Quantifying the spatial spillover effects of non-pharmaceutical interventions on pandemic risk.

BACKGROUND: Non-pharmaceutical interventions (NPIs) implemented in one place can affect neighboring regions by influencing people's behavior. However, existing epidemic models for NPIs evaluation rarely consider such spatial spillover effects, which may lead to a biased assessment of policy effects. METHODS: Using the US state-level mobility and policy data from January 6 to August 2, 2020, we develop a quantitative framework that includes both a panel spatial econometric model and an S-SEIR (Spillover-Susceptible-Exposed-Infected-Recovered) model to quantify the spatial spillover effects of NPIs on human mobility and COVID-19 transmission. RESULTS: The spatial spillover effects of NPIs explain [Formula: see text] [[Formula: see text] credible interval: 52.8-[Formula: see text]] of national cumulative confirmed cases, suggesting that the presence of the spillover effect significantly enhances the NPI influence. Simulations based on the S-SEIR model further show that increasing interventions in only a few states with larger intrastate human mobility intensity significantly reduce the cases nationwide. These region-based interventions also can carry over to interstate lockdowns. CONCLUSIONS: Our study provides a framework for evaluating and comparing the effectiveness of different intervention strategies conditional on NPI spillovers, and calls for collaboration from different regions.

Healthy cities initiative in China: Progress, challenges, and the way forward.

China implemented the first phase of its National Healthy Cities pilot program from 2016-20. Along with related urban health governmental initiatives, the program has helped put health on the agenda of local governments while raising public awareness. Healthy City actions taken at the municipal scale also prepared cities to deal with the COVID-19 pandemic. However, after intermittent trials spanning the past two decades, the Healthy Cities initiative in China has reached a crucial juncture. It risks becoming inconsequential given its overlap with other health promotion efforts, changing public health priorities in response to the pandemic, and the partial adoption of the Healthy Cities approach advanced by the World Health Organization (WHO). We recommend aligning the Healthy Cities initiative in China with strategic national and global level agendas such as Healthy China 2030 and the Sustainable Development Goals (SDGs) by providing an integrative governance framework to facilitate a coherent intersectoral program to systemically improve population health. Achieving this alignment will require leveraging the full spectrum of best practices in Healthy Cities actions and expanding assessment efforts. Funding: Tsinghua-Toyota Joint Research Fund "Healthy city systems for smart cities" program.

Assessing the spatial distribution of and inequality in 15-minute PCR test site accessibility in Beijing and Guangzhou, China.

China has been planning to construct SARS-CoV-2 antigen testing sites within a 15-min walk in most major cities to timely identify asymptomatic cases and stop the transmission of COVID-19. However, little is known about the spatial distribution of 15-min accessibility to PCR test sites. In this study, we analyze the spatial distribution of and inequality in 15-min accessibility to PCR test sites in two major Chinese cities (Beijing and Guangzhou) based on the cumulative-opportunity model. The results indicate that the current distribution of 15-min accessibility to PCR test sites is satisfactory when normal commuting is not disrupted. However, disruptions of normal commuting (e.g., due to work-from-home restrictions) can negatively influence 15-min accessibility to PCR test sites and increase its inequality. Our study provides policymakers with up-to-date knowledge about the spatial distribution of 15-min accessibility to PCR test sites, identifies the disadvantaged neighborhoods in terms of test site accessibility, and highlights the changes in accessibility and inequality because of travel disruptions.

Associations between COVID-19 risk, multiple environmental exposures, and housing conditions: A study using individual-level GPS-based real-time sensing data.

