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Grimm M, Ziegler L, Seglias A, Mademilov M, Magdieva K, Mirzalieva G, Taalaibekova A, Suter S, Schneider SR, Zoller F, Bissig V, Reinhard L, Bauer M, Müller J, Ulrich TL, Carta AF, Bader PR, Bitos K, Reiser AE, Champigneulle B, Ashyralieva D, Scheiwiller PM, Ulrich S, Sooronbaev TM, Furian M, Bloch KE. SARS-CoV-2 Transmission during High-Altitude Field Studies. High Alt Med Biol 2024. [PMID: 38634740 DOI: 10.1089/ham.2023.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Grimm, Mirjam, Lucie Ziegler, Annina Seglias, Maamed Mademilov, Kamila Magdieva, Gulzada Mirzalieva, Aijan Taalaibekova, Simone Suter, Simon R. Schneider, Fiona Zoller, Vera Bissig, Lukas Reinhard, Meret Bauer, Julian Müller, Tanja L. Ulrich, Arcangelo F. Carta, Patrick R. Bader, Konstantinos Bitos, Aurelia E. Reiser, Benoit Champigneulle, Damira Ashyralieva, Philipp M. Scheiwiller, Silvia Ulrich, Talant M. Sooronbaev, Michael Furian, and Konrad E. Bloch. SARS-CoV-2 Transmission during High-Altitude Field Studies. High Alt Med Biol. 00:00-00, 2024. Background: Throughout the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic, virus transmission during clinical research was of concern. Therefore, during high-altitude field studies performed in 2021, we took specific COVID-19 precautions and investigated the occurrence of SARS-CoV-2 infection. Methods: From May to September 2021, we performed studies in patients with chronic obstructive pulmonary disease (COPD) and in healthy school-age children in Kyrgyzstan in high-altitude facilities at 3,100 m and 3,250 m and at 760 m. The various implemented COVID-19 safety measures included systematic SARS-CoV-2 rapid antigen testing (RAT). Main outcomes were SARS-CoV-2-RAT-positive rate among participants and staff at initial presentation (prevalence) and SARS-CoV-2-RAT-positive conversion during and within 10 days after studies (incidence). Results: Among 338 participants and staff, SARS-CoV-2-RAT-positive prevalence was 15 (4.4%). During mean ± SD duration of individual study participation of 3.1 ± 1.0 day and within 10 days, RAT-positive conversion occurred in 1/237(0.4%) participants. Among staff working in studies for 31.5 ± 29.3 days, SARS-CoV-2-RAT-positive conversion was 11/101(10.9%). In all 338 individuals involved in the studies over the course of 15.6 weeks, the median SARS-CoV-2-RAT-positive incidence was 0.00%/week (quartiles 0.00; 0.64). Over the same period, the median background incidence among the total Kyrgyz population of 6,636 million was 0.06%/week (0.03; 0.11), p = 0.013 (Wilcoxon rank sum test). Conclusions: Taking precautions by implementing specific safety measures, SARS-CoV-2 transmission during clinical studies was very rare, and the SARS-CoV-2 incidence among participants and staff was lower than that in the general population during the same period. The results are reassuring and may help in decision-making on the conduct of clinical research in similar settings.
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Affiliation(s)
- Mirjam Grimm
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Lucie Ziegler
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Annina Seglias
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Maamed Mademilov
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Kamila Magdieva
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Gulzada Mirzalieva
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Aijan Taalaibekova
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Simone Suter
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Simon R Schneider
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Fiona Zoller
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Vera Bissig
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Lukas Reinhard
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Meret Bauer
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Julian Müller
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Tanja L Ulrich
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Arcangelo F Carta
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Patrick R Bader
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Konstantinos Bitos
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Aurelia E Reiser
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | | | - Damira Ashyralieva
- National Institute of Public Health, Ministry of Health, Bishkek, Kyrgyz Republic
| | - Philipp M Scheiwiller
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Silvia Ulrich
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Talant M Sooronbaev
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Michael Furian
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Konrad E Bloch
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
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Vizcardo DA, R. Araníbar J, Munayco Escate CV. High altitudes, population density, and poverty: Unraveling the complexities of COVID-19 in Peru during the years 2020-2022. Prev Med Rep 2023; 36:102423. [PMID: 37753378 PMCID: PMC10518345 DOI: 10.1016/j.pmedr.2023.102423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023] Open
Abstract
Background Several factors related to hospitalizations, morbidity, and mortality from COVID-19 have been identified. However, limited exploration has been done on geographic and socioeconomic factors that could significantly impact these outcomes. Objectives This study aimed to determine whether altitude, population density, and percentage of population in total poverty are associated with COVID-19 incidence per 1000 inhabitants and COVID-19 case-fatality rate in Peru, from 2020 to 2022. Methods This study utilized a multiple group ecological design and relied on secondary databases containing daily records of COVID-19 positive cases and deaths due to COVID-19. An epidemiological analysis was performed, subsequently processed using a random effects model. Results As of August 2022, Peru had recorded a total of 3,838,028 COVID-19 positive cases and 215,023 deaths due to COVID-19. Our analysis revealed a statistically significant negative association between altitude and COVID-19 incidence (aBETA: -0.004; Standard Error: 0.001; p < 0.05). Moreover, we observed a positive association between population density and incidence (aBETA: 0.006; Standard Error: 0.001; p < 0.05). However, we found no significant association between the percentage of population in total poverty and COVID-19 incidence. Conclusion Our study found that an increase in altitude was associated with a decrease in COVID-19 incidence, while an increase in population density was associated with an increase in COVID-19 incidence. High altitude, population density and percentage of population in total poverty does not change case-fatality rate due to COVID-19.
