Association between PM2.5air pollution, temperature, and sunlight during different infectious stages with the case fatality of COVID-19 in the United Kingdom: a modeling study
M Pear Hossain, Wen Zhou, Marco Y T Leung, Hsiang-Yu Yuan
doi:10.1101/2023.04.07.23288300
Although the relationship between the environmental factors such as weather conditions and air pollution and COVID-19 case fatality rate (CFR) has been found, the impacts of these factors to which infected cases are exposed at different infectious stages (e.g., virus exposure time, incubation period, and at or after symptom onset) are still unknown. Understanding this link can help reduce mortality rates. During the first wave of COVID-19 in the United Kingdom (UK), the CFR varied widely between and among the four countries of the UK, allowing such differential impacts to be assessed. We developed a generalized linear mixed-effect model combined with distributed lag nonlinear models to estimate the odds ratio of the weather factors (i.e., temperature, sunlight, relative humidity, and rainfall) and air pollution (i.e., ozone, ܱܰ ଶ , ܱܵ ଶ , ,ܱܥ ܯܲ ଵ and ܯܲ ଶ.ହ ) using data between March 26, 2020 and May 12, 2020 in the UK. After retrospectively time adjusted CFR was estimated using back-projection technique, the stepwise model selection method was used to choose the best model based on Akaike information criteria (AIC) and the closeness between the predicted and observed values of CFR. We found that the low temperature (8-11 ל ,)ܥ prolonged sunlight duration (11-13hours) and increased ܯܲ ଶ.ହ (11-18 ߤ݃/݉ ଷ ) after the incubation period posed a greater risk of death (measured by odds ratio (OR)) than the earlier infectious stages. The risk reached its maximum level when the low temperature occurred one day after (OR = 1.76; 95% CI: 1.10-2.81), prolonged sunlight duration 2-3 days after (OR = 1.50; 95% CI: 1.03-2.18) and increased ܯܲ ଶ.ହ at the onset of symptom (OR =1.72; 95% CI: 1.30-2.26). In contrast, prolonged sunlight duration showed a protective effect during the incubation period or earlier. After reopening, many COVID-19 cases will be identified after their symptoms appear. The findings highlight the importance of designing different preventive measures against severe illness or death considering the time before and after symptom onset.
Statement and Declarations
Competing Interest The authors have no relevant financial or non-financial interests to disclosed.
Author Contributions All authors contributed to the study conception and design. The first draft of the manuscript was written by M Pear Hossain and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
M. Pear Hossain
Ethics approval The current study did not need any ethical approval since no animal model or organ was not used in this study.
Consent to publish All authors give their consent to publish this article.
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