Few studies have used individual-level data to explore the association between COVID-19 risk with multiple environmental exposures and housing conditions. Using individual-level data collected with GPS-tracking smartphones, mobile air-pollutant and noise sensors, an activity-travel diary, and a questionnaire from two typical neighborhoods in a dense and well-developed city (i.e., Hong Kong), this study seeks to examine 1) the associations between multiple environmental exposures (i.e., different types of greenspace, PM2.5, and noise) and housing conditions (i.e., housing types, ownership, and overcrowding) with individuals' COVID-19 risk both in residential neighborhoods and along daily mobility trajectories; 2) which social groups are disadvantaged in COVID-19 risk through the perspective of the neighborhood effect averaging problem (NEAP). Using separate multiple linear regression and logistical regression models, we found a significant negative association between COVID-19 risk with greenspace (i.e., NDVI) both in residential areas and along people's daily mobility trajectories. Meanwhile, we also found that high open space and recreational land exposure and poor housing conditions were positively associated with COVID-19 risk in high-risk neighborhoods, and noise exposure was positively associated with COVID-19 risk in low-risk neighborhoods. Further, people with work places in high-risk areas and poor housing conditions were disadvantaged in COVID-19 risk.

COVID-19 infection rate but not severity is associated with availability of greenness in the United States.

Human exposure to greenness is associated with COVID-19 prevalence and severity, but most relevant research has focused on the relationships between greenness and COVID-19 infection rates. In contrast, relatively little is known about the associations between greenness and COVID-19 hospitalizations and deaths, which are important for risk assessment, resource allocation, and intervention strategies. Moreover, it is unclear whether greenness could help reduce health inequities by offering more benefits to disadvantaged populations. Here, we estimated the associations between availability of greenness (expressed as population-density-weighted normalized difference vegetation index) and COVID-19 outcomes across the urban-rural continuum gradient in the United States using generalized additive models with a negative binomial distribution. We aggregated individual COVID-19 records at the county level, which includes 3,040 counties for COVID-19 case infection rates, 1,397 counties for case hospitalization rates, and 1,305 counties for case fatality rates. Our area-level ecological study suggests that although availability of greenness shows null relationships with COVID-19 case hospitalization and fatality rates, COVID-19 infection rate is statistically significant and negatively associated with more greenness availability. When performing stratified analyses by different sociodemographic groups, availability of greenness shows stronger negative associations for men than for women, and for adults than for the elderly. This indicates that greenness might have greater health benefits for the former than the latter, and thus has limited effects for ameliorating COVID-19 related inequity. The revealed greenness-COVID-19 links across different space, time and sociodemographic groups provide working hypotheses for the targeted design of nature-based interventions and greening policies to benefit human well-being and reduce health inequity. This has important implications for the post-pandemic recovery and future public health crises.

Toward a Healthy Urban Living Environment: Assessing 15-Minute Green-Blue Space Accessibility

Exposure to green-blue space has been shown to be associated with better physical and mental health outcomes. The advent of COVID-19 has underlined the importance for people to have access to green-blue spaces in proximity to their residences due to pandemic-related restrictions on activity space. The implementation of the 15-min concept, which advocates that people should be able to reach locations of essential functions like green-blue spaces within 15 min of active travel, can bring green-blue spaces nearer to where people live. Nonetheless, there is still a lack of understanding of the social and spatial (in)equality in 15-min green-blue space accessibility by active travel in cities seeking to embrace the concept, such as Hong Kong. This study explores 15-min green-blue space accessibility by walking and cycling in Hong Kong to reveal the distribution of disadvantaged neighborhoods. The results show that neighborhoods in Kowloon's districts are the most disadvantaged in accessing green-blue spaces within 15 min of active travel. Our study provides policymakers with valuable insights and knowledge conducive to formulating policies aimed at reducing inequality in 15-min accessibility.

Integrated analysis of doubly disadvantaged neighborhoods by considering both green space and blue space accessibility and COVID-19 infection risk.

The ongoing COVID-19 pandemic has taken a heavy toll on the physical and mental health of the public. Nevertheless, the presence of green and blue spaces has been shown to be able to encourage physical activities and alleviate the mental distress caused by COVID-19. However, just as the impact of COVID-19 varies by geographical region and area, the distribution of green and blue spaces is also different across different neighborhoods and areas. By using Hong Kong as the study area, we determine the local neighborhoods that suffer from both high COVID-19 infection risk as well as low green and blue space accessibility. The results show that some of the poorest neighborhoods in the territory such as Sham Shui Po, Kwun Tong and Wong Tai Sin are also among the most doubly disadvantaged in terms of COVID-19 infection risk as well as green and blue space accessibility.