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Dushianthan A, Bracegirdle L, Cusack R, Cumpstey AF, Postle AD, Grocott MPW. Alveolar Hyperoxia and Exacerbation of Lung Injury in Critically Ill SARS-CoV-2 Pneumonia. Med Sci (Basel) 2023; 11:70. [PMID: 37987325 PMCID: PMC10660857 DOI: 10.3390/medsci11040070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/17/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023] Open
Abstract
Acute hypoxic respiratory failure (AHRF) is a prominent feature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) critical illness. The severity of gas exchange impairment correlates with worse prognosis, and AHRF requiring mechanical ventilation is associated with substantial mortality. Persistent impaired gas exchange leading to hypoxemia often warrants the prolonged administration of a high fraction of inspired oxygen (FiO2). In SARS-CoV-2 AHRF, systemic vasculopathy with lung microthrombosis and microangiopathy further exacerbates poor gas exchange due to alveolar inflammation and oedema. Capillary congestion with microthrombosis is a common autopsy finding in the lungs of patients who die with coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome. The need for a high FiO2 to normalise arterial hypoxemia and tissue hypoxia can result in alveolar hyperoxia. This in turn can lead to local alveolar oxidative stress with associated inflammation, alveolar epithelial cell apoptosis, surfactant dysfunction, pulmonary vascular abnormalities, resorption atelectasis, and impairment of innate immunity predisposing to secondary bacterial infections. While oxygen is a life-saving treatment, alveolar hyperoxia may exacerbate pre-existing lung injury. In this review, we provide a summary of oxygen toxicity mechanisms, evaluating the consequences of alveolar hyperoxia in COVID-19 and propose established and potential exploratory treatment pathways to minimise alveolar hyperoxia.
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Affiliation(s)
- Ahilanandan Dushianthan
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Luke Bracegirdle
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Rebecca Cusack
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Andrew F Cumpstey
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Anthony D Postle
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Michael P W Grocott
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
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Vélez-Páez JL, Baldeón-Rojas L, Cañadas Herrera C, Montalvo MP, Jara FE, Aguayo-Moscoso S, Tercero-Martínez W, Saltos L, Jiménez-Alulima G, Guerrero V, Pérez-Galarza J. Receiver operating characteristic (ROC) to determine cut-off points of clinical and biomolecular markers to discriminate mortality in severe COVID-19 living at high altitude. BMC Pulm Med 2023; 23:393. [PMID: 37848858 PMCID: PMC10583315 DOI: 10.1186/s12890-023-02691-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/30/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND In 2020, Ecuador had one of the highest death rates because of COVID-19. The role of clinical and biomolecular markers in COVID disease prognosis, is still not well supported by available data. In order for these markers to have practical application in clinical decision-making regarding patient treatment and prognosis, it is necessary to know an optimal cut-off point, taking into consideration ethnic differences and geographic conditions. AIM To determine the value of clinical and biomolecular markers, to predict mortality of patients with severe COVID-19 living at high altitude. METHODS In this study, receiver operating characteristic (ROC) curves, area under the curve (AUC) of ROC, sensitivity, specificity and likelihood ratios were calculated to determine levels of clinical and biomolecular markers that best differentiate survivors versus non-survivors in severe COVID subjects that live at a high altitude setting. RESULTS Selected cut-off values for ferritin (≥ 1225 ng/dl, p = 0.026), IL-6 (≥ 11 pg/ml, p = 0.005) and NLR (≥ 22, p = 0.008) at 24 h, as well as PaFiO2 (≤ 164 mmHg, p = 0.015), NLR (≥ 16, p = p = 0.013) and SOFA (≥ 6, p = 0.031) at 72 h, appear to have good discriminating power to differentiate survivors versus non-survivors. Additionally, odds ratios for ferritin (OR = 3.38); IL-6 (OR = 17.07); PaFiO2 (OR = 4.61); NLR 24 h (OR = 4.95); NLR 72 h (OR = 4.46), and SOFA (OR = 3.77) indicate increased risk of mortality when cut-off points were taken into consideration. CONCLUSIONS We proposed a straightforward and understandable method to identify dichotomized levels of clinical and biomolecular markers that can discriminate between survivors and non-survivors patients with severe COVID-19 living at high altitudes.
