Covid-19 with Respect to Protection or Risk at High Altitude: A Global Perspective

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2) has affected every demography disproportionately, including even the native highland populations. Hypobaric-hypoxic settings at high altitudeS (HAS, >=2500 m) present an extreme environment that impacts the survival of permanent residents, possibly including SARS-CoV-2. Conflicting hypotheses have been presented for coronavirus disease 2019 (COVID-19) incidence and fatality at HA. To evaluate protection or risk against COVID-19 incidence and fatality in humans under hypobaric-hypoxic environment of HA (>=2501 masl). Global COVID-19 data for March 2020-2021 obtained from official websites of the Indian Government, John Hopkins University, and Worldometer were clustered into six 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. Of relevance, data analyses revealed four distinct responses, namely, partial risk, total risk, partial protection, and total protection from COVID-19 at HA, 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). Varied patterns of protection and risk against COVID-19 incidence and fatality were observed among the HA populations. However, it is premature to generalize COVID-19 effects on any particular demography without further extensive studies.