Effects of High Temperature on COVID-19 Deaths in U.S. Counties

The United States of America (USA) was afflicted by extreme heat in the summer of 2021 and some states experienced a record-hot or top-10 hottest summer. Meanwhile, the United States was also one of the countries impacted most by the coronavirus disease 2019 (COVID-19) pandemic. Growing numbers of studies have revealed that meteorological factors such as temperature may influence the number of confirmed COVID-19 cases and deaths. However, the associations between temperature and COVID-19 severity differ in various study areas and periods, especially in periods of high temperatures. Here we choose 119 US counties with large counts of COVID-19 deaths during the summer of 2021 to examine the relationship between COVID-19 deaths and temperature by applying a two-stage epidemiological analytical approach. We also calculate the years of life lost (YLL) owing to COVID-19 and the corresponding values attributable to high temperature exposure. The daily mean temperature is approximately positively correlated with COVID-19 deaths nationwide, with a relative risk of 1.108 (95% confidence interval: 1.046, 1.173) in the 90th percentile of the mean temperature distribution compared with the median temperature. In addition, 0.02 YLL per COVID-19 death attributable to high temperature are estimated at the national level, and distinct spatial variability from -0.10 to 0.08 years is observed in different states. Our results provide new evidence on the relationship between high temperature and COVID-19 deaths, which might help us to understand the underlying modulation of the COVID-19 pandemic by meteorological variables and to develop epidemic policy response strategies.