The most effective interventions: By 23 January 2020, China had imposed a national emergency response to restrict travel and impose social distancing measures on its populace in an attempt to inhibit the transmission of severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2). However, which measures were most effective is uncertain. Tian et al. performed a quantitative analysis of the impact of control measures between 31 December 2019 and 19 February 2020, which encompasses the Lunar New Year period when millions of people traveled across China for family visits. Travel restrictions in and out of Wuhan were too late to prevent the spread of the virus to 262 cities within 28 days. However, the epidemic peaked in Hubei province on 4 February 2020, indicating that measures such as closing citywide public transport and entertainment venues and banning public gatherings combined to avert hundreds of thousands of cases of infection. It is unlikely that this decline happened because the supply of susceptible people was exhausted, so relaxing control measures could lead to a resurgence. Science , this issue p. 638

Having adopted a dynamic zero-COVID strategy to respond to SARS-CoV-2 variants with higher transmissibility since August 2021, China is now considering whether, and for how long, this policy can remain in place. The debate has thus shifted towards the identification of mitigation strategies for minimizing disruption to the healthcare system in the case of a nationwide epidemic. To this aim, we developed an age-structured stochastic compartmental susceptible-latent-infectious-removed-susceptible model of SARS-CoV-2 transmission calibrated on the initial growth phase for the 2022 Omicron outbreak in Shanghai, to project COVID-19 burden (that is, number of cases, patients requiring hospitalization and intensive care, and deaths) under hypothetical mitigation scenarios. The model also considers age-specific vaccine coverage data, vaccine efficacy against different clinical endpoints, waning of immunity, different antiviral therapies and nonpharmaceutical interventions. We find that the level of immunity induced by the March 2022 vaccination campaign would be insufficient to prevent an Omicron wave that would result in exceeding critical care capacity with a projected intensive care unit peak demand of 15.6 times the existing capacity and causing approximately 1.55 million deaths. However, we also estimate that protecting vulnerable individuals by ensuring accessibility to vaccines and antiviral therapies, and maintaining implementation of nonpharmaceutical interventions could be sufficient to prevent overwhelming the healthcare system, suggesting that these factors should be points of emphasis in future mitigation policies.

With frequent air pollution episodes in China, growing research emphasis has been put on quantifying meteorological influences on PM_2.5 concentrations. However, these studies mainly focus on isolated cities, whilst meteorological influences on PM_2.5 concentrations at the national scale have not yet been examined comprehensively. This research employs the CCM (convergent cross-mapping) method to understand the influence of individual meteorological factors on local PM_2.5 concentrations in 188 monitoring cities across China. Results indicate that meteorological influences on PM_2.5 concentrations have notable seasonal and regional variations. For the heavily polluted North China region, when PM_2.5 concentrations are high, meteorological influences on PM_2.5 concentrations are strong. The dominant meteorological influence for PM_2.5 concentrations varies across locations and demonstrates regional similarities. For the most polluted winter, the dominant meteorological driver for local PM_2.5 concentrations is mainly the wind within the North China region, whilst precipitation is the dominant meteorological influence for most coastal regions. At the national scale, the influence of temperature, humidity and wind on PM_2.5 concentrations is much larger than that of other meteorological factors. Amongst eight factors, temperature exerts the strongest and most stable influence on national PM_2.5 concentrations in all seasons. Due to notable temporal and spatial differences in meteorological influences on local PM_2.5 concentrations, this research suggests pertinent environmental projects for air quality improvement should be designed accordingly for specific regions.

The global dynamics of seasonal influenza viruses inform the design of surveillance, intervention, and vaccination strategies. The COVID-19 pandemic provided a singular opportunity to evaluate how influenza circulation worldwide was perturbed by human behavioral changes. We combine molecular, epidemiological, and international travel data and find that the pandemic’s onset led to a shift in the intensity and structure of international influenza lineage movement. During the pandemic, South Asia played an important role as a phylogenetic trunk location of influenza A viruses, whereas West Asia maintained the circulation of influenza B/Victoria. We explore drivers of influenza lineage dynamics across the pandemic period and reasons for the possible extinction of the B/Yamagata lineage. After a period of 3 years, the intensity of among-region influenza lineage movements returned to pre-pandemic levels, with the exception of B/Yamagata, after the recovery of global air traffic, highlighting the robustness of global lineage dispersal patterns to substantial perturbation.

In early March 2022, a major outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant spread rapidly throughout Shanghai, China. Here we aimed to provide a description of the epidemiological characteristics and spatiotemporal transmission dynamics of the Omicron outbreak under the population-based screening and lockdown policies implemented in Shanghai. We extracted individual information on SARS-CoV-2 infections reported between January 1 and May 31, 2022, and on the timeline of the adopted non-pharmaceutical interventions. The epidemic was divided into three phases: i) sporadic infections (January 1–February 28), ii) local transmission (March 1–March 31), and iii) city-wide lockdown (April 1 to May 31). We described the epidemic spread during these three phases and the subdistrict-level spatiotemporal distribution of the infections. To evaluate the impact on the transmission of SARS-CoV-2 of the adopted targeted interventions in Phase 2 and city-wide lockdown in Phase 3, we estimated the dynamics of the net reproduction number (R_t). A surge in imported infections in Phase 1 triggered cryptic local transmission of the Omicron variant in early March, resulting in the largest outbreak in mainland China since the original wave. A total of 626,000 SARS-CoV-2 infections were reported in 99.5% (215/216) of the subdistricts of Shanghai until the end of May. The spatial distribution of the infections was highly heterogeneous, with 37% of the subdistricts accounting for 80% of all infections. A clear trend from the city center towards adjacent suburban and rural areas was observed, with a progressive slowdown of the epidemic spread (from 463 to 244 meters/day) prior to the citywide lockdown. During Phase 2, R_t remained well above 1 despite the implementation of multiple targeted interventions. The citywide lockdown imposed on April 1 led to a marked decrease in transmission, bringing R_t below the epidemic threshold in the entire city on April 14 and ultimately leading to containment of the outbreak. Our results highlight the risk of widespread outbreaks in mainland China, particularly under the heightened pressure of imported infections. The targeted interventions adopted in March 2022 were not capable of halting transmission, and the implementation of a strict, prolonged city-wide lockdown was needed to successfully contain the outbreak, highlighting the challenges for containing Omicron outbreaks. Key Program of the National Natural Science Foundation of China (82130093); Shanghai Rising-Star Program (22QA1402300).

COVID-19 vaccination is being conducted in over 200 countries and regions to control SARS-CoV-2 transmission and return to a pre-pandemic lifestyle. However, understanding when non-pharmaceutical interventions (NPIs) can be lifted as immunity builds up remains a key question for policy makers. To address this, we built a data-driven model of SARS-CoV-2 transmission for China. We estimated that, to prevent the escalation of local outbreaks to widespread epidemics, stringent NPIs need to remain in place at least one year after the start of vaccination. Should NPIs alone be capable of keeping the reproduction number (R_t) around 1.3, the synergetic effect of NPIs and vaccination could reduce the COVID-19 burden by up to 99% and bring R_t below the epidemic threshold in about 9 months. Maintaining strict NPIs throughout 2021 is of paramount importance to reduce COVID-19 burden while vaccines are distributed to the population, especially in large populations with little natural immunity.