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Affiliation(s)
- Jorge Luis Vélez-Páez
- Pablo Arturo Suarez Hospital, Intensive Care Unit, Clinical Research Center, Quito, Ecuador
- Faculty of Medical Sciences, Central University of Ecuador, Quito, Ecuador
| | - Lucy Baldeón-Rojas
- Faculty of Medical Sciences, Central University of Ecuador, Quito, Ecuador
- Research Institute of Biomedicine, Central University of Ecuador, Quito, Ecuador
| | | | | | - Fernando Esteban Jara
- Pablo Arturo Suarez Hospital, Intensive Care Unit, Clinical Research Center, Quito, Ecuador
| | | | - Wendy Tercero-Martínez
- Pablo Arturo Suarez Hospital, Intensive Care Unit, Clinical Research Center, Quito, Ecuador
| | - Lenin Saltos
- Pablo Arturo Suarez Hospital, Intensive Care Unit, Clinical Research Center, Quito, Ecuador
| | - Glenda Jiménez-Alulima
- Pablo Arturo Suarez Hospital, Intensive Care Unit, Clinical Research Center, Quito, Ecuador
| | - Verónica Guerrero
- Pablo Arturo Suarez Hospital, Intensive Care Unit, Clinical Research Center, Quito, Ecuador
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Small E, Phillips C, Bunzel W, Cleaver L, Joshi N, Gardner L, Maharjan R, Marvel J. Prior Ambulatory Mild Coronavirus Disease 2019 Does Not Increase Risk of Acute Mountain Sickness. High Alt Med Biol 2023; 24:201-208. [PMID: 37306966 DOI: 10.1089/ham.2022.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
Small, Elan, Caleb Phillips, William Bunzel, Lakota Cleaver, Nishant Joshi, Laurel Gardner, Rony Maharjan, and James Marvel. Prior ambulatory mild coronavirus disease 2019 does not increase risk of acute mountain sickness. High Alt Med Biol. 24:201-208, 2023. Background: Given its long-term morbidity, understanding how prior coronavirus disease 2019 (COVID-19) may affect acute mountain sickness (AMS) susceptibility is important for preascent risk stratification. The objective of this study was to examine if prior COVID-19 impacts risk of AMS. Materials and Methods: This was a prospective observational study conducted in Lobuje (4,940 m) and Manang (3,519 m), Nepal, from April to May 2022. AMS was defined by the 2018 Lake Louise Questionnaire criteria. COVID-19 severity was defined using the World Health Organization-developed criteria. Results: In the Lobuje cohort of 2,027, 46.2% of surveyed individuals reported history of COVID-19, with 25.7% AMS point-prevalence. There was no significant relationship between prior ambulatory mild COVID-19 and AMS (p = 0.6) or moderate AMS (p = 1.0). In the Manang cohort of 908, 42.8% reported history of COVID-19, with 14.7% AMS point-prevalence. There was no significant relationship between prior ambulatory mild COVID-19 and AMS (p = 0.3) or moderate AMS (p = 0.4). Average months since COVID-19 was 7.4 (interquartile range [IQR] 3-10) for Lobuje, 6.2 (IQR 3-6) for Manang. Both cohorts rarely exhibited moderate COVID-19 history. Conclusions: Prior ambulatory mild COVID-19 was not associated with increased risk of AMS and should not preclude high-altitude travel.
