Spatial Epidemiology of COVID-19 Pandemic: Disease Risk, Prognosis, and Complications

Why do some populations display a higher attack and mortality rate from the current coronavirus disease 2019 (COVID-19) pandemic than others? Are there geographic, environmental, behavioral, genetic, and comorbidity differences that influence spatial dynamics of COVID-19 transmission and outcomes? Where are the regional and country-level hotspots, and what drives those hotspots? These are some of the questions the current chapter strives to answer. The dynamics of transmission and consequences of COVID-19 are not homogeneous but instead have a geographical and spatial clustering. Population-level genetic, vaccination rates, health care disparities, SARS-CoV-2 variants, and meteorological factors are all underlying determinants of the disease dynamics globally, regionally, nationally, and locally. Disease surveillance frameworks to control, mitigate, and prevent the SARS- CoV-2 infections, particularly in low- and middle-income countries, are critical. Lastly, we highlight the spatial differences in the consequences of the pandemic focusing on behavioral and post-acute sequelae of SARS-CoV-2 infection. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Spatial factors for COVID-19 associated community deaths in an urban area of Lusaka, Zambia: an observational study

We retrospectively analyzed spatial factors for coronavirus disease 2019 (COVID-19)-associated community deaths i.e., brought-in-dead (BID) in Lusaka, Zambia, between March and July 2020. A total of 127 cases of BID with geocoordinate data of their houses were identified during the study period. Median interquartile range (IQR) of the age of these cases was 49 (34-70) years old, and 47 cases (37.0%) were elderly individuals over 60 years old. Seventy-five cases (75%) of BID were identified in July 2020, when the total number of cases and deaths was largest in Zambia. Among those whose information regarding their underlying medical condition was available, hypertension was most common (22.9%, 8/35). Among Lusaka's 94 townships, the numbers (median, IQR) of cases were significantly larger in those characterized as unplanned residential areas compared to planned areas (1.0, 0.0-4.0 vs 0.0, 0.0-1.0;p=0.030). The proportion of individuals who require more than 30 minutes to obtain water was correlated with a larger number of BID cases per 105 population in each township (rho=0.28, p=0.006). The number of BID cases was larger in unplanned residential areas, which highlighted the importance of targeted public health interventions specifically to those areas to reduce the total number of COVID-19 associated community deaths in Lusaka. Brought-in-dead surveillance might be beneficial in monitoring epidemic conditions of COVID-19 in such high-risk areas. Furthermore, inadequate access to water, sanitation, and hygiene (WASH) might be associated with such distinct geographical distributions of COVID-19 associated community deaths in Lusaka, Zambia.Copyright © Amos Hamukale et al.

Geographic disparities and temporal changes of COVID-19 incidence risks in North Dakota, United States.

BACKGROUND: COVID-19 is an important public health concern due to its high morbidity, mortality and socioeconomic impact. Its burden varies by geographic location affecting some communities more than others. Identifying these disparities is important for guiding health planning and service provision. Therefore, this study investigated geographical disparities and temporal changes of the percentage of positive COVID-19 tests and COVID-19 incidence risk in North Dakota. METHODS: COVID-19 retrospective data on total number of tests and confirmed cases reported in North Dakota from March 2020 to September 2021 were obtained from the North Dakota COVID-19 Dashboard and Department of Health, respectively. Monthly incidence risks of the disease were calculated and reported as number of cases per 100,000 persons. To adjust for geographic autocorrelation and the small number problem, Spatial Empirical Bayesian (SEB) smoothing was performed using queen spatial weights. Identification of high-risk geographic clusters of percentages of positive tests and COVID-19 incidence risks were accomplished using Tango's flexible spatial scan statistic. ArcGIS was used to display and visiualize the geographic distribution of percentages of positive tests, COVID-19 incidence risks, and high-risk clusters. RESULTS: County-level percentages of positive tests and SEB incidence risks varied by geographic location ranging from 0.11% to 13.67% and 122 to 16,443 cases per 100,000 persons, respectively. Clusters of high percentages of positive tests were consistently detected in the western part of the state. High incidence risks were identified in the central and south-western parts of the state, where significant high-risk spatial clusters were reported. Additionally, two peaks (August 2020-December 2020 and August 2021-September 2021) and two non-peak periods of COVID-19 incidence risk (March 2020-July 2020 and January 2021-July 2021) were observed. CONCLUSION: Geographic disparities in COVID incidence risks exist in North Dakota with high-risk clusters being identified in the rural central and southwest parts of the state. These findings are useful for guiding intervention strategies by identifying high risk communities so that resources for disease control can be better allocated to communities in need based on empirical evidence. Future studies will investigate predictors of the identified disparities so as to guide planning, disease control and health policy.

