Alleviation of PM2.5-associated Risk of Daily Influenza Hospitalization by COVID-19 Lockdown Measures: A Time-series Study in Northeastern Thailand
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Objectives: Abrupt changes in air pollution levels associated with the coronavirus disease 2019 (COVID-19) outbreak present a unique opportunity to evaluate the effects of air pollution on influenza risk, at a time when emission sources were less active and personal hygiene practices were more rigorous.Methods: This time-series study examined the relationship between influenza cases (n=22 874) and air pollutant concentrations from 2018 to 2021, comparing the timeframes before and during the COVID-19 pandemic in and around Thailand’s Khon Kaen province. Poisson generalized additive modeling was employed to estimate the relative risk of hospitalization for influenza associated with air pollutant levels.Results: Before the COVID-19 outbreak, both the average daily number of influenza hospitalizations and particulate matter with an aerodynamic diameter of 2.5 μm or less (PM<sub>2.5</sub>) concentration exceeded those later observed during the pandemic (<i>p</i><0.001). In single-pollutant models, a 10 μg/m<sup>3</sup> increase in PM<sub>2.5</sub> before COVID-19 was significantly associated with increased influenza risk upon exposure to cumulative-day lags, specifically lags 0-5 and 0-6 (<i>p</i><0.01). After adjustment for co-pollutants, PM<sub>2.5</sub> demonstrated the strongest effects at lags 0 and 4, with elevated risk found across all cumulative-day lags (0-1, 0-2, 0-3, 0-4, 0-5, and 0-6) and significantly greater risk in the winter and summer at lag 0-5 (<i>p</i><0.01). However, the PM<sub>2.5</sub> level was not significantly associated with influenza risk during the COVID-19 outbreak.Conclusions: Lockdown measures implemented during the COVID-19 pandemic could mitigate the risk of PM<sub>2.5</sub>-induced influenza. Effective regulatory actions in the context of COVID-19 may decrease PM<sub>2.5</sub> emissions and improve hygiene practices, thereby reducing influenza hospitalizations.
Abstract
Objectives: Abrupt changes in air pollution levels associated with the coronavirus disease 2019 (COVID-19) outbreak present a unique opportunity to evaluate the effects of air pollution on influenza risk, at a time when emission sources were less active and personal hygiene practices were more rigorous.Methods: This time-series study examined the relationship between influenza cases (n=22 874) and air pollutant concentrations from 2018 to 2021, comparing the timeframes before and during the COVID-19 pandemic in and around Thailand’s Khon Kaen province. Poisson generalized additive modeling was employed to estimate the relative risk of hospitalization for influenza associated with air pollutant levels.Results: Before the COVID-19 outbreak, both the average daily number of influenza hospitalizations and particulate matter with an aerodynamic diameter of 2.5 μm or less (PM<sub>2.5</sub>) concentration exceeded those later observed during the pandemic (<i>p</i><0.001). In single-pollutant models, a 10 μg/m<sup>3</sup> increase in PM<sub>2.5</sub> before COVID-19 was significantly associated with increased influenza risk upon exposure to cumulative-day lags, specifically lags 0-5 and 0-6 (<i>p</i><0.01). After adjustment for co-pollutants, PM<sub>2.5</sub> demonstrated the strongest effects at lags 0 and 4, with elevated risk found across all cumulative-day lags (0-1, 0-2, 0-3, 0-4, 0-5, and 0-6) and significantly greater risk in the winter and summer at lag 0-5 (<i>p</i><0.01). However, the PM<sub>2.5</sub> level was not significantly associated with influenza risk during the COVID-19 outbreak.Conclusions: Lockdown measures implemented during the COVID-19 pandemic could mitigate the risk of PM<sub>2.5</sub>-induced influenza. Effective regulatory actions in the context of COVID-19 may decrease PM<sub>2.5</sub> emissions and improve hygiene practices, thereby reducing influenza hospitalizations.
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