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Affiliation(s)
- Elan Small
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Caleb Phillips
- Department of Computational Science, University of Colorado, Boulder, Colorado, USA
| | - William Bunzel
- Department of Emergency Medicine, University of California San Francisco Fresno, Fresno, California, USA
| | - Lakota Cleaver
- Department of Emergency Medicine, Yale New Haven Health, New Haven, Connecticut, USA
| | - Nishant Joshi
- Department of General Practice and Emergency Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Laurel Gardner
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Rony Maharjan
- Department of General Practice and Emergency Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - James Marvel
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
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Baquerizo-Sedano L, Goni L, Sayón-Orea C, González-Muniesa P. A U-shaped protection of altitude against mortality and infection of COVID-19 in Peru: an ecological study. BMC Public Health 2023; 23:1054. [PMID: 37264338 DOI: 10.1186/s12889-023-15537-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/27/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has affected the world in multiple ways and has been a challenge for the health systems of each country. From the beginning, risk factors for the severity and mortality of the disease were considered, as the spread of the virus was related to the living conditions of each population. METHODS In this ecological study we have evaluated the role of geography, precisely the altitude above sea level in the incidence and mortality of COVID-19 in Peru. Incidence and mortality data were taken from the open-access database of the government of Peru until March 2021. COVID-19 cases and COVID-19 mortality were treated as cases/density population and 1000 x cases/inhabitants while altitude was treated as continuous and as a categorical variable divided in 7 categories. The relationship between COVID-19 cases or deaths for COVID-19 and altitude as continuous variable was determined using Spearman correlation test. Meanwhile when altitude was considered as a categorical variable, Poisson regression or negative binomial analyses were applied. RESULTS A significant inverse correlation was found between COVID-19 cases by population density and altitude (r=-0.37 p < 0.001). By altitude categories, the lowest risk for infection was observed between 3,000 and 3,500 m (IRR 0.08; 95% CI 0.05,0.12). Moreover, we found an inverse correlation between altitude and COVID-19 mortality (r=-0.39 p < 0.001). Also, the lowest risk for mortality was observed between 3,000 and 3,500 m (IRR 0.12; 95%CI 0.08; 0.18). Similar results were found when analyses were adjusted for inhabitants and stratified by sex. CONCLUSION This study reports an inverse relationship between COVID-19 incidence and mortality with respect to the altitude of residence, particularly, a u-shaped protection is shown, with a highest benefit between 3000 and 3500 m. The possibility of using hypoxia as an alternative treatment requires more complex studies that should allow knowing the physiological and environmental mechanisms of the protective role.
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Affiliation(s)
- L Baquerizo-Sedano
- Facultad de Ciencias de la Salud, Universidad Privada del Norte, Lima, Peru
- Faculty of Pharmacy and Nutrition, Department of Food Sciences and Physiology, University of Navarra, Pamplona, Spain
- Center for Nutrition Research, University of Navarra, Pamplona, Spain
| | - L Goni
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- IDISNA - Navarra Institute for Health Research, Pamplona, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Carlos III Health Institute (ISCIII), Madrid, Spain
| | - C Sayón-Orea
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- IDISNA - Navarra Institute for Health Research, Pamplona, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Carlos III Health Institute (ISCIII), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
| | - P González-Muniesa
- Faculty of Pharmacy and Nutrition, Department of Food Sciences and Physiology, University of Navarra, Pamplona, Spain.
- Center for Nutrition Research, University of Navarra, Pamplona, Spain.
- IDISNA - Navarra Institute for Health Research, Pamplona, Spain.
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Carlos III Health Institute (ISCIII), Madrid, Spain.
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Mantilla Caicedo GC, Rusticucci M, Suli S, Dankiewicz V, Ayala S, Caiman Peñarete A, Díaz M, Fontán S, Chesini F, Jiménez-Buitrago D, Barreto Pedraza LR, Barrera F. Spatio-temporal multidisciplinary analysis of socio-environmental conditions to explore the COVID-19 early evolution in urban sites in South America. Heliyon 2023; 9:e16056. [PMID: 37200576 PMCID: PMC10162854 DOI: 10.1016/j.heliyon.2023.e16056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/24/2023] [Accepted: 05/03/2023] [Indexed: 05/20/2023] Open
Abstract
This study aimed to analyse how socio-environmental conditions affected the early evolution of COVID-19 in 14 urban sites in South America based on a spatio-temporal multidisciplinary approach. The daily incidence rate of new COVID-19 cases with symptoms as the dependent variable and meteorological-climatic data (mean, maximum, and minimum temperature, precipitation, and relative humidity) as the independent variables were analysed. The study period was from March to November of 2020. We inquired associations of these variables with COVID-19 data using Spearman's non-parametric correlation test, and a principal component analysis considering socio economic and demographic variables, new cases, and rates of COVID-19 new cases. Finally, an analysis using non-metric multidimensional scale ordering by the Bray-Curtis similarity matrix of meteorological data, socio economic and demographic variables, and COVID-19 was performed. Our findings revealed that the average, maximum, and minimum temperatures and relative humidity were significantly associated with rates of COVID-19 new cases in most of the sites, while precipitation was significantly associated only in four sites. Additionally, demographic variables such as the number of inhabitants, the percentage of the population aged 60 years and above, the masculinity index, and the GINI index showed a significant correlation with COVID-19 cases. Due to the rapid evolution of the COVID-19 pandemic, these findings provide strong evidence that biomedical, social, and physical sciences should join forces in truly multidisciplinary research that is critically needed in the current state of our region.
