Discussion
We found that throughout the epidemic
of COVID-19 in NSW, Australia − both during the exponential and
descending phases of the epidemic − there was a consistent negative
relationship between relative humidity and case occurrence: a 1%
decrease in relative humidity was predicted to increase cases about
7−8%, with a more pronounced effect at a relative humidity <
75−79%. In almost all PHUs this negative relationship between relative
humidity and cases was found.
Given that SARS-CoV-2 transmission is thought to be primarily via the
respiratory route (Cai et al., 2020), and that coronaviruses are known
to be susceptible in the environment (Casanova et al., 2010), the
finding of an association with relative humidity is expected. This
association might occur via the effect on respiratory aerosols and
therefore infectious material remaining airborne for longer; or it could
be a more direct effect on the survivability of the virus in the
environment. The lack of a consistent association between temperature
and COVID-19 cases in this and other studies (Qi et al., 2020) − as well
as for SARS and MERS-CoV cases (Tan et al., 2005; Gardner et al., 2019;
Altamimi and Ahmed, 2020) − suggests that it is the former that
influences SARS-CoV-2 transmission. This raises an interesting question,
and one with potentially profound importance for public health: could
increasing relative humidity contribute to a reduction in SAR-CoV-2
infections when infectious individuals mix with susceptible individuals?
In the current study − as with other studies conducted to date on SARS,
SARS-CoV-2 and MERS-CoV − we used data collected from meteorological
recording stations under the assumption that either cases were infected
in an outdoors setting, or that ambient outdoors weather conditions are
a proxy for the indoors environment (if that is where most infections
occur). Measuring the indoors environment is not possible when
retrospectively analyzing hundreds of disease cases that have occurred
in an epidemic across an entire country or state. The conduct of
controlled studies of the relationship between COVID-19 cases and
factors such as relative humidity is challenging.
It is important to highlight that COVID-19 cases used in this study
occurred predominantly during the autumn season in southern hemisphere.
In contrast, most COVID-19 cases in northern hemisphere have been
reported during the winter and spring seasons. Despite the seasons being
diametrically opposed, the negative relationship between humidity and
cases we observed in the Australian autumn is consistent with that
observed in the Chinese winter (Qi et al., 2020). Combined with evidence
from studies in the northern hemisphere, the influence of relative
humidity on COVID-19 incidence was found to be always negative in
different regions, suggesting that the relationship could be universal:
humidity is more sensitive to COVID-19 transmission and periods of lower
humidity might forecast spikes in SARS-CoV-2 transmission. In the
absence of a vaccine, such observations allow the more timely, efficient
and effective deployment of public health interventions.