Associative evidence for the potential of humidification as a non-pharmaceutical intervention for influenza and SARS-CoV-2 transmission

Background Both influenza and SARS-CoV-2 viruses show a strong seasonal spreading in temperate regions. Several studies indicated that changes in indoor humidity could be one of the key factors explaining this. Objective The purpose of this study is to quantify the association between relevant epidemiological metrics and humidity in both influenza and SARS-CoV-2 epidemic periods. Methods The atmospheric dew point temperature serves as a proxy for indoor relative humidity. This study considered the weekly mortality rate in the Netherlands between 1995 and 2019 to determine the correlation between the dew point and the spread of influenza. During influenza epidemic periods in the Netherlands, governmental restrictions were absent; therefore, there is no need to control this confounder. During the SARS-CoV-2 pandemic, governmental restrictions strongly varied over time. To control this effect, periods with a relatively constant governmental intervention level were selected to analyze the reproduction rate. We also examine SARS-CoV-2 deaths in the nursing home setting, where health policy and social factors were less variable. Viral transmissibility was measured by computing the ratio between the estimated daily number of infectious persons in the Netherlands and the lagged mortality figures in the nursing homes. Results For both influenza and SARS-CoV-2, a significant correlation was found between the dew point temperature and the aforementioned epidemiological metrics. The findings are consistent with the anticipated mechanisms related to droplet evaporation, stability of virus in the indoor environment, and impairment of the natural defenses of the respiratory tract in dry air. Significance This information is helpful to understand the seasonal pattern of respiratory viruses and motivate further study to what extent it is possible to alter the seasonal pattern by actively intervening in the adverse role of low humidity during fall and winter in temperate regions. Impact A solid understanding and quantification of the role of humidity on the transmission of respiratory viruses is imperative for epidemiological modeling and the installation of non-pharmaceutical interventions. The results of this study indicate that improving the indoor humidity by humidifiers could be a promising technology for reducing the spread of both influenza and SARS-CoV-2 during winter and fall in the temperate zone. The identification of this potential should be seen as a strong motivation to invest in further prospective testing of this non-pharmaceutical intervention.