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Affiliation(s)
| | - Matilde Rusticucci
- Universidad de Buenos Aires, Departamento de Ciencias de la Atmósfera y los Océanos, CONICET, Argentina
| | - Solange Suli
- Universidad de Buenos Aires, Departamento de Ciencias de la Atmósfera y los Océanos, CONICET, Argentina
| | - Verónica Dankiewicz
- Universidad de Buenos Aires, Departamento de Ciencias de la Atmósfera y los Océanos, CONICET, Argentina
| | - Salvador Ayala
- Universidad de Chile, Programa de Doctorado en Salud Pública, Instituto de Salud Pública de Chile, Chile
| | - Alexandra Caiman Peñarete
- Subred Integrada de Servicios Hospitalarios Centro Oriente ESE, Red Hospitalaria Bogotá Distrito Capital, Colombia
| | - Martín Díaz
- Universidad Nacional de La Matanza, Departamento de Ciencias de la Salud, Argentina
| | - Silvia Fontán
- Universidad Nacional de La Matanza, Departamento de Ciencias de la Salud, Argentina
| | | | - Diana Jiménez-Buitrago
- Ministerio de Salud y Protección Social, Mesa de Variabilidad y Cambio Climático de la CONASA, Colombia
| | - Luis R. Barreto Pedraza
- Instituto de Hidrología, Meteorología y Estudios Ambientales - IDEAM, Subdirección de Meteorología, Mesa de Variabilidad y Cambio Climático de la CONASA, Miembro del grupo QuASAR UPN, Colombia
| | - Facundo Barrera
- Centro Austral de Investigaciones Científicas (CADIC), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ushuaia, Argentina
- Centro i∼mar, Universidad de Los Lagos, Chile and Centre for Climate and Resilience Research (CR)2, Casilla 557, Puerto Montt Chile
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Lapo-Talledo GJ, Talledo-Delgado JA, Fernández-Aballí LS. A competing risk survival analysis of the sociodemographic factors of COVID-19 in-hospital mortality in Ecuador. CAD SAUDE PUBLICA 2023; 39:e00294721. [PMID: 36753093 DOI: 10.1590/0102-311xen294721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 12/01/2022] [Indexed: 02/09/2023] Open
Abstract
This study aimed to analyze the effect of sociodemographic characteristics on COVID-19 in-hospital mortality in Ecuador from March 1 to December 31, 2020. This retrospective longitudinal study was performed with data from publicly accessible registries of the Ecuadorian National Institute of Statistics and Censuses (INEC). Data underwent a competing risk analysis with estimates of the cumulative incidence function (CIF). The effect of covariates on CIFs was estimated using the Fine-Gray model and results were expressed as adjusted subdistribution hazard ratios (SHR). The analysis included 30,991 confirmed COVID-19 patients with a mean age of 56.57±18.53 years; 60.7% (n = 18,816) were men and 39.3% (n = 12,175) were women. Being of advanced age, especially older than or equal to 75 years (SHR = 17.97; 95%CI: 13.08-24.69), being a man (SHR = 1.29; 95%CI: 1.22-1.36), living in rural areas (SHR = 1.18; 95%CI: 1.10-1.26), and receiving care in a public health center (SHR = 1.64; 95%CI: 1.51-1.78) were factors that increased the incidence of death from COVID-19, while living at an elevation higher than 2,500 meters above sea level (SHR = 0.69; 95%CI: 0.66-0.73) decreased this incidence. Since the incidence of death for individuals living in rural areas and who received medical care from the public sector was higher, income and poverty are important factors in the final outcome of this disease.
