Re: “Mortality Attributed to COVID-19 in High-Altitude Populations” by Woolcott and Bergman

High Altitude Medicine & BiologyVol. 22, No. 1 Letters to the EditorFree AccessRe: “Mortality Attributed COVID-19 in High-Altitude Populations” by Woolcott and BergmanGustavo Zubieta-Calleja, Alfredo Merino-Luna, Natalia Zubieta-DeUrioste, N. Freddy Armijo-Subieta, Jorge Soliz, Christian Arias-Reyes, Raffo Escalante-Kanashiro, Jose Antonio Carmona-Suazo, Alberto López-Bascope, Manuel Calle-Aracena, Murray Epstein, Enrique MaraviGustavo Zubieta-CallejaAddress correspondence to: Gustavo MD, Pulmonary Pathology Institute (HAPPI—IPPA), Department, Av. Copacabana Prolongación # 55, La Paz, Bolivia E-mail Address: [email protected] Bolivia.Search for more papers this author, Merino-LunaUniversidad Peruana de Ciencias Aplicadas (UPC), Lima, Perú.Search Zubieta-DeUriosteHigh Armijo-SubietaUniversidad Franz Tamayo, SolizHigh Bolivia.Institut Universitaire Cardiologie et Pneumologie Québec, Laval University, Quebec City, Canada.Search Arias-ReyesInstitut Escalante-KanashiroUniversidad Perú.Unidad Cuidados Intensivos Instituto Nacional Salud del Niño, Carmona-SuazoHospital Juarez, Mexico Mexico.Search López-BascopeHospital Angeles Mexico, Calle-AracenaUniversidad Autónoma Tomas Frias, Potosí, EpsteinUniversity of Miami Miller School Medicine, Miami, Florida, USA.Search MaraviProf. Emeritus, Intensive Care, Complejo Hospitalario Navarra-O, Universidad Navarra, Pamplona, España.Search authorPublished Online:29 Mar 2021https://doi.org/10.1089/ham.2020.0195AboutSectionsPDF/EPUB Permissions CitationsPermissionsDownload CitationsTrack CitationsAdd favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Dear Editor,We have read with interest article Bergman, (Woolcott 2020), disagree their conclusion that “Altitude is associated mortality men younger than 65 years.” It essential contrast existing data from Peru fully weigh veracity conclusions.Their overestimate risk due underdiagnosis. According diagnostic policies United States, other Latin American countries, tests were only performed patients evident symptoms. Such an approach can give rise inaccurate many countries. The Mexican government's are complex, there no travel restrictions between high lowlands. Furthermore, quoting Woolcott, since “Kong demonstrated a higher proportion asymptomatic cases populations located >3,000 m those at lower altitudes (*500–2,000 m)” then ratio deaths confirmed increases increasing altitude, diluting case fatality rate. total number (although inexact) be used calculate precisely (asymptomatic+oligosymptomatic+severe+critical). All these relevant variables change authors' incidence rate completely.Only considering analysis counties municipalities reported might epidemiologically correct. However, it lead miscalculation as death all regions affected COVID-19. When analyzing geographical distribution illness, providing on absence studied feature (i.e., per region) important must considered final computation results title.Moreover, statement “Whether different residing low altitude remains unknown” 2020) not accurate. Several recent publications preprints document differences rates lowlands (Rivero Montoya peer-reviewed Peru.In where restrictions, confounding factor acute ascent travelers presymptomatic may pose increased compared highlanders. Tolerance hypoxia dependent hemoglobin (Zubieta-Calleja al., 2020). Table presents permanent residents strict quarantine changes.Table 1. Incidence, Mortality Case Fatality during PandemicAltitudesPopulation millionsCOVID-19 %Mortality %Case %Bolivia Lowlands <1500 m4.038.456.18.6 Moderate 1500–2500 m3.252624.25.5 >2500 m4.3835.619.73.2Peru m15.140.253.65.9 m4.523.228.73.5 m8.336.617.73.1The very initial documented high-altitude cities has been replicated parts world (data 23 countries under peer review). Accinelli Leon Barca (2020) found similar Peru. This attributed several environmental biological factors mitigate including (1) ultraviolet (UV) radiation, (2) dry air, (3) later appearance regions, (4) potential physiological such hypothesized reduced expression angiotensin converting enzyme 2, membrane which SARS-CoV-2 virus binds gains entry into cell, detailed review (Danser slowly slope accelerated over time, nevertheless levels lowland areas (Fig. 1). Pun al. highlighted features, seasonal weather patterns temperature, latitudes viral transmission, explain why differ Bergman's study States outcomes. Zubieta also stressed importance UV radiation reduction (http://altitudeclinic.com/blog/2020/06/covid-19-pubs/).FIG. cumulative data, March 10–October 8, 2020. two main states (departments): Paz (dashed blue line) Santa Cruz (top green line), latter 16% larger population first presented 26% cases. Although pandemic started almost simultaneously both departments 10, was “lag” areas, world.We hope extensive set herein will constitute platform enabling future clinical investigations disorder. clear tendency toward ages sea level (Table 1).Authors' ContributionsG.Z.-C. N.Z.-D. generated concept, wrote article, provided Figure E.M. suggested writing letter approved it. A.M.-L. statistics table. F.A.S. J.S., C.A.-R., M.E. gave suggestions, structured, edited article. R.E.-K., A.L.-B., J.M.C.-A. information subject. J.A.C.-S. insight México. authors reviewed accepted article.ReferencesAccinelli RA Leon-Abarca JA. (2020). At less frequent: experience Arch Bronconeumol 56:760–761. Crossref, Medline, Google ScholarDanser AHJ, Epstein M, Batlle D. Renin-angiotensin system blockers pandemic: present evidence abandon renin-angiotensin blockers. Hypertension 75:1382–1385. ScholarPun Turner R, Strapazzon G, Brugger H, Swenson ER. Lower altitude: Facts confounders. Alt Med Biol 21:217–222. Link, ScholarRivero AC, M. COVID19 en población residente zonas geográficas alturas superiores 2500 msnm (in Spanish). SITUA 23:19–26. ScholarWoolcott OO, Bergman RN. populations. 21:409–416. ScholarZubieta-Calleja GR, Zubieta-DeUrioste N, Venkatesh T, Das K, Soliz J. pneumolysis simulating extreme exposure altered oxygen transport physiology; multiple diseases, scarce need ventilators: Andean Condor' s-eye-view. Rev Recent Clin Trials [Epub ahead print]; DOI: 10.2174/1574887115666200925141108. ScholarFiguresReferencesRelatedDetailsCited byBiomarkers predictors critically ill obese altitude6 April 2023 | BMC Vol. 23, 1Mean Platelet Volume Predictor Severity: A Prospective Cohort Study Highlands Peru15 2022 Diseases, 2High-altitude better short-term survival admitted ICU31 PLOS ONE, 17, 3Analysis Excess Data Different Altitudes During Outbreak Ecuador Esteban Ortiz-Prado, Raul Patricio Fernandez Naranjo, Eduardo Vasconez, Katherine Simbaña-Rivera, Trigomar Correa-Sancho, Alex Lister, Calvopiña, Ginés Viscor13 December 2021 Biology, 4Elevated Humoral Immune Response Revealed Anti-RBD “In-House” ELISA14 October Frontiers 8 22Issue 1Mar InformationCopyright 2021, Mary Ann Liebert, Inc., publishersTo cite article:Gustavo Maravi.Re: Bergman.High Biology.Mar 2021.102-104.http://doi.org/10.1089/ham.2020.0195Published Volume: 22 Issue 1: 29, 2021Online Ahead Print:February 9, 2021PDF download