A space-time model for analyzing contagious people based on geolocation data using inverse graphs

Mobile devices provide us with an important source of data that capture spatial movements of individuals and allow us to derive general mobility patterns for a population over time. In this article, we present a mathematical foundation that allows us to harmonize mobile geolocation data using differential geometry and graph theory to identify spatial behavior patterns. In particular, we focus on models programmed using Computer Algebra Systems and based on a space-time model that allows for describing the patterns of contagion through spatial movement patterns. In addition, we show how the approach can be used to develop algorithms for finding ”patient zero” or, respectively, for identifying the selection of candidates that are most likely to be contagious. The approach can be applied by information systems to evaluate data on complex population movements, such as those captured by mobile geolocation data, in a way that analytically identifies, e.g., critical spatial areas, critical temporal segments, and potentially vulnerable individuals with respect to contact events. © 2023 the Author(s), licensee AIMS Press.

The study of spatial autocorrelation for infectious disease epidemiology decision-making: a systematized literature review

In recent years, the global spread of communicable diseases such as Ebola and COVID-19 has stressed the need for clear, geographically targeted, and actionable public health recommendations at appropriate spatial scales. Country-level stakeholders are increasingly utilizing spatial data and spatial decision support systems to optimize resource allocation, and researchers have access to a growing library of spatial data, tools, and software. Application of spatial methods, however, varies widely between researchers, resulting in often unstandardized results, which may be difficult to compare across geographical settings. This literature review aims to compare epidemiological studies, which applies methods including spatial autocorrelation to describe, explain, or predict spatial patterns underlying infectious disease health outcomes, and to describe whether those studies provide clear recommendations.The results of our analysis show an increasing trend in the number of publications applying spatial analysis in epidemiological research per year, with COVID-19, tuberculosis and dengue predominantly studied (43% of n = 98 total articles), and a majority of publication coming from Asia (62%). Spatial autocorrelation was quantified in the majority of studies (72%), and 57 (58%) of articles include some form of statistical modeling of which 11 (19%) accounted for spatial autocorrelation in the model. Most studies (68%) provided some level of recommendation regarding how results should be interpreted for future research or policy development, however often using vague, cautious terms. We recommend the development of standards for spatial epidemiological methods and reporting, and for spatial epidemiological studies to more clearly propose how their findings support or challenge current public health practice. © CAB International 2022 (Online ISSN 1749-8848)

Geographic disparities and temporal changes of COVID-19 hospitalization risks in North Dakota.

Background: Although the burden of the coronavirus disease 2019 (COVID-19) has been different across communities in the US, little is known about the disparities in COVID-19 burden in North Dakota (ND) and yet this information is important for guiding planning and provision of health services. Therefore, the objective of this study was to identify geographic disparities of COVID-19 hospitalization risks in ND. Methods: Data on COVID-19 hospitalizations from March 2020 to September 2021 were obtained from the ND Department of Health. Monthly hospitalization risks were computed and temporal changes in hospitalization risks were assessed graphically. County-level age-adjusted and spatial empirical Bayes (SEB) smoothed hospitalization risks were computed. Geographic distributions of both unsmoothed and smoothed hospitalization risks were visualized using choropleth maps. Clusters of counties with high hospitalization risks were identified using Kulldorff's circular and Tango's flexible spatial scan statistics and displayed on maps. Results: There was a total of 4,938 COVID-19 hospitalizations during the study period. Overall, hospitalization risks were relatively stable from January to July and spiked in the fall. The highest COVID-19 hospitalization risk was observed in November 2020 (153 hospitalizations per 100,000 persons) while the lowest was in March 2020 (4 hospitalizations per 100,000 persons). Counties in the western and central parts of the state tended to have consistently high age-adjusted hospitalization risks, while low age-adjusted hospitalization risks were observed in the east. Significant high hospitalization risk clusters were identified in the north-west and south-central parts of the state. Conclusions: The findings confirm that geographic disparities in COVID-19 hospitalization risks exist in ND. Specific attention is required to address counties with high hospitalization risks, especially those located in the north-west and south-central parts of ND. Future studies will investigate determinants of the identified disparities in hospitalization risks.

