Impact of altitude on COVID-19 infection and death in the United States: A modeling and observational study

Abstract

Background COVID-19, the disease caused by SARS-CoV-2, has caused a pandemic, sparing few regions. However, limited reports suggest differing infection and death rates across geographic areas including populations that reside at higher elevations (HE). We aimed to determine if COVID-19 infection, death, and case mortality rates differed in higher versus low elevation (LE) U.S. counties. Methods Using publicly available geographic and COVID-19 data, we calculated per capita infection and death rates and case mortality in population density matched HE and LE U.S. counties. We also performed population-scale regression analysis to investigate the association between county elevation and COVID-19 infection rates. Findings Population density matching of LA (< 914m, n = 58) and HE (>2133m, n = 58) counties yielded significantly lower COVID-19 cases at HE versus LE (615 versus 905, p = 0.034). HE per capita deaths were significantly lower than LE (9.4 versus 19.5, p = 0.017). However, case mortality did not differ between HE and LE (1.78% versus 1.46%, p = 0.27). Regression analysis, adjusted for relevant covariates, demonstrated decreased COVID-19 infection rates by 12.82%, 12.01%, and 11.72% per 495m of county centroid elevation, for cases recorded over the previous 30, 90, and 120 days, respectively. Conclusions This population-adjusted, controlled analysis suggests that higher elevation attenuates infection and death. Ongoing work from our group aims to identify the environmental, biological, and social factors of residence at HE that impact infection, transmission, and pathogenesis of COVID-19 in an effort to harness these mechanisms for future public health and/or treatment interventions.

Elevated Humoral Immune Response to SARS-CoV-2 at High Altitudes Revealed by an Anti-RBD “In-House” ELISA

“…This brief communication reports the development of an "In-House" ELISA that is being used to survey seroprevalence in our region, and has uncovered that inhabitants of Tafí del Valle, a village situated in the Andean foothills at more than 2,000 meters above median sea level (mamsl), showed significantly higher anti-RBD titers than the population of San Miguel de Tucumán, located around 400 mamsl. To our knowledge, this is the first study showing an increased antibody response against SARS-CoV-2 in highaltitude individuals, adding more evidence regarding the effect of altitude on the interplay between this novel coronavirus, the immune system and the outcome of the infection (5)(6)(7)(8)(9)(10).…”

Altitude does not protect against SARS‐CoV‐2 infections and mortality due to COVID‐19

“…They suggest that the reported lower incidence and mortality of COVID-19 in high-altitude places observed by others (Stephens et al, 2021) remain to be confirmed. Stephens et al (2021) study two groups: one living in counties located at altitudes less than 914 m and the other at altitudes higher than 2133 m. Castagnetto et al (2020) assessing data at district level have demonstrated that at different altitude ranges from 0 to <1000 m, 1000 to 2500 m, and 2500 to 4700 m in Peru, the negative association with altitude was observed only in the group ranging from 0 to <1000 m. If analysis is done using all altitudes from 0 to 4700 m a negative association is observed between altitude and cases with SARS-CoV-2. Fernandes et al (2021) assessing 154 cities in Brazil located between 5 and 1135 m. They observe a negative association between altitude and cases of SARS-CoV-2.…”

Intermittent hypoxic conditioning: experience and potential in cardiac rehabilitation programs

“…Они также представили первые доказательства того, что защита женщин от смерти от COVID-19 снижается с увеличением высоты проживания [29]. В январе 2021г Stephens KE, et al показали, что совокупные показатели заболеваемости и смертности от COVID-19 на душу населения были значительно ниже в штатах США, расположенных на высоте выше 2133 м над уровнем моря [30].…”

“…По их мнению, низкий уровень заболеваемости в высокогорных районах может быть связан с естественным "социальным дистанцированием", а также с более высоким уровнем физической активности и низкой распространенностью ожирения, известного как один из факторов риска у пациентов с COVID-19 [31]. В свою очередь, Arias-Reyes C и Stephens KE делают вывод о том, что именно высотная адаптация является одним из факторов, обеспечивающих защиту организма от вирусных инфекций и развития заболевания [28,30]. Serebrovska Z, et al (2020) дополнительно указывают на то, что умеренные дозы перемежающейся гипоксии обладают противовоспалительным действием, уменьшая экспрессию провоспалительных цитокинов.…”