Disparities in COVID-19 incidence and fatality rates at high-altitude

Abstract

Background SARS-CoV-2 has affected every demography disproportionately, including even the native highland populations. Hypobaric-hypoxic settings at high-altitude (HA, >2,500 masl) present an extreme environment that impacts the survival of permanent residents, possibly including SARS-CoV-2. Conflicting hypotheses have been presented for COVID-19 incidence and fatality at HA. Objectives To evaluate protection or risk against COVID-19 incidence and fatality in humans under hypobaric-hypoxic environment of high-altitude (>2,501 masl). Methods Global COVID-19 data of March 2020-21, employed from official websites of the Indian Government, John Hopkins University, and Worldometer were clustered into 6 altitude categories. Clinical cofactors and comorbidities data were evaluated with COVID-19 incidence and fatality. Extensive comparisons and correlations using several statistical tools estimated the risk and protection. Results Of relevance, data analyses revealed four distinct responses, namely, partial risk, total risk, partial protection, and total protection from COVID-19 at high-altitude indicating a mixed baggage and complexity of the infection. Surprisingly, it included the countries within the same geographic region. Moreover, body mass index, hypertension, and diabetes correlated significantly with COVID-19 incidence and fatality rate (P ≤ 0.05). Conclusions Varied patterns of protection and risk against COVID-19 incidence and fatality were observed among the high-altitude populations. It is though premature to generalize COVID-19 effects on any particular demography without further extensive studies.

Development and validation of a scoring system to predict mortality in patients hospitalized with COVID-19: A retrospective cohort study in two large hospitals in Ecuador

“…Nevertheless, when we circumscribed the calculation of the AUC to female hospitalized patients and to patients of the Guayaquil hospital the AUC was reduced. These findings could be explained by several factors: (i) the score could be less effective in predicting in-hospital death at the sea level, maybe the lower COVID-19 related deaths in altitude were the results from a biological adaptation to hypoxemia, due to environmental factors [34], or related to the different contexts between both cities/altitudes [59], (ii) the score could be less effective in predicting in-hospital death for females maybe because of the lack of information regarding comorbidities which are, generally, more frequent among females [60], and (iii) the lack of a similar representativeness of Guayaquil and female population by comparison with their counterparts (patients from Quito and male), when building the score. In summary, the score seems to work best for hospitalized men in Quito.…”