Epidemic Diffusion Network of Spain: A Mobility Model to Characterize the Transmission Routes of Disease.

Human mobility drives the geographical diffusion of infectious diseases at different scales, but few studies focus on mobility itself. Using publicly available data from Spain, we define a Mobility Matrix that captures constant flows between provinces by using a distance-like measure of effective distance to build a network model with the 52 provinces and 135 relevant edges. Madrid, Valladolid and Araba/Álaba are the most relevant nodes in terms of degree and strength. The shortest routes (most likely path between two points) between all provinces are calculated. A total of 7 mobility communities were found with a modularity of 63%, and a relationship was established with a cumulative incidence of COVID-19 in 14 days (CI14) during the study period. In conclusion, mobility patterns in Spain are governed by a small number of high-flow connections that remain constant in time and seem unaffected by seasonality or restrictions. Most of the travels happen within communities that do not completely represent political borders, and a wave-like spreading pattern with occasional long-distance jumps (small-world properties) can be identified. This information can be incorporated into preparedness and response plans targeting locations that are at risk of contagion preventively, underscoring the importance of coordination between administrations when addressing health emergencies.

Spatiotemporal heterogeneities of the associations between human mobility and close contacts with COVID-19 infections in the United States

It has been well-established that human mobility has an inseparable relationship with COVID-19 infections. As the COVID-19 pandemic progresses, our knowledge on how human behaviors including mobility and close contact associates with the pandemic also need to stay updated. In this paper, we examine the relationship of the effective reproduction number (Rt) of COVID-19 daily cases with the two indices that provide mobility insights: Mobility Index (CMI) and Contact Index (CCI). Both relationships are evaluated through Maximal Information Coefficient (MIC). Using the Bayesian Change Point Detection and the KShape clustering algorithms, we found significant temporal and spatial heterogeneities among the relationship between two indices and the daily confirmed COVID-19 cases. Although CMI has demonstrated high correlation with COVID-19 cases in 2020, CCI became much more correlated with COVID-19 cases than CMI in 2021. During the first wave in 2020, it is also shown that mobility has a high impact on states outside of Farwest and Southeast than those states within that region. © 2022 ACM.

Infrastructure for spatiotemporal exploration of interregional and international interaction of epidemiological data (DEMO PAPER)

The recent waves of COVID-19 highlighted the importance of understanding and quantifying spatiotemporal interactions to infer, model, and predict disease spread in real time. In this demonstration paper, we present a robust infrastructure for interactive exploration of interregional and international spatiotemporal interactions via time-lagged correlations of increases in COVID-19 incidence. This infrastructure consists of: (i) an operational data store (ODS) coupled with automated scripts for downloading, cleaning, and processing data from heterogeneous sources;(ii) a server application handling on-demand analyses of the database data through a RESTful API;and (iii) a web application providing the interactive dashboard to explore various correlation and geostatistical metrics of the integrated data in spacetime. The environment allows users to study focal spatiotemporal trends and the potential of regions to export and import the virus. Moreover, the application has the potential to reveal the effect of the national border to mitigate the interaction, particularly the spread of the virus. The infrastructure serves COVID-19 data from Germany, Poland, and Czechia, with the possibility of extension to other regions and topics. The dashboard is under active development and accessible on www.where2test.de/correlation. © 2022 Owner/Author.

Understanding the spatiotemporal heterogeneities in the associations between COVID-19 infections and both human mobility and close contacts in the United States

It has been well-established that human mobility has an inseparable relationship with COVID-19 infections. As social-distancing and stay-at-home orders lifted and data availability increased, our knowledge on how human behaviors including mobility and close interpersonal contacts associate with the pandemic progression also needs to stay updated. In this paper, we examine the relationship of COVID-19 daily transmissibility measured by the total confirmed cases and the effective reproduction number (Rt) with the two indices that provide human behavior insights: Cuebiq Mobility Index (CMI) and Cuebiq Contact Index (CCI). The correlations between each index and COVID-19 infections are evaluated using the Maximal Information Coefficient (MIC) which is powerful in capturing complex relationships. Moreover, the study period is segmented into three periods by Bayesian Change Point Detection to examine temporal heterogeneity and the mainland US states are grouped into three distinct clusters using the KShape clustering algorithm to further examine spatial heterogeneity. The CCI and CMI exhibited very different patterns and we found significant temporal and spatial heterogeneities among the relationships between the two indices and COVID-19 infection rate. Although human mobility has demonstrated high correlation with COVID-19 infection rate in 2020, close contacts became much more correlated with COVID-19 infection than mobility in 2021. However, states in the Plains and Rocky Mountains area are exceptions to this observation. During the first wave in 2020, it is also shown that mobility has a high impact on states outside of Farwest and Southeast than those states within that region. © 2022 ACM.