Examining the Influence of Housing Conditions and Daily Greenspace Exposure on People's Perceived COVID-19 Risk and Distress.

Many people have worried about COVID-19 infection, job loss, income reduction, and family conflict during the COVID-19 pandemic. Some social groups may be particularly vulnerable due to their residential neighborhoods and daily activities. On the other hand, people's daily exposure to greenspace offers promising pathways for reducing these worries associated with COVID-19. Using data collected with a questionnaire and a two-day activity diary from two typical neighborhoods in Hong Kong, this study examines how people's housing conditions and daily greenspace exposure affect their perceived COVID-19 risk and distress (i.e., worries about job loss, income reduction, and family conflict) during the pandemic. First, the study compares people's perceived COVID-19 risk and distress based on their residential neighborhoods. Further, it examines the associations between people's perceived COVID-19 risk and distress with their housing conditions and daily greenspace exposure using ordinal logistic regression models. The results indicate that living in a high-risk neighborhood, being married, renting a residential unit, and living in a large household are significantly associated with a higher neighborhood-based perceived COVID-19 risk and distress during the pandemic. In addition, people also reported lower mobility-based perceived COVID-19 risk when compared to their neighborhood-based perceived COVID-19 risk, while they still have a high perceived COVID-19 risk in their occupational venues if they have to work in a high-risk district (e.g., Kowloon). Lastly, daily greenspace exposure (i.e., woodland) could reduce people's perceived COVID-19 risk and distress. These results have important implications for the public health authority when formulating the measures during the COVID-19 pandemic.

Racial/Ethnic Inequity in Transit-Based Spatial Accessibility to COVID-19 Vaccination Sites.

With the ongoing spread of COVID-19, vaccination stands as an effective measure to control and mitigate the impact of the disease. However, due to the unequal distribution of COVID-19 vaccination sites, people can have different levels of spatial accessibility to COVID-19 vaccination. This study adopts an improved gravity-based model to measure the racial/ethnic inequity in transit-based spatial accessibility to COVID-19 vaccination sites in the Chicago Metropolitan Area. The results show that Black-majority and Hispanic-majority neighborhoods have significantly lower transit-based spatial accessibility to COVID-19 vaccination sites compared to White-majority neighborhoods. This research concludes that minority-dominated inner-city neighborhoods, despite better public transit coverage, are still disadvantaged in terms of transit-based spatial accessibility to COVID-19 vaccination sites. This is probably due to their higher population densities, which increase the competition for the limited supply of COVID-19 vaccination sites within each catchment area.

Differences in Sleep Patterns and Mental Health Problems During Different Periods of COVID-19 Outbreak Among Community-Dwelling Older Men in Hong Kong.

Objectives: To determine the association of sleep with mental health among Hong Kong community-dwelling older men in the context of the COVID-19 pandemic. Methods: This additional analysis was derived from the community-dwelling men aged >60 recruited during three COVID-19 outbreaks (i.e., pre-outbreak, between the second and third wave, and during the third wave) in Hong Kong from July 2019 to September 2020. Sleep and mental health were measured by Pittsburgh Sleep Quality Index questionnaire and Hospital Anxiety and Depression Scale, respectively. Multivariate logistic regression models were performed for the associations between sleep and mental health after considering the outbreaks' impact. Results: Subjects enrolled between the second and third wave tended to have better sleep but worse mental health. Positive associations between poor sleep and depression (AOR = 3.27, 95% CI: 1.60-7.03) and anxiety (AOR = 2.40, 95% CI: 1.07-5.76) were observed. The period "between second and third wave" was positively associated with depression (AOR = 2.65, 95% CI: 1.22-5.83), showing an additive interaction with poor sleep. Conclusion: The positive association between poor sleep and depression was aggravated by the period "between the second and third wave" among community-dwelling older males in Hong Kong.

Reconciling public health common good and individual privacy: new methods and issues in geoprivacy.

