Abstract
INTRODUCTION: Several studies have analyzed the influence of meteorological and geographical factors on the incidence of COVID-19. Seasonality could be important in the transmission of SARS-CoV-2. This study aims to evaluate the geographical pattern of COVID-19 in Spain and its relationship with different meteorological variables. METHODS: A provincial ecological study analyzing the influence of meteorological and geographical factors on the cumulative incidence of COVID-19 in the 52 (24 coastal and 28 inland) Spanish provinces during the first three waves was carried out. The cumulative incidence was calculated with data from the National Statistical Institute (INE) and the National Epidemiological Surveillance Network (RENAVE), while the meteorological variables were obtained from the Spanish Meteorological Agency (AEMET). RESULTS: The total cumulative incidence, in all three waves, was lower in the coastal provinces than in the inland ones (566±181 vs. 782±154; p=2.5×10(-5)). The cumulative incidence correlated negatively with mean air temperature (r=-0.49; p=2.2×10(-4)) and rainfall (r=-0.33; p=0.01), and positively with altitude (r=0.56; p=1. 4×10(-5)). The Spanish provinces with an average temperature <10°C had almost twice the cumulative incidence than the provinces with temperatures >16°C. The mean air temperature and rainfall were associated with the cumulative incidence of COVID-19, regardless of other factors (Beta Coefficient of -0.62; p=3.7×10(-7) and -0.47; p=4.2×10(-5) respectively). CONCLUSIONS: Meteorological and geographical factors could influence the evolution of the pandemic in Spain. Knowledge regarding the seasonality of the virus would help to predict new waves of COVID-19 infections.