Influenza's plummeting during the COVID-19 pandemic: The roles of mask-wearing, mobility change, and SARS-CoV-2 interference.

Seasonal influenza activity typically peaks in the winter months but plummeted globally during the current coronavirus disease 2019 (COVID-19) pandemic. Unraveling lessons from influenza's unprecedented low profile is critical in informing preparedness for incoming influenza seasons. Here, we explored a country-specific inference model to estimate the effects of mask-wearing, mobility changes (international and domestic), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) interference in China, England, and the United States. We found that a one-week increase in mask-wearing intervention had a percent reduction of 11.3%-35.2% in influenza activity in these areas. The one-week mobility mitigation had smaller effects for the international (1.7%-6.5%) and the domestic community (1.6% to 2.8%). In 2020-2021, the mask-wearing intervention alone could decline percent positivity by 13.3-19.8. The mobility change alone could reduce percent positivity by 5.2-14.0, of which 79.8%-98.2% were attributed to the deflected international travel. Only in 2019-2020, SARS-CoV-2 interference had statistically significant effects. There was a reduction in percent positivity of 7.6 (2.4-14.4) and 10.2 (7.2-13.6) in northern China and England, respectively. Our results have implications for understanding how influenza evolves under non-pharmaceutical interventions and other respiratory diseases and will inform health policy and the design of tailored public health measures.

Tracking long-term population exposure risks to PM2.5 and ozone in urban agglomerations of China 2015-2021.

China has experienced severe air pollution in the past decade, especially PM2.5 and emerging ozone pollution recently. In this study, we comprehensively analyzed long-term population exposure risks to PM2.5 and ozone in urban agglomerations of China during 2015-2021 regarding two-stage clean-air actions based on the Ministry of Ecology and the Environment (MEE) air monitoring network. Overall, the ratio of the population living in the regions exceeding the Chinese National Ambient Air Quality Standard (35 µg/m3) decreases by 29.9 % for PM2.5 from 2015 to 2021, driven by high proportions in the Middle Plain (MP, 42.3 %) and Lan-Xi (35.0 %) regions. However, this ratio almost remains unchanged for ozone and even increases by 1.5 % in the MP region. As expected, the improved air quality leads to 234.7 × 103 avoided premature mortality (ΔMort), mainly ascribed to the reduction in PM2.5 concentration. COVID-19 pandemic may influence the annual variation of PM2.5-related ΔMort as it affects the shape of the population exposure curve to become much steeper. Although all eleven urban agglomerations share stroke (43.6 %) and ischaemic heart disease (IHD, 30.1 %) as the two largest contributors to total ΔMort, cause-specific ΔMort is highly regional heterogeneous, in which ozone-related ΔMort is significantly higher (21 %) in the Tibet region than other urban agglomeration. Despite ozone-related ΔMort being one order of magnitude lower than PM2.5-related ΔMort from 2015 to 2021, ozone-related ΔMort is predicted to increase in major urban agglomerations initially along with a continuous decline for PM2.5-related ΔMort from 2020 to 2060, highlighting the importance of ozone control. Coordinated controls of PM2.5 and O3 are warranted for reducing health burdens in China during achieving carbon neutrality.

Spatiotemporal variations of air pollutants and ozone prediction using machine learning algorithms in the Beijing-Tianjin-Hebei region from 2014 to 2021.

China was seriously affected by air pollution in the past decade, especially for particulate matter (PM) and emerging ozone pollution recently. In this study, we systematically examined the spatiotemporal variations of six air pollutants and conducted ozone prediction using machine learning (ML) algorithms in the Beijing-Tianjin-Hebei (BTH) region. The annual-average concentrations of CO, PM10, PM2.5 and SO2 decreased at a rate of 141, 11.0, 6.6 and 5.6 µg/m3/year, while a pattern of initial increase and later decrease was observed for NO2 and O3_8 h. The concentration of SO2, CO and NO2 was higher in Tangshan and Xingtai, while northern BTH region has lower levels of CO, NO2 and PM. Spatial variations of ozone were relatively small in the BTH region. Monthly variations of PM10 displayed an increase in March probably due to wind-blown dusts from Northwest China. A seasonal and diurnal pattern with summer and afternoon peaks was found for ozone, which was contrast with other pollutants. Further ML algorithms such as Random Forest (RF) model and Decision tree (DT) regression showed good ozone prediction performance (daily: R2 = 0.83 and 0.73, RMSE = 30.0 and 37.3 µg/m3, respectively; monthly: R2 = 0.93 and 0.88, RMSE = 12.1 and 15.8 µg/m3, respectively) based on 10-fold cross-validation. Both RF model and DT regression relied more on the spatial trend as higher temporal prediction performance was achieved. Solar radiation- and temperature-related variables presented high importance at daily level, whereas sea level pressure dominated at monthly level. The spatiotemporal heterogeneity in variable importance was further confirmed using case studies based on RF model. In addition, variable importance was possibly influenced by the emission reductions due to COVID-19 pandemic. Despite its possible weakness to capture ozone extremes, RF model was beneficial and suggested for predicting spatiotemporal variations of ozone in future studies.

The Incoming Influenza Season - China, the United Kingdom, and the United States, 2021-2022.

INTRODUCTION: Seasonal influenza activity has declined globally since the widespread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. There has been scarce information to understand the future dynamics of influenza - and under different hypothesis on relaxation of non-pharmaceutical interventions (NPIs) in particular - after the disruptions to seasonal patterns. METHODS: We collected data from public sources in China, the United Kingdom, and the United States, and forecasted the influenza dynamics in the incoming 2021-2022 season under different NPIs. We considered Northern China and Southern China separately, due to the sharp difference in the patterns of seasonal influenza. For the United Kingdom, data were collected for England only. RESULTS: Compared to the epidemics in 2017-2019, longer and blunter influenza outbreaks could occur should NPIs be fully lifted, with percent positivity varying from 10.5 to 18.6 in the studying regions. The rebounds would be smaller if the mask-wearing intervention continued or the international mobility stayed low, but sharper if the mask-wearing intervention was lifted in the middle of influenza season. Further, influenza activity could stay low under a much less stringent mask-wearing intervention coordinated with influenza vaccination. CONCLUSIONS: The results added to our understandings of future influenza dynamics after the global decline during the coronavirus disease 2019 (COVID-19) pandemic. In light of the uncertainty on the incoming circulation strains and the relatively low negative impacts of mask wearing on society, our findings suggested that wearing mask could be considered as an accompanying mitigation measure in influenza prevention and control, especially for seasons after long periods of low-exposure to influenza viruses.