Non-negligible contributions to human health from increased household air pollution exposure during the COVID-19 lockdown in China.

BACKGROUND: Ambient and household air pollution are found to lead to premature deaths from all-cause or cause-specific death. The national lockdown measures in China during COVID-19 were found to lead to abrupt changes in ambient surface air quality, but indoor air quality changes were neglected. In this study, we aim to investigate the impacts of lockdown measures on both ambient and household air pollution as well as the short-term health effects of air pollution changes. METHODS: In this study, an up-to-date emission inventory from January to March 2020 in China was developed based on air quality observations in combination with emission-concentration response functions derived from chemical transport modeling. These emission inventories, together with the emissions data from 2017 to 2019, were fed into the state-of-the-art regional chemistry transport model to simulate the air quality in the North China Plain. A hypothetical scenario assuming no lockdown effects in 2020 was also performed to determine the effects of the lockdown on air quality in 2020. A difference-to-difference approach was adopted to isolate the effects on air quality due to meteorological conditions and long-term decreasing emission trends by comparing the PM2.5 changes during lockdown to those before lockdown in 2020 and in previous years (2017-2019). The short-term premature mortality changes from both ambient and household PM2.5 changes were quantified based on two recent epidemiological studies, with uncertainty of urban and rural population migration considerations. FINDINGS: The national lockdown measures during COVID-19 led to a reduction of 5.1 µg m-3 in ambient PM2.5 across the North China Plain (NCP) from January 25th to March 5th compared with the hypothetical simulation with no lockdown measures. However, a difference-to-difference method showed that the daily domain average PM2.5 in the NCP decreased by 9.7 µg m-3 between lockdown periods before lockdown in 2020, while it decreased by 7.9 µg m-3 during the same periods for the previous three-year average from 2017 to 2019, demonstrating that lockdown measures may only have caused a 1.8 µg m-3 decrease in the NCP. We then found that the integrated population-weighted PM2.5, including both ambient and indoor PM2.5 exposure, increased by 5.1 µg m-3 during the lockdown periods compared to the hypothetical scenario, leading to additional premature deaths of 609 (95% CI: 415-775) to 2,860 (95% CI: 1,436-4,273) in the short term, depending on the relative risk chosen from the epidemiological studies. INTERPRETATION: Our study indicates that lockdown measures in China led to abrupt reductions in ambient PM2.5 concentration but also led to significant increases in indoor PM2.5 exposure due to confined indoor activities and increased usages of household fuel for cooking and heating. We estimated that hundreds of premature deaths were added as a combination of decreased ambient PM2.5 and increased household PM2.5. Our findings suggest that the reduction in ambient PM2.5 was negated by increased exposure to household air pollution, resulting in an overall increase in integrated population weighted exposure. Although lockdown measures were instrumental in reducing the exposure to pollution concentration in cities, rural areas bore the brunt, mainly due to the use of dirty solid fuels, increased population density due to the large-scale migration of people from urban to rural areas during the Chinese New Year and long exposure time to HAP due to restrictions in outdoor movement.

Role of emission controls in reducing the 2050 climate change penalty for PM2.5 in China.

Previous studies demonstrated that global warming can lead to deteriorated air quality even when anthropogenic emissions were kept constant, which has been called a climate change penalty on air quality. It is expected that anthropogenic emissions will decrease significantly in the future considering the aggressive emission control actions in China. However, the dependence of climate change penalty on the choice of emission scenario is still uncertain. To fill this gap, we conducted multiple independent model simulations to investigate the response of PM2.5 to future (2050) climate warming (RCP8.5) in China but with different emission scenarios, including the constant 2015 emissions, the 2050 CLE emissions (based on Current Legislation), and the 2050 MTFR emissions (based on Maximum Technically Feasible Reduction). For each set of emissions, we estimate climate change penalty as the difference in PM2.5 between a pair of simulations with either 2015 or 2050 meteorology. Under 2015 emissions, we find a PM2.5 climate change penalty of 1.43 µg m-3 in Eastern China, leading to an additional 35,000 PM2.5-related premature deaths [95% confidence interval (CI), 21,000-40,000] by 2050. However, the PM2.5 climate change penalty weakens to 0.24 µg m-3 with strict anthropogenic emission controls under the 2050 MTFR emissions, which decreases the associated PM2.5-related deaths to 17,000. The smaller MTFR climate change penalty contributes 14% of the total PM2.5 decrease when both emissions and meteorology are changed from 2015 to 2050, and 24% of total health benefits associated with this PM2.5 decrease in Eastern China. This finding suggests that controlling anthropogenic emissions can effectively reduce the climate change penalty on PM2.5 and its associated premature deaths, even though a climate change penalty still occurs even under MTFR. Strengthened controls on anthropogenic emissions are key to attaining air quality targets and protecting human health in the context of future global climate change.