Association of regional Covid-19 mortality with indicators of indoor ventilation, including temperature and wind: insights into the upcoming winter: Update Dec. 5, 2021

BackgroundOutdoor environmental variables, such as cold temperatures and low wind speed, have been correlated with incidence and mortality from Covid-19 (caused by the SARS-CoV-2 virus). However, as Covid-19 predominantly spreads indoors, the degree to which outdoor environmental variables might directly cause disease spread is unclear. MethodsWorld regions were considered to have reliable data if the excess mortality did not greatly exceed reported Covid-19 mortality. The relative risk of Covid-19 mortality for 142 regions as a function of median weekly temperature and wind speed was determined. For instance, Covid-19 mortality following warm weeks in a country was compared with mortality following cold weeks in the same country. ResultsCovid-19 mortality increases with cooling from 20 C to close to freezing (0 to 4 C, p<0.001). The relation of Covid-19 mortality with temperature demonstrates a maximum close to freezing. Below -5 C, the decrease in mortality with further cooling was statistically significant (p<0.01). With warming above room temperature (20 to 24 C), there is a nonsignificant trend for mortality to increase again. A literature review demonstrated that window opening and indoor ventilation tend to increase with warming in the range from freezing to room temperature. ConclusionThe steep decline in Covid-19 mortality with warming in the range from freezing to room temperature may relate to window opening and less indoor crowding when it is comfortable outside. Below freezing, all windows are closed, and further cooling increases stack ventilation (secondary to indoor-outdoor temperature differences) and thereby tends to decrease Covid-19 mortality. Opening windows and other tools for improving indoor ventilation may decrease the spread of Covid-19.