Impact of hydrological factors on the dynamic of COVID-19 epidemic: A multi-region study in China

Considering the live SARS-CoV-2 was detected and isolated from the excrement and urine of infected patients, the potential public health risk of its waterborne transmission should be paid broad and close attention. The purpose of the current study is to investigate the associations between COVID-19 incidences and hydrological factors such as lake area, river length, precipitation and volume of water resources in 30 regions of China. All confirmed cases for each areas were divided into two clusters including first cases cluster driven by imported cases during the period of January 20th to January 29th, 2020 and second cases cluster driven by local cases during the period of January 30th to March 1st, 2020. Based on the results of descriptive analysis and nonlinear regression analysis, positive associations with COVID-19 confirmed numbers were observed for migration scale index (MSI), river length, precipitation and volume of water resources, but negative associations for population density. The correlation coefficient in the second stage cases cluster is apparently higher than that in the first stage cases cluster. Then, the negative binomial-generalized linear model (NB-GLM) was fitted to estimate area-specific effects of hydrological variables on relative risk (RR) with the incorporation of additional variables (e.g., MSI) and the effects of exposure-lag-response. The statistically significant associations between RR and river length, the volume of water resources, precipitation were obtained by meta-analysis as 1.24 (95% CI: 1.22, 1.27), 2.56 (95% CI: 2.50, 2.61) and 1.59 (95% CI: 1.56, 1.62), respectively. The possible water transmission routes of SARS-CoV-2 and the potential capacity of long-distance transmission of SARS-CoV-2 in water environment was also discussed. Our results could provide a better guidance for local and global authorities to broaden the mind for understanding the natural-social system or intervening measures for COVID-19 control at the current or futural stage.