Spatial patterns and environmental influences of COVID-19 outbreaks, post-Omicron.

The seasonality of many respiratory pathogen outbreaks, such as influenza and respiratory syncytial virus, is driven by climate factors, such as specific humidity or temperature. However, it remains unclear whether climate plays a role in determining the seasonality of COVID-19, given that the evolution of novel strains likely plays a key role in shaping outbreak dynamics. Here we use Emergency Department data to explore spatial differences in COVID-19 outbreak dynamics over three years, from April 2022 through March 2025. We observe that outbreak patterns varied across latitude, with southern states experiencing larger summer peaks and northern states facing more evenly distributed summer to winter outbreaks or larger winter peaks. We find that specific humidity and temperature at the state level are significantly associated with observed differences in ED visits with a COVID-19 diagnosis, even after controlling for state-level variation in vaccination status. Our results imply a role for climate in influencing COVID-19 outbreak dynamics. We anticipate these findings will provide a foundational understanding of factors shaping SARS-CoV-2 transmission as COVID-19 becomes endemic in the United States.