the first COVID-19 related death was confirmed in Wuhan, Hubei. The Chinese government responded to the outbreak with a lockdown that impacted most residents of Hubei province and lasted for almost three months. At the time, the lockdown was the strictest both within China and worldwide. Using an interactive web-based experiment conducted half a year after the lockdown with participants from 11 Chinese provinces, we investigate the behavioral effects of this 'shock' event experienced by the population of Hubei. We find that both one's place of residence and the strictness of lockdown measures in their province are robust predictors of individual social distancing behavior. Further, we observe that informational messages are effective at increasing compliance with social distancing throughout China, whereas fines for noncompliance work better within Hubei province relative to the rest of the country. We also report that residents of Hubei increase their propensity to social distance when exposed to social environments characterized by the presence of a superspreader, while the effect is not present outside of the province. Our results appear to be specific to the context of COVID-19 and are not explained by general differences in risk attitudes and social preferences.

Do open data impact citizens' behavior? Assessing face mask panic buying behaviors during the Covid-19 pandemic

Data are essential for digital solutions and supporting citizens' everyday behavior. Open data initiatives have expanded worldwide in the last decades, yet investigating the actual usage of open data and evaluating their impacts are insufficient. Thus, in this paper, we examine an exemplary use case of open data during the early stage of the Covid-19 pandemic and assess its impacts on citizens. Based on quasi-experimental methods, the study found that publishing local stores' real-time face mask stock levels as open data may have influenced people's purchase behaviors. Results indicate a reduced panic buying behavior as a consequence of the openly accessible information in the form of an online mask map. Furthermore, the results also suggested that such open-data-based countermeasures did not equally impact every citizen and rather varied among socioeconomic conditions, in particular the education level.

Vaccination and Government Stringent Control as Effective Strategies in Preventing SARS-CoV-2 Infections: A Global Perspective

With the rapid implementation of global vaccination against the coronavirus disease 2019 (COVID-19), the threat posed by the disease has been mitigated, yet it remains a major global public health concern. Few studies have estimated the effects of vaccination and government stringent control measures on the disease transmission from a global perspective. To address this, we collected 216 countries' data on COVID-19 daily reported cases, daily vaccinations, daily government stringency indexes (GSIs), and the human development index (HDI) from the dataset of the World Health Organization (WHO) and the Our World in Data COVID-19 (OWID). We utilized the interrupted time series (ITS) model to examine how the incidence was affected by the vaccination and GSI at continental and country levels from 22 January 2020 to 13 February 2022. We found that the effectiveness of vaccination was better in Europe, North America, and Africa than in Asia, South America, and Oceania. The long-term effects outperformed the short-term effects in most cases. Countries with a high HDI usually had a high vaccination coverage, resulting in better vaccination effects. Nonetheless, some countries with high vaccination coverage did not receive a relatively low incidence due to the weaker GSI. The results suggest that in addition to increasing population vaccination coverage, it is crucial to maintain a certain level of government stringent measures to prevent and control the disease. The strategy is particularly appropriate for countries with low vaccination coverage at present.

Men smoke less under the COVID-19 closure policies: The role of altruism

This study examines whether people smoked more under the Coronavirus Disease 2019 (COVID-19) closure policies which trapped them at home with their families. In such circumstances, the pleasure from smoking could be more tempting than usual, but at the same time smokers’ families are more likely to be victims of passive smoking. This study uses temporal and regional variations in policy strengths with data from the Oxford COVID-19 Government Response Tracker project (OxCGRT) to examine the impact of COVID-19 closure policies on smoking behaviors. With longitudinal data from the China Family Panel Studies (CFPS) in 2018 and 2020, we find diminished smoking behaviors among Chinese male adults when the government implemented strict public health policies for the COVID-19 pandemic. People with more conscientiousness personality traits or stronger pro-family attitudes tend to smoke less as policy stringency increases.

Increased anxiety from fear of Omicron in China as compared to North America and Western Europe: A cross-sectional Kendall's tau-b analysis using the generalized anxiety disorder 7-item questionnaire

BACKGROUND

Policies dealing with the Coronavirus Disease 2019 (COVID-19) pandemic vary across the globe, the different governmental responses then affect the public perception of COVID-19. Many unofficial Chinese media outlets frequently spread misinformation about COVID-19 and exaggerated reports of rare sequelae of Omicron for monetization and attention seeking, leading to panics in the Chinese public. In comparison the attitudes toward Omicron in other countries around the world, especially in North America and Western Europe have shifted to a more relaxed stance.

OBJECTIVE

This article primarily aims to investigate the association between Chinese people's attitudes toward the potential after-effects of Omicron and their anxiety status, as compared to these of people living in North America or Western Europe.

METHODS

We conducted a questionnaire survey via the Credamo and collected valid data from 500 Chinese (not living in Shanghai), another 500 Chinese (living in Shanghai) and 500 people living in North America or Western Europe in June 2022. Kendall's coefficient of rank correlation tau-sub-b was used to examine this association.

RESULTS

The results suggested that subjective attitudes of Chinese participants toward the sequelae of Omicron were positively and significantly associated with their anxiety status [i.e., the Generalized Anxiety Disorder 7-item (GAD-7) scores] in Shanghai (China) (Tb = 0.44, p < 0.01) and other parts of China outside Shanghai (Tb = 0.37, p < 0.01). However, no such significant correlation was found in North America & Western Europe (Tb = -0.01, p > 0.05).

CONCLUSION

Our findings showed that Chinese participants who were more worried about the after-effects of Omicron had higher levels of anxiety. Although it is true that Long COVID-19 should be a concern, exaggerated media reporting can impact negatively on an individual's mental wellbeing. Only through the dissemination of robust scientific studies, the misinformation and the fears that follow it can be put to rest.