Broad Impacts of Coronavirus Disease 2019 (COVID-19) Pandemic on Acute Respiratory Infections in China: An Observational Study

Abstract

Background To combat the COVID-19 pandemic, nonpharmaceutical interventions (NPI) were implemented worldwide, which impacted a broad spectrum of acute respiratory infections (ARI). Methods Etiologically diagnostic data from 142 559 cases with ARIs, who were tested for eight viral pathogens (influenza virus, IFV; respiratory syncytial virus, RSV; human parainfluenza virus, HPIV; human adenovirus; human metapneumovirus; human coronavirus, HCoV; human bocavirus, HBoV, and human rhinovirus, HRV) between 2012 and 2021, were analyzed to assess the changes of respiratory infections in China during the first COVID-19 pandemic year compared to pre-pandemic years. Results Test positive rates of all respiratory viruses decreased during 2020, compared to the average levels during 2012−2019, with changes ranging from -17·2% for RSV to -87·6% for IFV. Sharp decreases mostly occurred between February and August when massive NPIs remained active, although HRV rebounded to the historical level during the summer. While IFV and HMPV were consistently suppressed year round, RSV, HPIV, HCoV, HRV HBov resurged and went beyond historical levels during September, 2020−January, 2021, after NPIs were largely relaxed and schools reopened. Resurgence was more prominent among children younger than 18 years and in Northern China. These observations remain valid after accounting for seasonality and long-term trend of each virus. Conclusions Activities of respiratory viral infections were reduced substantially in the early phases of the COVID-19 pandemic, and massive NPIs were likely the main driver. Lifting of NPIs can lead to resurgence of viral infections, particularly in children.

Dynamics of influenza‐like illness under urbanization procedure and COVID‐19 pandemic in the subcenter of Beijing during 2013–2021

“…15,28,29 ILI activity among people aged over 25 years remained at a low level, which is in line with previous studies. 15,29,30 It suggests that influenza prevention and control in newly developed urbanization areas should be focused at places like schools and kindergartens in facing the assault of increasing population diversity, mobility, and human contact. 11,15,28,29 However, we found the lowest ILI activity among the elder population within our study interval comparing to other age groups.…”

“…Changes in urbanization has led to specific changes in the intensity of influenza epidemics 25–27 . Under the stronger interconnection among intensive population with different living conditions, dynamic of ILI was confirmed to be aggravated, particularly among those susceptible populations like children and adolescents under 25 years 15,28,29 . ILI activity among people aged over 25 years remained at a low level, which is in line with previous studies 15,29,30 .…”

“… 15 , 29 , 30 It suggests that influenza prevention and control in newly developed urbanization areas should be focused at places like schools and kindergartens in facing the assault of increasing population diversity, mobility, and human contact. 11 , 15 , 28 , 29 However, we found the lowest ILI activity among the elder population within our study interval comparing to other age groups. This might be due to the influenza vaccination strategies conducted in Beijing that vaccination to influenza was largely encouraged and free of charge for each older adult aged over 60 years and school‐aged children for more than one decade.…”

“… 13 , 14 Studies have explored the impact of COVID‐19 pandemic and related NPIs on respiratory diseases like influenza, since they share similar transmission modes and symptoms. 15 , 16 Several studies indicated that the activity of ILI generally decreased by NPIs in the short run. 17 , 18 , 19 However, the impact of NPIs on ILI dynamic after the first wave was still needed to be illustrated.…”

Sharp decline in rates of community respiratory viral detection among patients at the National Institutes of Health Clinical Center during the coronavirus disease 2019 (COVID-19) pandemic

“…The colder weather in the late fall and early winter of 2021 may already be heralding the return of non-SARS-COV-2 respiratory infection. Some institutions have observed an increase in RSV and other respiratory virus infections (39).…”