Background: Exposure to poor air quality leads to increased premature mortality from cardiovascular and respiratory diseases. Among the far-reaching implications of the ongoing COVID-19 pandemic, a substantial improvement in air quality was observed worldwide after the lockdowns imposed by many countries. We aimed to assess the implications of different lockdown measures on air pollution levels in Europe and China, as well as the short-term and long-term health impact. Methods: For this modelling study, observations of fine particulate matter (PM2·5) concentrations from more than 2500 stations in Europe and China during 2016–20 were integrated with chemical transport model simulations to reconstruct PM2·5 fields at high spatiotemporal resolution. The health benefits, expressed as short-term and long-term avoided mortality from PM2·5 exposure associated with the interventions imposed to control the COVID-19 pandemic, were quantified on the basis of the latest epidemiological studies. To explore the long-term variability in air quality and associated premature mortality, we built different scenarios of economic recovery (immediate or gradual resumption of activities, a second outbreak in autumn, and permanent lockdown for the whole of 2020). Findings: The lockdown interventions led to a reduction in population-weighted PM2·5 of 14·5 μg m−3 across China (−29·7%) and 2·2 μg m−3 across Europe (−17·1%), with unprecedented reductions of 40 μg m−3 in bimonthly mean PM2·5 in the areas most affected by COVID-19 in China. In the short term, an estimated 24 200 (95% CI 22 380–26 010) premature deaths were averted throughout China between Feb 1 and March 31, and an estimated 2190 (1960–2420) deaths were averted in Europe between Feb 21 and May 17. We also estimated a positive number of long-term avoided premature fatalities due to reduced PM2·5 concentrations, ranging from 76 400 (95% CI 62 600–86 900) to 287 000 (233 700–328 300) for China, and from 13 600 (11 900–15 300) to 29 500 (25 800–33 300) for Europe, depending on the future scenarios of economic recovery adopted. Interpretation: These results indicate that lockdown interventions led to substantial reductions in PM2·5 concentrations in China and Europe. We estimated that tens of thousands of premature deaths from air pollution were avoided, although with significant differences observed in Europe and China. Our findings suggest that considerable improvements in air quality are achievable in both China and Europe when stringent emission control policies are adopted. Funding: None. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license

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