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      Reductions in mortality resulting from reduced air pollution levels due to COVID-19 mitigation measures

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          Abstract

          To control the novel coronavirus disease (COVID-19) outbreak, state and local governments in the United States have implemented several mitigation efforts that resulted in lower emissions of traffic-related air pollutants. This study examined the impacts of COVID-19 mitigation measures on air pollution levels and the subsequent reductions in mortality for urban areas in 10 US states and the District of Columbia. We calculated changes in levels of particulate matter with aerodynamic diameter no larger than 2.5 μm (PM 2.5) during mitigation period versus the baseline period (pre-mitigation measure) using the difference-in-difference approach and the estimated avoided total and cause-specific mortality attributable to these changes in PM 2.5 by state and district. We found that PM 2.5 concentration during the mitigation period decreased for most states (except for 3 states) and the capital. Decreases of average PM 2.5 concentration ranged from 0.25 μg/m 3 (4.3%) in Maryland to 4.20 μg/m 3 (45.1%) in California. On average, PM 2.5 levels across 7 states and the capital reduced by 12.8%. We estimated that PM 2.5 reduction during the mitigation period lowered air pollution-related total and cause-specific deaths. An estimated 483 (95% CI: 307, 665) PM 2.5-related deaths was avoided in the urban areas of California. Our findings have implications for the effects of mitigation efforts and provide insight into the mortality reductions can be achieved from reduced air pollution levels.

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          Highlights

          • PM 2.5 levels during COVID-19 mitigation decreased across 7 states and the capital.

          • PM 2.5 reduction during COVID-19 mitigation is estimated to lowered air pollution-related deaths.

          • Findings have implications for the indirect health effects of mitigation efforts.

          • Results have implications for potential health benefits from air pollution policy.

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          Most cited references25

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          Association between short-term exposure to air pollution and COVID-19 infection: Evidence from China

          The novel coronavirus pneumonia, namely COVID-19, has become a global public health problem. Previous studies have found that air pollution is a risk factor for respiratory infection by carrying microorganisms and affecting body's immunity. This study aimed to explore the relationship between ambient air pollutants and the infection caused by the novel coronavirus. Daily confirmed cases, air pollution concentration and meteorological variables in 120 cities were obtained from January 23, 2020 to February 29, 2020 in China. We applied a generalized additive model to investigate the associations of six air pollutants (PM2.5, PM10, SO2, CO, NO2 and O3) with COVID-19 confirmed cases. We observed significantly positive associations of PM2.5, PM10, NO2 and O3 in the last two weeks with newly COVID-19 confirmed cases. A 10-μg/m3 increase (lag0–14) in PM2.5, PM10, NO2, and O3 was associated with a 2.24% (95% CI: 1.02 to 3.46), 1.76% (95% CI: 0.89 to 2.63), 6.94% (95% CI: 2.38 to 11.51), and 4.76% (95% CI: 1.99 to 7.52) increase in the daily counts of confirmed cases, respectively. However, a 10-μg/m3 increase (lag0–14) in SO2 was associated with a 7.79% decrease (95% CI: −14.57 to −1.01) in COVID-19 confirmed cases. Our results indicate that there is a significant relationship between air pollution and COVID-19 infection, which could partially explain the effect of national lockdown and provide implications for the control and prevention of this novel disease.
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            Can atmospheric pollution be considered a co-factor in extremely high level of SARS-CoV-2 lethality in Northern Italy? ☆

            This paper investigates the correlation between the high level of Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) lethality and the atmospheric pollution in Northern Italy. Indeed, Lombardy and Emilia Romagna are Italian regions with both the highest level of virus lethality in the world and one of Europe’s most polluted area. Based on this correlation, this paper analyzes the possible link between pollution and the development of acute respiratory distress syndrome and eventually death. We provide evidence that people living in an area with high levels of pollutant are more prone to develop chronic respiratory conditions and suitable to any infective agent. Moreover, a prolonged exposure to air pollution leads to a chronic inflammatory stimulus, even in young and healthy subjects. We conclude that the high level of pollution in Northern Italy should be considered an additional co-factor of the high level of lethality recorded in that area.
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              Designing Difference in Difference Studies: Best Practices for Public Health Policy Research

              The difference in difference (DID) design is a quasi-experimental research design that researchers often use to study causal relationships in public health settings where randomized controlled trials (RCTs) are infeasible or unethical. However, causal inference poses many challenges in DID designs. In this article, we review key features of DID designs with an emphasis on public health policy research. Contemporary researchers should take an active approach to the design of DID studies, seeking to construct comparison groups, sensitivity analyses, and robustness checks that help validate the method's assumptions. We explain the key assumptions of the design and discuss analytic tactics, supplementary analysis, and approaches to statistical inference that are often important in applied research. The DID design is not a perfect substitute for randomized experiments, but it often represents a feasible way to learn about casual relationships. We conclude by noting that combining elements from multiple quasi-experimental techniques may be important in the next wave of innovations to the DID approach.
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                Author and article information

                Contributors
                Journal
                Sci Total Environ
                Sci. Total Environ
                The Science of the Total Environment
                Elsevier B.V.
                0048-9697
                1879-1026
                17 July 2020
                20 November 2020
                17 July 2020
                : 744
                : 141012
                Affiliations
                Yale School of the Environment, Yale University, New Haven, CT, USA
                Author notes
                [* ]Corresponding author at: School of Forestry & Environmental Studies, Yale University, 195 Prospect Street, New Haven, CT 06511, USA. jiyoung.son@ 123456yale.edu
                Article
                S0048-9697(20)34541-1 141012
                10.1016/j.scitotenv.2020.141012
                7366090
                32693269
                e7c953de-c7e6-4965-ad9c-f79e76b7dd48
                © 2020 Elsevier B.V. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 22 June 2020
                : 11 July 2020
                : 14 July 2020
                Categories
                Article

                General environmental science
                air pollution,covid-19,mitigation,mortality reduction
                General environmental science
                air pollution, covid-19, mitigation, mortality reduction

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