OBJECTIVETo investigate the impact of temperature and absolute humidity on the coronavirus disease 2019 (COVID-19) outbreak. DESIGNEcological study. SETTING31 provincial-level regions in mainland China. MAIN OUTCOME MEASURESData on COVID-19 incidence and climate between Jan 20 and Feb 29, 2020. RESULTSThe number of new confirm COVID-19 cases in mainland China peaked on Feb 1, 2020. COVID-19 daily incidence were lowest at -10 {degrees}C and highest at 10 {degrees}C, while the maximum incidence was observed at the absolute humidity of approximately 7 g/m3. COVID-19 incidence changed with temperature as daily incidence decreased when the temperature rose. No significant association between COVID-19 incidence and absolute humidity was observed in distributed lag nonlinear models. Additionally, A modified susceptible-exposed-infectious-recovered (M-SEIR) model confirmed that transmission rate decreased with the increase of temperature, leading to further decrease of infection rate and outbreak scale. CONCLUSIONTemperature is an environmental driver of the COVID-19 outbreak in China. Lower and higher temperatures might be positive to decrease the COVID-19 incidence. M-SEIR models help to better evaluate environmental and social impacts on COVID-19. What is already known on this topicO_LIMany infectious diseases present an environmental pattern in their incidence. C_LIO_LIEnvironmental factors, such as climate and weather condition, could drive the space and time correlations of infectious diseases, including influenza. C_LIO_LISevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be transmitted through aerosols, large droplets, or direct contact with secretions (or fomites) as influenza virus can. C_LIO_LILittle is known about environmental pattern in COVID-19 incidence. C_LI What this study addsO_LIThe significant association between COVID-19 daily incidence and temperature was confirmed, using 3 methods, based on the data on COVID-19 and weather from 31 provincial-level regions in mainland China. C_LIO_LIEnvironmental factors were considered on the basis of SEIR model, and a modified susceptible-exposed-infectious-recovered (M-SEIR) model was developed. C_LIO_LISimulations of the COVID-19 outbreak in Wuhan presented similar effects of temperature on incidence as the incidence decrease with the increase of temperature. C_LI
The impact of temperature and absolute humidity on the coronavirus disease 2019 (COVID-19) outbreak - evidence from China