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Ricalde-Castillo Y, Celis-Mendoza M, Morales-García M, Huancahuire-Vega S, Calizaya-Milla YE, Saintila J, Sairitupa-Sanchez LZ, Morales-García SB, Morales-García WC. Sociodemographic Factors, Mental Health, and Emotional Eating Associated With Concern for COVID-19 Contagion in Nurses: A Cross-Sectional Study. J Prim Care Community Health 2023; 14:21501319231200400. [PMID: 37731344 PMCID: PMC10515584 DOI: 10.1177/21501319231200400] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 08/02/2023] [Accepted: 08/24/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE To determine the association between sociodemographic factors, stress, depression and anxiety, emotional eating, and concern about COVID-19 contagion in first and second-line Peruvian nurses. METHODOLOGY The study was cross-sectional and conducted with 500 Peruvian nurses of both sexes, over 18 years of age. Validated questionnaires were used to measure sociodemographic aspects, concern about COVID-19, generalized anxiety, depression, self-perceived stress, and emotional eating. Multiple linear regression analysis was performed to analyze the factors affecting concern about COVID-19 contagion. RESULTS The multiple linear regression analysis showed that stress, being between the ages of 18 and 29 years, being male, being from the coastal region or the jungle region, having a bachelor's degree, severe anxiety, and severe depression were associated with higher concern about COVID-19. On the other hand, having more than 5 to 10 years of experience and more than 10 years of experience, low emotional eating, and non-emotional eating were negatively associated with concern. This model explained 44.05% of the variability among the participating nurses. CONCLUSION These findings provide resources for future research on the comprehensive well-being of nursing staff by exploring various sociodemographic aspects and mental conditions associated with greater concern about COVID-19. Meanwhile, years of experience and emotional eating behavior were associated with lower concern about COVID-19. Future studies could incorporate this information to preserve the mental and physical health of nurses in the face of potential occupational threats.
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Kumar R, Aktay-Cetin Ö, Craddock V, Morales-Cano D, Kosanovic D, Cogolludo A, Perez-Vizcaino F, Avdeev S, Kumar A, Ram AK, Agarwal S, Chakraborty A, Savai R, de Jesus Perez V, Graham BB, Butrous G, Dhillon NK. Potential long-term effects of SARS-CoV-2 infection on the pulmonary vasculature: Multilayered cross-talks in the setting of coinfections and comorbidities. PLoS Pathog 2023; 19:e1011063. [PMID: 36634048 PMCID: PMC9836319 DOI: 10.1371/journal.ppat.1011063] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The Coronavirus Disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and its sublineages pose a new challenge to healthcare systems worldwide due to its ability to efficiently spread in immunized populations and its resistance to currently available therapies. COVID-19, although targeting primarily the respiratory system, is also now well established that later affects every organ in the body. Most importantly, despite the available therapy and vaccine-elicited protection, the long-term consequences of viral infection in breakthrough and asymptomatic individuals are areas of concern. In the past two years, investigators accumulated evidence on how the virus triggers our immune system and the molecular signals involved in the cross-talk between immune cells and structural cells in the pulmonary vasculature to drive pathological lung complications such as endothelial dysfunction and thrombosis. In the review, we emphasize recent updates on the pathophysiological inflammatory and immune responses associated with SARS-CoV-2 infection and their potential long-term consequences that may consequently lead to the development of pulmonary vascular diseases.
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Affiliation(s)
- Rahul Kumar
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Lung Biology Center, Zuckerberg San Francisco General Hospital, San Francisco, California, United States of America
| | - Öznur Aktay-Cetin
- Max Planck Institute for Heart and Lung Research, Member of the German Center for Lung Research (DZL), Member of the Cardio-Pulmonary Institute (CPI), Bad Nauheim, Germany
- Institute for Lung Health (ILH), Justus Liebig University, Giessen, Germany
| | - Vaughn Craddock
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States of America
| | - Daniel Morales-Cano
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Djuro Kosanovic
- Department of Pulmonology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Angel Cogolludo
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Ciber Enfermedades Respiratorias (Ciberes), Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
| | - Francisco Perez-Vizcaino
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Ciber Enfermedades Respiratorias (Ciberes), Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
| | - Sergey Avdeev
- Department of Pulmonology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Ashok Kumar
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States of America
| | - Anil Kumar Ram
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States of America
| | - Stuti Agarwal
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University Medical Center, California, United States of America
| | - Ananya Chakraborty
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University Medical Center, California, United States of America
| | - Rajkumar Savai
- Max Planck Institute for Heart and Lung Research, Member of the German Center for Lung Research (DZL), Member of the Cardio-Pulmonary Institute (CPI), Bad Nauheim, Germany
- Institute for Lung Health (ILH), Justus Liebig University, Giessen, Germany
