天气、空气污染和病毒变种对急诊科急性呼吸衰竭型新冠肺炎的影响。

Impact of weather, air pollution and virus variant on COVID-19 with acute respiratory failure in the emergency department.

作者信息

Ting Man-Ju, Hsieh Chien-Chieh, Chen Pau-Chung

机构信息

Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan.

Department of Biomedical Engineering, National Taiwan University, Taiwan; Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Emergency Medicine, Ten Chan General Hospital, Chung-Li, Taoyuan City, Taiwan; International Bachelor Program in Electrical and Communication Engineering, Yuan Ze University, Taoyuan, Taiwan.

出版信息

Am J Emerg Med. 2025 Aug;94:96-102. doi: 10.1016/j.ajem.2025.04.043. Epub 2025 Apr 20.

DOI:10.1016/j.ajem.2025.04.043

PMID:40279832

Abstract

BACKGROUND

Air pollution and meteorological factors are thought to contribute to increased risk of severe COVID-19, but the evidence is still controversial. This study aimed to assess the effects of weather, air pollution and SARS-CoV-2 variants on COVID-19 with acute respiratory failure (ARF) and investigate the respiratory management in the emergency department (ED).

METHODS

We conducted a prospective observational study of 469 COVID-19 ED visits from March 1, 2020 to December 31, 2023. Data on air pollutant levels and weather variables was obtained from Taiwan Central Weather Bureau (CWB) and Environmental Protection Administration (EPA). The generalized linear models extending bivariate and multivariable Poisson regression models were used to estimate the association between the weather variables, air pollutants, virus variants, and COVID-19 patients with ARF.

RESULTS

Among the 469 patients, 64 % were male, and the mean age was 70 ± 6 years. Overall, 18 % (n = 84) of the cohort died, 43 % (n = 200) were intubated, and 70 % (n = 326) were admitted to the ICU. We observed significantly positive associations between PM, PM, temperature, and wind speed with ED visits for COVID-19 with ARF. Every 1 μg/m increase in PM, PM, each 1 m/s increase in wind speed, and 1 °C increase in temperature were significantly associated with a 34.1 % (95 % CI: 8.2 %-66.1 %), 45.4 % (95 % CI: 39.4 %-46.6 %), 19.0 % (95 % CI: 11.4 %-27.0 %), and 10.4 % (95 % CI: 6.9 %-13.9 %) increase in the average daily number of COVID-19 patients respectively. In contrast, NO, SO, relative humidity, and sunshine were significantly associated with lower average daily numbers of severe COVID-19 patients. Moreover, virus variants were significantly positive associations between humidity and sunshine, 53.9 % (95 % CI: 37.0 %-70.3 %) and 5.4 % (95 % CI: 0.6 %-10.4 %) respectively.

CONCLUSION

The relationship between air pollution, climate change, virus variants, and COVID-19 is highly intricate. Air pollution exacerbates the severity of COVID-19, climate change influences virus transmission and human immune responses, and viral variants make pandemic control more challenging. These interactions are critical for future prediction, prevention and responses to global health crises.

摘要

背景

空气污染和气象因素被认为会增加患重症 COVID-19 的风险，但证据仍存在争议。本研究旨在评估天气、空气污染和 SARS-CoV-2 变体对伴有急性呼吸衰竭（ARF）的 COVID-19 的影响，并探讨急诊科（ED）的呼吸管理。

方法

我们对 2020 年 3 月 1 日至 2023 年 12 月 31 日期间 469 例因 COVID-19 到急诊科就诊的患者进行了前瞻性观察研究。空气污染物水平和气象变量的数据来自台湾中央气象局（CWB）和环境保护署（EPA）。使用扩展双变量和多变量泊松回归模型的广义线性模型来估计气象变量、空气污染物、病毒变体与伴有 ARF 的 COVID-19 患者之间的关联。

结果

在 469 例患者中，64%为男性，平均年龄为 70±6 岁。总体而言，该队列中有 18%（n = 84）死亡，43%（n = 200）接受了插管，70%（n = 326）被收入重症监护病房。我们观察到 PM、PM、温度和风速与伴有 ARF 的 COVID-19 患者到急诊科就诊之间存在显著的正相关。PM、PM 每增加 1 μg/m³，风速每增加 1 m/s，温度每升高 1°C，分别与 COVID-19 患者平均每日就诊人数增加 34.1%（95%CI：8.2% - 66.1%）、45.4%（95%CI：39.4% - 46.6%）、19.0%（95%CI：11.4% - 27.0%）和 10.4%（95%CI：6.9% - 13.9%）显著相关。相比之下，NO₂、SO₂、相对湿度和日照与重症 COVID-19 患者的平均每日就诊人数显著降低相关。此外，病毒变体与湿度和日照之间存在显著的正相关，分别为 53.9%（95%CI：37.0% - 70.3%）和 5.4%（95%CI：0.6% - 10.4%）。