Seasonal trends in COVID-19 cases, hospitalizations, and deaths in the United States and Europe

Abstract Determining whether SARS-CoV-2 exhibits seasonality like other respiratory viruses is critical for public health planning. We evaluated whether COVID-19 rates follow a seasonal pattern using time series models. We used time series decomposition to extract the annual seasonal component of COVID-19 case, hospitalization, and death rates from March 2020 through July 2022 for the United States and Europe. Models were adjusted for a country-specific stringency index to account for confounding by nonpharmaceutical interventions. Despite year-round disease activity, we identified seasonal spikes in COVID-19 from approximately November-April for all outcomes and in all countries. Our results support employing annual preventative measures against SARS-CoV-2, such as administering seasonal booster vaccines in a similar timeframe as those in place for influenza. Whether certain high-risk individuals may need more than one COVID-19 vaccine booster dose each year will depend on factors like vaccine durability against severe illness and levels of year-round disease activity.