C oronavirus disease (COVID-19) infection, after the first case reported in Wuhan, China, on December 31, 2019 and declared a pandemic by the World Health Organization in March 2020, has climbed by September 2nd to 26,076,572 cases and 864,162 deaths worldwide.Although it has been suggested that living at high altitude could decrease the rate of coronavirus transmission and mortality from COVID-19 (Arias-Reyes et al., 2020), new studies have not confirmed this protective effect. In fact, the case-fatality rate in Peru did not change with altitude (Segovia-Juarez et al., 2020).In the United States and Mexico, populations located >2,000 m have a higher total cumulative number of COVID-19 cases and a higher mortality rate attributable to COVID-19 than those located <1,500 m (Woolcott and Bergman, 2020). This study included data up to April 13, 2020, in the United States and up to May 13, 2020, in Mexico.A recent comprehensive review calls into question whether environmental factors, particularly ambient hypoxia, may be responsible at high altitude for reducing viral transmission and mortality due to COVID-19 (Pun et al., 2020). These conflicting results need further clarification and more current data. For this, we have assessed data from Peru, a country with one of the highest per capita number of infections and mortality rate worldwide.We used data of COVID-19 cases from 1,636 districts located from 5 to 4,705 m. The data set of COVID-19 cases (N = 535,946, from March 6 to August 15, 2020) was obtained from the National Open Data Platform (MINSA, 2020). Population and altitude data were gathered from National Institute of Information and Statistics (INEI, 2019), and combined with the aforementioned data set. This afforded altitude and district population information for 509,521 positive cases, representing people living at different altitudes, and providing the possibility of studying the effect of altitude with enough power to determine statistical significance.We considered three ranges: (1) altitudes <1,000 m, (2) altitudes between 1,000 and 2,500 m, and (3) altitudes