Preprint Review Version 2 Preserved in Portico This version is not peer-reviewed

Possible Effects of Air Temperature on 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


Currently available data are consistent with increased severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replication at temperatures encountered in the upper airways (25–33°C when breathing room temperature air, 25°C) compared to those in the lower airways (37°C). One factor that may contribute to more rapid viral growth in the upper airways is the exponential increase in SARS-CoV-2 stability that occurs with reductions in temperature, as measured in vitro. Because SARS-CoV-2 frequently initiates infection in the upper airways before spreading through the body, increased upper airway viral growth early in the disease course may result in more rapid progression of disease and potentially contribute to more severe outcomes. Similarly, higher SARS-CoV-2 viral titer in the upper airways likely supports more efficient transmission. Conversely, the possible significance of air temperature to upper airway viral growth suggests that prolonged delivery of heated air might represent a preventative measure and prophylactic treatment for coronavirus disease 2019.


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



Comments (1)

Comment 1
Received: 6 September 2021
Commenter: Dominique Kang
Commenter's Conflict of Interests: Author
Comment: Inspired by peer review comments, we have made major revisions and incorporated many additional relevant references.

We have also modified our introduction, body, and conclusion to acknowledge the fact that conclusive demonstration of an effect remains to be performed and we have further highlighted the hypothesis-generating aspects of our paper, emphasizing that this is a proposed effect based on the review and survey of existing data, and that temperature changes could contribute to lower rates of thermal inactivation and result in higher rates of viral growth, which in turn may potentially affect viral shedding, viral load densities, transmission rates, and patient outcomes.  Further proof of this will require more complex clinical studies, which we hope this paper will provoke.  As an aside, we have also incorporated reference to a recent study published this month utilizing the ideas discussed in our paper, which although preliminary, suggest the potential for a valuable clinical effect (La Marca, et al., 2021).  We have modified our title to better reflect the ideas encapsulated in our manuscript, such that the new title is “Possible Effects of Air Temperature on COVID-19 Disease Severity and Transmission Rates.” We have also added more data to support the relevance of air temperature to transmission rates and disease severity.
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