The impact of ambient temperature and air pollution on SARS-CoV2 infection and Post COVID-19 condition in Belgium (2021-2022)

Environ Res. 2024 Apr 1:246:118066. doi: 10.1016/j.envres.2023.118066. Epub 2023 Dec 29.


Introduction: The associations between non-optimal ambient temperature, air pollution and SARS-CoV-2 infection and post COVID-19 condition (PCC) remain constrained in current understanding. We conducted a retrospective analysis to explore how ambient temperature affected SARS-CoV-2 infection in individuals who later developed PCC compared to those who did not. We investigated if these associations were modified by air pollution.

Methods: We conducted a bidirectional time-stratified case-crossover study among individuals who tested positive for SARS-CoV-2 between May 2021 and June 2022. We included 6302 infections, with 2850 PCC cases. We used conditional logistic regression and distributed lag non-linear models to obtain odds ratios (OR) and 95% confidence intervals (CI) for non-optimal temperatures relative to the period median temperature (10.6 °C) on lags 0 to 5. For effect modification, daily average PM2.5 concentrations were categorized using the period median concentration (8.8 μg/m3). Z-tests were used to compare the results by PCC status and PM2.5.

Results: Non-optimal cold temperatures increased the cumulative odds of infection (OR = 1.93; 95%CI:1.67-2.23, OR = 3.53; 95%CI:2.72-4.58, for moderate and extreme cold, respectively), with the strongest associations observed for non-PCC cases. Non-optimal heat temperatures decreased the odds of infection except for moderate heat among PCC cases (OR = 1.32; 95%CI:0.89-1.96). When PM2.5 was >8.8 μg/m3, the associations with cold were stronger, and moderate heat doubled the odds of infection with later development of PCC (OR = 2.18; 95%CI:1.01-4.69). When PM2.5 was ≤8.8 μg/m3, exposure to non-optimal temperatures reduced the odds of infection.

Conclusion: Exposure to cold increases SARS-CoV2 risk, especially on days with moderate to high air pollution. Heated temperatures and moderate to high air pollution during infection may cause PCC. These findings stress the need for mitigation and adaptation strategies for climate change to reduce increasing trends in the frequency of weather extremes that have consequences on air pollution concentrations.

Keywords: Air pollution; Ambient temperature(s); Climate change; Post COVID-19 conditions; SARS-CoV2 infection.

MeSH terms

  • Air Pollutants* / analysis
  • Air Pollution* / adverse effects
  • Air Pollution* / analysis
  • Belgium / epidemiology
  • COVID-19* / epidemiology
  • Cross-Over Studies
  • Environmental Exposure / analysis
  • Humans
  • Particulate Matter / analysis
  • RNA, Viral
  • Retrospective Studies
  • SARS-CoV-2
  • Temperature


  • Air Pollutants
  • RNA, Viral
  • Particulate Matter