- Department of Internal Medicine, Justus Liebig University Giessen, Member of the DZL, Member of CPI, Giessen, Germany
- Frankfurt Cancer Institute (FCI), Goethe University, Frankfurt am Main, Germany
| | - Vinicio de Jesus Perez
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University Medical Center, California, United States of America
| | - Brian B. Graham
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Lung Biology Center, Zuckerberg San Francisco General Hospital, San Francisco, California, United States of America
| | - Ghazwan Butrous
- Cardiopulmonary Sciences, University of Kent, Canterbury, United Kingdom
| | - Navneet K. Dhillon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States of America
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Mimicking Gene-Environment Interaction of Higher Altitude Dwellers by Intermittent Hypoxia Training: COVID-19 Preventive Strategies. BIOLOGY 2022; 12:biology12010006. [PMID: 36671699 PMCID: PMC9855005 DOI: 10.3390/biology12010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/30/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
Cyclooxygenase 2 (COX2) inhibitors have been demonstrated to protect against hypoxia pathogenesis in several investigations. It has also been utilized as an adjuvant therapy in the treatment of COVID-19. COX inhibitors, which have previously been shown to be effective in treating previous viral and malarial infections are strong candidates for improving the COVID-19 therapeutic doctrine. However, another COX inhibitor, ibuprofen, is linked to an increase in the angiotensin-converting enzyme 2 (ACE2), which could increase virus susceptibility. Hence, inhibiting COX2 via therapeutics might not always be protective and we need to investigate the downstream molecules that may be involved in hypoxia environment adaptation. Research has discovered that people who are accustomed to reduced oxygen levels at altitude may be protected against the harmful effects of COVID-19. It is important to highlight that the study's conclusions only applied to those who regularly lived at high altitudes; they did not apply to those who occasionally moved to higher altitudes but still lived at lower altitudes. COVID-19 appears to be more dangerous to individuals residing at lower altitudes. The downstream molecules in the (COX2) pathway have been shown to adapt in high-altitude dwellers, which may partially explain why these individuals have a lower prevalence of COVID-19 infection. More research is needed, however, to directly address COX2 expression in people living at higher altitudes. It is possible to mimic the gene-environment interaction of higher altitude people by intermittent hypoxia training. COX-2 adaptation resulting from hypoxic exposure at altitude or intermittent hypoxia exercise training (IHT) seems to have an important therapeutic function. Swimming, a type of IHT, was found to lower COX-2 protein production, a pro-inflammatory milieu transcription factor, while increasing the anti-inflammatory microenvironment. Furthermore, Intermittent Hypoxia Preconditioning (IHP) has been demonstrated in numerous clinical investigations to enhance patients' cardiopulmonary function, raise cardiorespiratory fitness, and increase tissues' and organs' tolerance to ischemia. Biochemical activities of IHP have also been reported as a feasible application strategy for IHP for the rehabilitation of COVID-19 patients. In this paper, we aim to highlight some of the most relevant shared genes implicated with COVID-19 pathogenesis and hypoxia. We hypothesize that COVID-19 pathogenesis and hypoxia share a similar mechanism that affects apoptosis, proliferation, the immune system, and metabolism. We also highlight the necessity of studying individuals who live at higher altitudes to emulate their gene-environment interactions and compare the findings with IHT. Finally, we propose COX2 as an upstream target for testing the effectiveness of IHT in preventing or minimizing the effects of COVID-19 and other oxygen-related pathological conditions in the future.
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12
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Burtscher J, Millet GP, Leitner B, Burtscher M. Health Benefits of Residence at Moderate Altitude Do Not Reduce COVID-19 Mortality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16074. [PMID: 36498148 PMCID: PMC9736022 DOI: 10.3390/ijerph192316074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Moderate altitude (1000−2000 m above sea level) residence is emerging as a protective factor from the mortality of various causes, including of cardiovascular diseases. Conversely, mortality from certain respiratory diseases is higher at these altitudes than in lowlands. These divergent outcomes could indicate either beneficial or detrimental effects of altitude on the mortality of COVID-19 that primarily infects the respiratory tract but results in multi-organ damage. Previous epidemiological data indeed suggest divergent outcomes of moderate to high altitude residence in various countries. Confounding factors, such as variations in the access to clinical facilities or selection biases of investigated populations, may contribute to the equivocation of these observations. We interrogated a dataset of the complete population of an Alpine country in the center of Europe with relatively similar testing and clinical support conditions across altitude-levels of residence (up to around 2000 m) to assess altitude-dependent mortality from COVID-19 throughout 2020. While a reduced all-cause mortality was confirmed for people living higher than 1000 m, no differences in the mortality from COVID-19 between the lowest and the highest altitude regions were observed for the overall population and the population older than 60 years as well. Conversely, COVID-19 mortality seems to have been reduced in the very old (>85 years) women at moderate altitudes.