Drivers of Spatial Expansions of Vampire Bat Rabies in Colombia.

Spatial expansions of vampire bat-transmitted rabies (VBR) are increasing the risk of lethal infections in livestock and humans in Latin America. Identifying the drivers of these expansions could improve current approaches to surveillance and prevention. We aimed to identify if VBR spatial expansions are occurring in Colombia and test factors associated with these expansions. We analyzed 2336 VBR outbreaks in livestock reported to the National Animal Health Agency (Instituto Colombiano Agropecuario-ICA) affecting 297 municipalities from 2000-2019. The area affected by VBR changed through time and was correlated to the reported number of outbreaks each year. Consistent with spatial expansions, some municipalities reported VBR outbreaks for the first time each year and nearly half of the estimated infected area in 2010-2019 did not report outbreaks in the previous decade. However, the number of newly infected municipalities decreased between 2000-2019, suggesting decelerating spatial expansions. Municipalities infected later had lower cattle populations and were located further from the local reporting offices of the ICA. Reducing the VBR burden in Colombia requires improving vaccination coverage in both endemic and newly infected areas while improving surveillance capacity in increasingly remote areas with lower cattle populations where rabies is emerging.

Small-scale spatiotemporal epidemiology of notifiable infectious diseases in China: a systematic review.

BACKGROUND: The prevalence of infectious diseases remains one of the major challenges faced by the Chinese health sector. Policymakers have a tremendous interest in investigating the spatiotemporal epidemiology of infectious diseases. We aimed to review the small-scale (city level, county level, or below) spatiotemporal epidemiology of notifiable infectious diseases in China through a systematic review, thus summarizing the evidence to facilitate more effective prevention and control of the diseases. METHODS: We searched four English language databases (PubMed, EMBASE, Cochrane Library, and Web of Science) and three Chinese databases (CNKI, WanFang, and SinoMed), for studies published between January 1, 2004 (the year in which China's Internet-based disease reporting system was established) and December 31, 2021. Eligible works were small-scale spatial or spatiotemporal studies focusing on at least one notifiable infectious disease, with the entire territory of mainland China as the study area. Two independent reviewers completed the review process based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: A total of 18,195 articles were identified, with 71 eligible for inclusion, focusing on 22 diseases. Thirty-one studies (43.66%) were analyzed using city-level data, 34 (47.89%) were analyzed using county-level data, and six (8.45%) used community or individual data. Approximately four-fifths (80.28%) of the studies visualized incidence using rate maps. Of these, 76.06% employed various spatial clustering methods to explore the spatial variations in the burden, with Moran's I statistic being the most common. Of the studies, 40.85% explored risk factors, in which the geographically weighted regression model was the most commonly used method. Climate, socioeconomic factors, and population density were the three most considered factors. CONCLUSIONS: Small-scale spatiotemporal epidemiology has been applied in studies on notifiable infectious diseases in China, involving spatiotemporal distribution and risk factors. Health authorities should improve prevention strategies and clarify the direction of future work in the field of infectious disease research in China.

Open data on Covid-19 in the Spanish autonomous communities: reutilization in spatial epidemiology studies

The Covid-19 pandemic has highlighted the need for governments and health administrations at all levels to have an open data registry that facilitates decision-making in the planning and management of health resources and provides information to citizens on the evolution of the epidemic. The concept of “open data” includes the possibility of reutilization by third parties. Space and time are basic dimensions used to structure and interpret the data of the variables that refer to the health status of the people themselves. Hence, the main objective of this study is to evaluate whether the autonomous communities’ data files regarding Covid-19 are reusable to analyze the evolution of the disease in basic spatial and temporal analysis units at the regional and national levels. To this end, open data files containing the number of diagnosed cases of Covid-19 distributed in basic health or administrative spatial units and temporal units were selected from the portals of the Spanish autonomous communities. The presence of infection-related, demographic, and temporal variables, as well as the download format and metadata, were mainly evaluated. Whether the structure of the files was homogeneous and adequate for the application of spatial analysis techniques was also analyzed. The results reveal a lack of standardization in the collection of data in both spatial and temporal units and an absence of, or ambiguity in, the meaning of the variables owing to a lack of metadata. An inadequate structure was also found in the files of seven autonomous communities, which would require subsequent processing of the data to enable their reuse and the application of analysis and spatial modeling techniques, both when carrying out global analyses and when comparing patterns of evolution between different regions. © 2022, El Profesional de la Informacion. All rights reserved.