This article provides a state-of-the-art summary of location privacy issues and geoprivacy-preserving methods in public health interventions and health research involving disaggregate geographic data about individuals. Synthetic data generation (from real data using machine learning) is discussed in detail as a promising privacy-preserving approach. To fully achieve their goals, privacy-preserving methods should form part of a wider comprehensive socio-technical framework for the appropriate disclosure, use and dissemination of data containing personal identifiable information. Select highlights are also presented from a related December 2021 AAG (American Association of Geographers) webinar that explored ethical and other issues surrounding the use of geospatial data to address public health issues during challenging crises, such as the COVID-19 pandemic.

The superspreading places of COVID-19 and the associated built-environment and socio-demographic features: A study using a spatial network framework and individual-level activity data.

Previous studies observed that most COVID-19 infections were transmitted by a few individuals at a few high-risk places (e.g., bars or social gathering venues). These individuals, often called superspreaders, transmit the virus to an unexpectedly large number of people. Further, a small number of superspreading places (SSPs) where this occurred account for a large number of COVID-19 transmissions. In this study, we propose a spatial network framework for identifying the SSPs that disproportionately spread COVID-19. Using individual-level activity data of the confirmed cases in Hong Kong, we first identify the high-risk places in the first four COVID-19 waves using the space-time kernel density method (STKDE). Then, we identify the SSPs among these high-risk places by constructing spatial networks that integrate the flow intensity of the confirmed cases. We also examine what built-environment and socio-demographic features would make a high-risk place to more likely become an SSP in different waves of COVID-19 by using regression models. The results indicate that some places had very high transmission risk and suffered from repeated COVID-19 outbreaks over the four waves, and some of these high-risk places were SSPs where most (about 80%) of the COVID-19 transmission occurred due to their intense spatial interactions with other places. Further, we find that high-risk places with dense urban renewal buildings and high median monthly household rent-to-income ratio have higher odds of being SSPs. The results also imply that the associations between built-environment and socio-demographic features with the high-risk places and SSPs are dynamic over time. The implications for better policymaking during the COVID-19 pandemic are discussed.

Comparing the space-time patterns of high-risk areas in different waves of COVID-19 in Hong Kong.

This study compares the space-time patterns and characteristics of high-risk areas of COVID-19 transmission in Hong Kong between January 23 and April 14 (the first and second waves) and between July 6 and August 29 (the third wave). Using space-time scan statistics and the contact tracing data of individual confirmed cases, we detect the clusters of residences of, and places visited by, both imported and local cases. We also identify the built-environment and demographic characteristics of the high-risk areas during different waves of COVID-19. We find considerable differences in the space-time patterns and characteristics of high-risk residential areas between waves. However, venues and buildings visited by the confirmed cases in different waves have similar characteristics. The results can inform policymakers to target mitigation measures in high-risk areas and at vulnerable groups, and provide guidance to the public to avoid visiting and conducting activities at high-risk places.

Assessing the Country-Level Excess All-Cause Mortality and the Impacts of Air Pollution and Human Activity during the COVID-19 Epidemic.

The impact of Coronavirus Disease 2019 (COVID-19) on cause-specific mortality has been investigated on a global scale. However, less is known about the excess all-cause mortality and air pollution-human activity responses. This study estimated the weekly excess all-cause mortality during COVID-19 and evaluated the impacts of air pollution and human activities on mortality variations during the 10th to 52nd weeks of 2020 among sixteen countries. A SARIMA model was adopted to estimate the mortality benchmark based on short-term mortality during 2015-2019 and calculate excess mortality. A quasi-likelihood Poisson-based GAM model was further applied for air pollution/human activity response evaluation, namely ground-level NO2 and PM2.5 and the visit frequencies of parks and workplaces. The findings showed that, compared with COVID-19 mortality (i.e., cause-specific mortality), excess all-cause mortality changed from -26.52% to 373.60% during the 10th to 52nd weeks across the sixteen countries examined, revealing higher excess all-cause mortality than COVID-19 mortality in most countries. For the impact of air pollution and human activities, the average country-level relative risk showed that one unit increase in weekly NO2, PM2.5, park visits and workplace visits was associated with approximately 1.54% increase and 0.19%, 0.23%, and 0.23% decrease in excess all-cause mortality, respectively. Moreover, compared with the impact on COVID-19 mortality, the relative risks of weekly NO2 and PM2.5 were lower, and the relative risks of weekly park and workplace visits were higher for excess all-cause mortality. These results suggest that the estimation based on excess all-cause mortality reduced the potential impact of air pollution and enhanced the influence of human activities compared with the estimation based on COVID-19 mortality.

