Background: The COVID-19 pandemic varies between countries, with suggestions that weather might contribute to the transmission mode, disease presentation, severity, and clinical outcomes. Yet the exact link between climate and COVID-19 is still not well-explored.
Objectives: This study aimed to evaluate the effect of hot geographical region weather [like United Arab Emirates (UAE)] on COVID-19 clinical profile and outcomes. Temperature, wind speed, cloud cover, precipitation, and other weather-related variables were studied concerning COVID-19 patients outcomes and laboratory results.
Methodology: A total of 434 COVID-19 positive patients admitted between January and June 2020, were recruited from Al Kuwait Hospital, Dubai, UAE. Temperature, wind speed, cloud cover, and precipitation rate were retrieved from history+ for the day when COVID-19 patients presented to the hospital. These weather parameters were correlated with COVID-19 clinical and laboratory parameters.
Results: Our results showed that patients needed admission in days with higher temperatures, higher solar radiation, and less humidity were associated with higher deaths. This association can be linked to the association of these weather parameters with age at diagnosis; higher C-reactive protein (CRP), neutrophil count, white cell count (WCC), aspartate aminotransferase (AST), and alkaline phosphatase (ALP); and lower lymphocyte count, estimated glomerular filtration rate (eGFR), hemoglobin (Hb), Na, and albumin, all of which are considered poor prognostic factors for COVID-19.
Conclusion: Our study highlighted the importance of weather-related variables on the dynamics of mortality and clinical outcomes of COVID-19. The hot weather might makes some people, especially those with comorbidities or older ages, develop aggressive inflammation that ends up with complications and mortality.
Introduction
The exact link between weather and COVID-19 spread is still not well-explored, although a few reports claimed that warm weather can slow down such spread and can help in predicting which geographic areas in different countries can have a higher risk of spread (1). One of the COVID-19 pandemic characteristics is a very rapid spread and high mortality rates in countries north of the equator known to have low seasonal air temperatures (2). Such countries with low humidity are suspected to favor the transmission and survival of SARS-COV-2 (3). Such a link is not surprising for the virus family as Middle East respiratory syndrome coronavirus (MERS-CoV) human cases in Saudi Arabia were more likely to occur when conditions were relatively cold and dry (4), where increasing temperature to 65°C had a strong negative effect on viral infectivity (5). Recently, the severity of COVID-19 in Europe was documented to be decreased significantly between March and May, and the seasonality of COVID-19 was suggested to explain that note (6).
Some reports suggested SARS-CoV-2 be inactivated relatively fast during summer due to the sunlight effect (7), and the overall epidemic intensity of COVID-19 was shown to be reduced slightly following days with higher temperatures (8). Short-term exposures to the ozone can influence COVID-19 transmission and initiation of the disease (9).
The COVID-19 pandemic was found to be correlated negatively with average temperature (10), wind speed 14 days ago, the temperature of the day (11), air quality (12) in terms of averaged ground levels of particulate matter concentrations (13), and relative humidity (14). Of these, temperature and humidity are essential features for predicting the COVID-19 mortality rate (15). Air pollution by an increase in PM2.5 accelerated transmission of SARS-CoV-2 (16) and triggered COVID-19 spread and lethality levels (17).
Nevertheless, cases in warm and humid countries have consistently increased later, opposite to the claimed effect of warm weather on the virus spread (18). On the other hand, some reports showed that there was no association between COVID-19 transmission and temperature or UV radiation in Chinese cities (19). For example, the temperature was shown to have no role in the containment of COVID-19 in Wuhan (20).
From the literature, such as dynamic multidimensional and complex weather, COVID-19 interaction cannot be explained as a general role. Still, they can suggest a regional trend that should be kept in mind when trying to understand pandemic dynamics. Based on that, we thought of exploring the correlation between weather parameters in Dubai, United Arab Emirates (UAE), and COVID-19 patients’ related clinical and laboratory characteristics. To our knowledge, this paper is the first to explore this relationship in the Middle East region.
Materials and Methods
Patient Data Collection
A total of 434 COVID-19-positive patients admitted between January and June 2020 were recruited from Al Kuwait Hospital, Dubai, UAE. The study was approved by the Ministry of Health and Prevention (MOHAP, Research Ethics Committee number MOHAP/DXB-REC/MMM/NO. 44/2020). Adult patients (above 18 years) with COVID-19 (confirmed by nasopharyngeal polymerase chain reaction, PCR-positive sample) were enrolled. Complete current and past medical history, along with their demographic data, history of recent travel or contact with another confirmed case(s), was documented. Patients were classified according to “Clinical Management of Critically Ill COVID-19 Patients” guidelines (Version 1, April 15, 2020) issued by MOHAP (6).
Blood and Radiological Tests
Laboratory tests were retrieved: (1) complete blood count, including neutrophil count (NR: 2–7 × 103/μL), lymphocyte count (NR: 1–3 × 103/μL), hemoglobin (Hb, NR: 12–15 g/dL), white cell count (WCC, NR: 4–11 × 103/μL), and platelet count (NR: 150–450 × 103/μL); (2) coagulation profile, including international normalized ratio (INR, NR: 0.8–1.29 s), prothrombin time (PT, NR: 9.9–12.3 s); (3) electrolytes, including sodium (Na, NR: 136–145 mmol/L) and potassium (K, NR: 3.6–5.1 mmol/L); (4) renal function tests, including urea (NR: 2.5–6.5 mmol/L), creatinine (NR: 53–88 μmol/L), and estimated glomerular filtration rate (eGFR, NR: 90–120 mL/min/1.73 m2); (5) liver function tests, including total serum bilirubin (NR: 3–17 μmol/L), alanine aminotransferase (ALT, NR: 16–63 IU/L), aspartate aminotransferase (AST, NR: 15–37 U/L), alkaline phosphatase (ALP, NR: 46–116 IU/L), and albumin (NR: 34–50 g/L); (6) inflammatory markers, including C-reactive protein (CRP, NR: 0–3 mg/L), D-dimers (NR: mg/dL), lactate dehydrogenase (LDH, NR: 85–227 IU/L), procalcitonin (NR: μg/L), and ferritin (8–388 μg/L). For risk of severe cases, the presence of lymphopenia, neutrophilia, high ALT and/or AST, high LDH, high CRP, high ferritin, high D-dimer, and high pro-calcitonin, above those of the age- and gender-matched references, were used as indicators of risk. Admission chest X-ray (presence of bilateral air consolidation) and computerized tomography (CT) scan (presence of bilateral peripheral ground-glass opacities) were documented.
Climate Data
We downloaded the temperature, wind speed, cloud cover, precipitation rate, and other weather parameters of Dubai City for the duration of patient recruitment using history+ (https://www.meteoblue.com/en/historyplus)
Read more at: https://www.frontiersin.org/articles/10.3389/fpubh.2021.618828/full
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