Tracking the national and regional COVID-19 epidemic status in the UK using weighted principal component analysis.

One of the difficulties in monitoring an ongoing pandemic is deciding on the metric that best describes its status when multiple intercorrelated measurements are available. Having a single measure, such as the effective reproduction number [Formula: see text], has been a simple and useful metric for tracking the epidemic and for imposing policy interventions to curb the increase when [Formula: see text]. While [Formula: see text] is easy to interpret in a fully susceptible population, it is more difficult to interpret for a population with heterogeneous prior immunity, e.g. from vaccination and prior infection. We propose an additional metric for tracking the UK epidemic that can capture the different spatial scales. These are the principal scores from a weighted principal component analysis. In this paper, we have used the methodology across the four UK nations and across the first two epidemic waves (January 2020-March 2021) to show that first principal score across nations and epidemic waves is a representative indicator of the state of the pandemic and is correlated with the trend in R. Hospitalizations are shown to be consistently representative; however, the precise dominant indicator, i.e. the principal loading(s) of the analysis, can vary geographically and across epidemic waves. This article is part of the theme issue 'Technical challenges of modelling real-life epidemics and examples of overcoming these'.

Global regularity and local variability of the space-temporal patterns of COVID 19 in Aragón (Spain)

Data from confirmed COVID-19 cases in Aragón (Spain), aggregated in 123 Basic Health Areas over 50 consecutive weeks, were used to identify, measure and characterise the spatio-temporal patterns of the pandemic. This was done using spatial and temporal autocorrelation measures, obtained from the data through the application of spatial statistics procedures (global and local Moran's I). The spatial and temporal incidence of COVID-19 in Aragón was neither homogeneous nor random, showing a certain overall regularity and notable local variability. This model can be explained by a process of spatial diffusion modified by long-distance contagions and restricted by measures implemented to control the pandemic. The information obtained is of great utility for public health decision-making relating to the organisation of healthcare resources and future measures to prevent and control the pandemic. © 2022 Asociacion de Geografos Espanoles. All rights reserved.

Spatial Syndromic Surveillance and COVID-19 in the U.S.: Local Cluster Mapping for Pandemic Preparedness.

Maps have become the de facto primary mode of visualizing the COVID-19 pandemic, from identifying local disease and vaccination patterns to understanding global trends. In addition to their widespread utilization for public communication, there have been a variety of advances in spatial methods created for localized operational needs. While broader dissemination of this more granular work is not commonplace due to the protections under Health Insurance Portability and Accountability Act (HIPAA), its role has been foundational to pandemic response for health systems, hospitals, and government agencies. In contrast to the retrospective views provided by the aggregated geographies found in the public domain, or those often utilized for academic research, operational response requires near real-time mapping based on continuously flowing address level data. This paper describes the opportunities and challenges presented in emergent disease mapping using dynamic patient data in the response to COVID-19 for northeast Ohio for the period 2020 to 2022. More specifically it shows how a new clustering tool developed by geographers in the initial phases of the pandemic to handle operational mapping continues to evolve with shifting pandemic needs, including new variant surges, vaccine targeting, and most recently, testing data shortfalls. This paper also demonstrates how the geographic approach applied provides the framework needed for future pandemic preparedness.

Spatio-temporal distribution pattern of COVID-19 in the Northern Italy during the first-wave scenario: The role of the highway network.