The stationarity bias in research on the environmental determinants of health.

An implicit assumption often made in research on the environmental determinants of health is that the relationships between environmental factors and their health effects are stable over space and time. This is the assumption of stationarity. The health impacts of environmental factors, however, may vary not only over space and time but also over the value ranges of the environmental factors under investigation. Few studies to date have examined how often the stationarity assumption is violated and when violated, to what extent findings might be misleading. Using selected studies as examples, this paper explores how the stationarity assumption can lead to misleading conclusions about health-environment relationships that may in turn have serious health consequences or policy implications. It encourages researchers to embrace nonstationarity and recognize its meaning because it helps direct our attention to the ignored factors or processes that may enhance our understanding of the phenomena under investigation.

Yearly and Daily Relationship Assessment between Air Pollution and Early-Stage COVID-19 Incidence: Evidence from 231 Countries and Regions

The novel coronavirus disease 2019 (COVID-19) has caused significantly changes in worldwide environmental and socioeconomics, especially in the early stage. Previous research has found that air pollution is potentially affected by these unprecedented changes and it affects COVID-19 infections. This study aims to explore the non-linear association between yearly and daily global air pollution and the confirmed cases of COVID-19. The concentrations of tropospheric air pollution (CO, NO2, O3, and SO2) and the daily confirmed cases between 23 January 2020 and 31 May 2020 were collected at the global scale. The yearly discrepancies of air pollutions and daily air pollution are associated with total and daily confirmed cases, respectively, based on the generalized additive model. We observed that there are significant spatially and temporally non-stationary variations between air pollution and confirmed cases of COVID-19. For the yearly assessment, the number of confirmed cases is associated with the positive fluctuation of CO, O3, and SO2 discrepancies, while the increasing NO2 discrepancies leads to the significant peak of confirmed cases variation. For the daily assessment, among the selected countries, positive linear or non-linear relationships are found between CO and SO2 concentrations and the daily confirmed cases, whereas NO2 concentrations are negatively correlated with the daily confirmed cases;variations in the ascending/declining associations are identified from the relationship of the O3-confirmed cases. The findings indicate that the non-linear relationships between global air pollution and the confirmed cases of COVID-19 are varied, which implicates the needs as well as the incorporation of our findings in the risk monitoring of public health on local, regional, and global scales.

Effects of urban functional fragmentation on nitrogen dioxide (NO2) variation with anthropogenic-emission restriction in China.

Urban functional fragmentation plays an important role in assessing Nitrogen Dioxide (NO2) emissions and variations. While the mediated impact of anthropogenic-emission restriction has not been comprehensively discussed, the lockdown response to the novel coronavirus disease 2019 (COVID-19) provides an unprecedented opportunity to meet this goal. This study proposes a new idea to explore the effects of urban functional fragmentation on NO2 variation with anthropogenic-emission restriction in China. First, NO2 variations are quantified by an Autoregressive Integrated Moving Average with external variables-Dynamic Time Warping (SARIMAX-DTW)-based model. Then, urban functional fragmentation indices including industrial/public Edge Density (ED) and Landscape Shape Index (LSI), urban functional Aggregation Index (AI) and Number of Patches (NP) are developed. Finally, the mediated impacts of anthropogenic-emission restriction are assessed by evaluating the fragmentation-NO2 variation association before and during the lockdown during COVID-19. The findings reveal negative effects of industrial ED, public LSI, urban functional AI and NP and positive effects of public ED and industrial LSI on NO2 variation based on the restricted anthropogenic emissions. By comparing the association analysis before and during lockdown, the mediated impact of anthropogenic-emission restriction is revealed to partially increase the effect of industrial ED, industrial LSI, public LSI, urban functional AI and NP and decrease the effect of public ED on NO2 variation. This study provides scientific findings for redesigning the urban environment in related to the urban functional configuration to mitigating the air pollution, ultimately developing sustainable societies.