Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed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

Kang, D.; Ellgen, C.; Kulstad, E. Possible Effects of Air Temperature on COVID‐19 Disease Severity and Transmission Rates. Journal of Medical Virology 2021, 93, 5358–5366, doi:10.1002/jmv.27042. Kang, D.; Ellgen, C.; Kulstad, E. Possible Effects of Air Temperature on COVID‐19 Disease Severity and Transmission Rates. Journal of Medical Virology 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


Biology and Life Sciences, Virology

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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Comment 2
Received: 4 August 2020
The commenter has declared there is no conflict of interests.
Comment: Sir I have mathematically derived equation for your above data which can prove this without any doubt.
Basically human body is an electrical engine, which works on principles of electricity and magnetism and on principles of thermodynamics.
According to me nerve and muscle are like electricity and magnetism.They both work in coordination just like how all other electricity and magnetism device work together.
And more importantly body doesn't understand any thing other than positive charge and negative charge. Body doesn't understand what type of virus has infected it.It is all named by we humans who have failed to understand in depth mechanism of human body.
When we are infected with any virus, it uses body host mechanism and starts multiplying producing large numbers of low energy electrons which have negative charge, mean time body's normal cells are also producing negative charge in the process of glycolysis,ETC. And these electrons are basically transferred to co2 and if any excess electrons,then those are removed by coenzymes and ultimately eliminated using buffer system, acid base balance and other mechanisms.
Now in infected individuals , there are excess electrons or negatively charged ions which occupy all our coenzymes and proteins which are present intracellularly and making cells to become more negative and finally hyperpolarized state. Ultimately result in dysfunction of cell ,when this happens to multiple cells,this leads to organ failure.

Now .I would to explain about role of temperature.
Basically body operates at 37 degrees Celsius. To maintain this temperature,it constantly requires heat energy. For this heat is derived from same biochemical reactions (glycolysis-Krebs cycle- ETC)
when one molecule of glucose enters this cycle, we capture 50% energy to make ATP and other 50% energy is lost as heat which is used to maintain body temperature.
Now during cold temperature more heat energy is required as a result we produce more ATP and more negative charges. Under normal conditions body can eliminate these excessive low energy electrons through co2.buffer systems.
But during infections ,there are lots of excess negative charges pumped by rapidly multiplying viral genome and these negative charges occupy coenzymes.proteins and other intracellular organelles causing cells to become hyperpolarise, when group of cells are affected,it will lead to organ failure.
This is why we are getting different symptoms in different covid patients ,depending on which cells they occupy first.
This is why infection rates spike in winter.
Body operates with very simple mechanisms that is by balancing between positives and negatives.
WINTER IS COMING, we need to act soon,
We need to fix temperature,so that less electrons will be produced by body and it helps to eliminate electrons produced by Infected cell.
At the end it all goes down to balancing between positive and negative,
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