Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

The Role of Temperature in COVID-19 Disease Severity and Transmission Rates

Version 1 : Received: 4 May 2020 / Approved: 5 May 2020 / Online: 5 May 2020 (10:47:18 CEST)
Version 2 : Received: 5 September 2021 / Approved: 6 September 2021 / Online: 6 September 2021 (13:23:23 CEST)

A peer-reviewed article of this Preprint also exists.

Journal reference: J. Med. Virol. 2021, 93, 5358-5366
DOI: 10.1002/jmv.27042


Air temperature and body temperature may influence COVID-19 disease severity and transmission rates. In vitro data indicate that SARS-CoV-2 loses infectivity at normal core body temperature (37°C); however, small reductions in temperature proximate to 37°C may result in substantially increased viral stability. If these results are representative of viral decay rates in vivo, then cooler temperatures in the body may enable more rapid viral growth. Breathing cool air—even as warm as 25°C—cools upper respiratory tract (URT) surfaces to several degrees below body temperature, and these lower temperatures may make the URT exceptionally conducive to SARS-CoV-2 replication. Increased URT viral load may enable more effective transmission. Additionally, because SARS-CoV-2 infection may frequently begin in the URT before spreading through the body, an increased rate of viral replication in the URT early in the disease course may result in more rapid progression of disease, potentially causing more severe adverse outcomes. Core body temperature may also be a factor in disease severity, as lower core body temperatures may enable more rapid viral growth. The significance of air temperature and body temperature to disease severity and transmission rates may inform preventative measures and post-exposure prophylaxis treatments for COVID-19.


Covid; covid-19; sars-cov-2; temperature; heat; body temperature; air temperature; viral decay; viral stability; transmission; severity



Comments (1)

Comment 1
Received: 19 July 2020
Commenter: Erik Kulstad
Commenter's Conflict of Interests: Equity ownership of a company, Attune Medical, with technology in the patient temperature management space.
Comment: Excellent overview of a topic of increasing interest, highlighting the potential relevant factor of body temperature in case fatality rate of COVID-19, and showing that body temperature may be among the many factors associated with age and sex that may help explain the differences in COVID-19 case fatality rate. Drs. Anne Drewry and Richard Hotchkiss out of Washington University in St. Louis have done groundbreaking work in this area, including the first randomized-controlled clinical trial on External Warming in Septic Patients ( Identifier: NCT02706275).

We've recently published a mathematical model of of patient warming, "The Use of Core Warming as a Treatment for Coronavirus Disease 2019 (COVID-19): an Initial Mathematical Model" (, and posted a planned clinical trial protocol, "Core warming of coronavirus disease 2019 (COVID-19) patients undergoing mechanical ventilation: protocol for a randomized controlled pilot study" (

Further clinical study is beginning, which we look forward to sharing once available.
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