Background: The rapid outbreak of Coronavirus disease 2019 (COVID-19) has posed several challenges to the scientific community. The goal of this paper is to investigate the spread of COVID-19 in Northern Italy during the so-called first wave scenario and to provide a qualitative comparison with the local highway net. Methods: Fixed a grid of days from February 27, 2020, the cumulative numbers of infections in each considered province have been compared to sequences of thresholds. As a consequence, a time-evolving classification of the state of danger in terms of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, in view of the smallest threshold overtaken by this comparison, has been obtained for each considered province. The provinces with a significant amount of cases have then been collected into matrices containing only the ones featuring a significant amount of cases. Results: The time evolution of the classification has then been qualitatively compared to the highway network, to identify similarities and thus linking the rapid spreading of COVID-19 and the highway connections. Conclusions: The obtained results demonstrate how the proposed model properly fits with the spread of COVID-19 along with the Italian highway transport network and could be implemented to analyze qualitatively other disease transmissions in different contexts and time periods.

Associations between nighttime light and COVID-19 incidence and mortality in the United States.

COVID-19 has caused almost 770,000 deaths in the United States by November 2021. The nighttime light (NTL), representing the intensity of human activities, may reflect the degree of human contacts and therefore the intensity of COVID-19 transmission. This study intended to assess the associations between NTL differences and COVID-19 incidence and mortality among U.S. counties. The COVID-19 data of U.S. counties as of 31 December 2020 were collected. The average NTL values for each county in 2019 and 2020 were derived from satellite data. A negative binomial mixed model was adopted to assess the relationships between NTL intensity and COVID-19 incidence and mortality. Compared to the counties with the lowest NTL level (0.14-0.37 nW/cm2/sr), those with the highest NTL level (1.78-59.61 nW/cm2/sr) were related with 15% higher mortality rates (mortality rate ratio:1.15, 95 %CI: 1.02-1.30, p-value: 0.02) and 23% higher incidence rates (incidence rate ratio:1.23, 95 %CI: 1.13-1.34, p-value < 0.0001). Our study suggested that more intensive NTL was related with higher incidence and mortality rates of COVID-19, and NTL had a stronger correlation with the COVID-19 incidence rate than mortality rate. Our findings have contributed solid epidemiological evidence to the existing COVID-19 knowledge pool, and would help policymakers develop interventions when faced with the potential risk of the following outbreaks.

Long-term spatial and population-structured planning of non-pharmaceutical interventions to epidemic outbreaks.

In this paper, we consider the problem of planning non-pharmaceutical interventions to control the spread of infectious diseases. We propose a new model derived from classical compartmental models; however, we model spatial and population-structure heterogeneity of population mixing. The resulting model is a large-scale non-linear and non-convex optimisation problem. In order to solve it, we apply a special variant of covariance matrix adaptation evolution strategy. We show that results obtained for three different objectives are better than natural heuristics and, moreover, that the introduction of an individual's mobility to the model is significant for the quality of the decisions. We apply our approach to a six-compartmental model with detailed Poland and COVID-19 disease data. The obtained results are non-trivialand sometimes unexpected; therefore, we believe that our model could be applied to support policy-makers in fighting diseases at the long-term decision-making level.

GIS-based spatio-temporal analysis and modeling of COVID-19 incidence rates in Europe.

The COVID-19 epidemic has emerged as one of the most severe public health crises worldwide, especially in Europe. Until early July 2021, reported infected cases exceeded 180 million, with almost 4 million associated deaths worldwide, almost a third of which are in continental Europe. We analyzed the spatio-temporal distribution of the disease incidence and mortality rates considering specific periods in this continent. Further, we applied Global Moran's I to examine the spatio-temporal distribution patterns of COVID-19 incidence rates and Getis-Ord Gi* hotspot analysis to represent high-risk areas of the disease. Additionally, we compiled a set of 40 demographic, socioeconomic, environmental, transportation, health, and behavioral indicators as potential explanatory variables to investigate the spatial variations of COVID-19 cumulative incidence rates (CIRs). Ordinary Least Squares (OLS), Spatial Lag model (SLM), Spatial Error Model (SLM), Geographically Weighted Regression (GWR), and Multiscale Geographically Weighted Regression (MGWR) regression models were implemented to examine the spatial dependence and non-stationary relationships. Based on our findings, the spatio-temporal distribution pattern of COVID-19 CIRs was highly clustered and the most high-risk clusters of the disease were situated in central and western Europe. Moreover, poverty and the elderly population were selected as the most influential variables due to their significant relationship with COVID-19 CIRs. Considering the non-stationary relationship between variables, MGWR could describe almost 69% of COVID-19 CIRs variations in Europe. Since this spatio-temporal research is conducted on a continental scale, spatial information obtained from the models could provide general insights to authorities for further targeted policies.