Broad Impacts of Coronavirus Disease 2019 (COVID-19) Pandemic on Acute Respiratory Infections in China: An Observational Study
Authors: Li Zhong Jie , Yu Lin Jie , Zhang Hai Yang , Shan Chun Xi , Lu Qing Bin , Zhang Xiao Ai , Ren Xiang , Zhang Cui Hong , Wang Yi Fei , Lin Sheng Hong , Xu Qiang , Jiang Bao Gui , Jiang Tao , Lv Chen Long , Chen Jin Jin , Gao George F , Yang Wei Zhong , Wang Li Ping , Yang Yang , Fang Li Qun , Liu Wei ,   Chinese Centers for Disease Control and Prevention (CDC) Etiology Surveillance Study Team of Acute Respiratory Infections, Yang Wei Zhong , Gao George F , Li Zhong Jie , Wang Li Ping , Ren Xiang , Wang Yi Fei , Lin Sheng Hong , Zhang Cui Hong , Geng Meng Jie , Wang Xin , Jing Huai Qi , Xu Wen Bo , Cui Ai Li , Shen Yu Juan , Jiang Yan Yan , Sun Qiao , Hao Li Peng , Ye Chu Chu , Liu Wei , Zhang Xiao Ai , Huang Liu Yu , Wang Yong , Zhang Wen Yi , Liu Ying Le , Wu Jian Guo , Zhang Qi , Liu Wei Yong , Sun Zi Yong , Zhan Fa Xian , Xiong Ying , Meng Lei , Yu De Shan , Wang Chun Xiang , Zhao Sheng Cang , Wang Wen Rui , Lei Xia , Li Juan Sheng , Wang Yu Hong , Zhang Yan , Yang Jun Peng , Wang Yan Bo , Quan Fu Cai , Xiong Zhi Jun , Liang Li Ping , Chang Quan E , Wang Yun , Wang Ping , Yang Zuo Sen , Mao Ling Ling , Li Jia Meng , Lv Li Kun , Xu Jun , Shu Chang , Chen Xiao , Chen Yu , Zhang Yan Jun , Cui Lun Biao , Zheng Kui Cheng , Zhang Xing Guo , Zhang Xi , Tu Li Hong , Yi Zhi Gang , Wang Wei , Zhao Shi Wen , Zhou Xiao Fang , Pei Xiao Fang , Zheng Tian Li , Zhong Xiao Ni , Li Qin , Ling Hua , Wang Ding Ming , Li Shi Jun , He Shu Sen , Li Meng Feng , Li Jun , Zhu Xun , Ke Chang Wen , Xiao Hong , Di Biao , Zhang Ying , Zhou Hong Wei , Yu Nan , Li Hong Jian , Yang Fang , Wang Fu Xiang , Wang Jun 
Published: November 2021

Abstract

Background
To combat the coronavirus disease 2019 (COVID-19) pandemic, nonpharmaceutical interventions (NPIs) were implemented worldwide, which impacted a broad spectrum of acute respiratory infections (ARIs).

Methods
Etiologically diagnostic data from 142 559 cases with ARIs, who were tested for 8 viral pathogens (influenza virus [IFV], respiratory syncytial virus [RSV], human parainfluenza virus [HPIV], human adenovirus [HAdV], human metapneumovirus [HMPV], human coronavirus [HCoV], human bocavirus [HBoV], and human rhinovirus [HRV]) between 2012 and 2021, were analyzed to assess the changes in respiratory infections in China during the first COVID-19 pandemic year compared with 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, and 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 &lt;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.