Does the pathogenesis of SARS-CoV-2 virus decrease at high-altitude?

Abstract

Does the pathogenesis of SAR-CoV-2 virus decrease at high-altitude?, Respiratory Physiology and amp; Neurobiology (2020), doi: https://doi. J o u r n a l P r e -p r o o fHighlights  COVID-19 infection is decreased in populations living at an altitude of above 3,000 masl  Highland inhabitants may be less susceptible to SARS-CoV-2 virus infection due to physiological acclimatization to hypoxia  High-altitude environmental factors may contribute to reduce the virulence of SARS-CoV-2 ABSTRACTIn the present study we analyze the epidemiologic data of COVID-19 of Tibet and high-altitude regions of Bolivia and Ecuador, and compare to lowland data, to test the hypothesis that high-altitude inhabitants (+2500 m above sea-level) are less susceptible to develop severe adverse effect in acute SARS-CoV-2 virus infection. Analysis of available epidemiological data suggest that physiological adaptations that counterbalance the hypoxic environment altitude may protect from severe impact of acute SARS-CoV-2 virus infection. Potential underlying mechanisms such as: (i) a compromised half-live of the virus caused by the high-altitude environment, and (ii) a hypoxia mediated down regulation of angiotensin-converting enzyme 2 (ACE2), which is the main binding target of SARS-CoV-2 virus in the pulmonary epithelia are discussed.

Altitude conditions seem to determine the evolution of COVID-19 in Brazil: a significance relationship with cases and deaths

“…In contrast to what other studies report regarding the greater spread of the in uenza virus in environments with lower air relative humidity [11], our data show that COVID-19 RI is higher in cities where RH is highest. These results are in line with those obtained by C Arias-Reyes, N Zubieta-DeUrioste, L Poma-Machicao, F Aliaga-Raudan, F Carvajal-Rodriguez, M Dutschmann, E Schneider-Gasser, G Zubieta-Calleja and J Soliz [3], which lists air dryness as one of the factors that control the spread of the virus at high altitudes. In working with climatic data from 5 large Brazilian cities (Manaus, Fortaleza, Brasília, Rio de Janeiro, and São Paulo), [12] showed that moderate relative air humidity (averages between 77.7 and 81.6%) favor the spread of this disease.…”

“…The lower air density and greater distance between molecules in Brazilian cities located at higher altitudes could also reduce the inoculation of airborne viruses compared to sea level. C Arias-Reyes, N Zubieta-DeUrioste, L Poma-Machicao, F Aliaga-Raudan, F Carvajal-Rodriguez, M Dutschmann, E Schneider-Gasser, G Zubieta-Calleja and J Soliz [3] suggested that inhabitants of cities with altitudes above 3,000 m a.s.l. are less susceptible to developing effects caused by COVID-19 due to ultraviolet radiation and thinner air.…”

“…During the survey of epidemiological data from Brazil, in May 2020, a study was published showing the relationship between altitude and the spread of COVID-19 based on epidemiological data from China, Bolivia, and Ecuador [3]. The authors showed that inhabitants are less susceptible to develop serious adverse effects caused by COVID-19 in cities with altitudes above 3,000 m a.s.l.…”

“…The authors showed that inhabitants are less susceptible to develop serious adverse effects caused by COVID-19 in cities with altitudes above 3,000 m a.s.l. [3]. These authors related this low incidence to compensatory adjustments in physiological systems and environmental factors, such as higher ultraviolet radiation and thinner atmosphere.…”

Environmental and climatic impact on the infection and mortality of SARS-CoV-2 in Peru

“…Although more studies are necessary, the rate of infection and the severity of the diseases seems different for people living in cities at high altitudes, where not only hipoxia is a major factor, but other factors such as air quality, solar radiation, and population density, could play a role in SARS-CoV-2 person-to-person transmission. Arias-Reyes et al (2020) suggested that there exists less rate of infection at high altitude possibly due to a lower level of expression of ACE2 compared to sea level. This observation is important, particularly since SARS-CoV-2 uses ACE2 as a point of infection for the cells (Ren et al, 2020).…”