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Affiliation(s)
- Johannes Burtscher
- Department of Biomedical Sciences, University of Lausanne, CH-1005 Lausanne, Switzerland
- Institute of Sport Sciences, University of Lausanne, CH-1015 Lausanne, Switzerland
| | - Gregoire P. Millet
- Department of Biomedical Sciences, University of Lausanne, CH-1005 Lausanne, Switzerland
- Institute of Sport Sciences, University of Lausanne, CH-1015 Lausanne, Switzerland
| | - Barbara Leitner
- Directorate Population, Statistics Austria, A-1110 Vienna, Austria
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, A-6020 Innsbruck, Austria
- Austrian Society for Alpine and High-Altitude Medicine, A-6020 Innsbruck, Austria
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13
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Izquierdo-Condoy JS, Fernandez-Naranjo R, Vasconez-González E, Cordovez S, Tello-De-la-Torre A, Paz C, Delgado-Moreira K, Carrington S, Viscor G, Ortiz-Prado E. Long COVID at Different Altitudes: A Countrywide Epidemiological Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192214673. [PMID: 36429392 PMCID: PMC9690364 DOI: 10.3390/ijerph192214673] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND Several reports from around the world have reported that some patients who have recovered from COVID-19 have experienced a range of persistent or new clinical symptoms after a SARS-CoV-2 infection. These symptoms can last from weeks to months, impacting everyday functioning to a significant number of patients. METHODS A cross-sectional analysis based on an online, self-reporting questionnaire was conducted in Ecuador from April to July 2022. Participants were invited by social media, radio, and TV to voluntarily participate in our study. A total of 2103 surveys were included in this study. We compared socio-demographic variables and long-term persisting symptoms at low (<2500 m) and high altitude (>2500 m). RESULTS Overall, 1100 (52.3%) responders claimed to have Long-COVID symptoms after SARS-CoV-2 infection. Most of these were reported by women (64.0%); the most affected group was young adults between 21 to 40 years (68.5%), and most long-haulers were mestizos (91.6%). We found that high altitude residents were more likely to report persisting symptoms (71.7%) versus those living at lower altitudes (29.3%). The most common symptoms were fatigue or tiredness (8.4%), hair loss (5.1%) and difficulty concentrating (5.0%). The highest proportion of symptoms was observed in the group that received less than 2 doses. CONCLUSIONS This is the first study describing post-COVID symptoms' persistence in low and high-altitude residents. Our findings demonstrate that women, especially those aging between 21-40, are more likely to describe Long-COVID. We also found that living at a high altitude was associated with higher reports of mood changes, tachycardia, decreased libido, insomnia, and palpitations compared to lowlanders. Finally, we found a greater risk to report Long-COVID symptoms among women, those with previous comorbidities and those who had a severer acute SARS-CoV-2 infection.
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Affiliation(s)
- Juan S. Izquierdo-Condoy
- One Health Research Group, Faculty of Health Science, Universidad de Las Americas, Quito 170137, Ecuador
- Health Management and Research Area, Department of Health Sciences, Universidad Internacional Iberoamericana, Arecibo, PR 00613, USA
| | - Raul Fernandez-Naranjo
- One Health Research Group, Faculty of Health Science, Universidad de Las Americas, Quito 170137, Ecuador
| | - Eduardo Vasconez-González
- One Health Research Group, Faculty of Health Science, Universidad de Las Americas, Quito 170137, Ecuador
| | - Simone Cordovez
- One Health Research Group, Faculty of Health Science, Universidad de Las Americas, Quito 170137, Ecuador
| | - Andrea Tello-De-la-Torre
- One Health Research Group, Faculty of Health Science, Universidad de Las Americas, Quito 170137, Ecuador
| | - Clara Paz
- One Health Research Group, Faculty of Health Science, Universidad de Las Americas, Quito 170137, Ecuador
| | - Karen Delgado-Moreira
- One Health Research Group, Faculty of Health Science, Universidad de Las Americas, Quito 170137, Ecuador
| | - Sarah Carrington
- Lugar, Medio y Sociedad Research Group, School of Economics, Universidad de Las Américas, Quito 170124, Ecuador
| | - Ginés Viscor
- Departament de Biologia Cel·lular, Fisiologia i Immunologia, Universitat de Barcelona, 08028 Barcelona, Spain
| | - Esteban Ortiz-Prado
- One Health Research Group, Faculty of Health Science, Universidad de Las Americas, Quito 170137, Ecuador
- Correspondence: ; Tel.: +593-995-760-693
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14
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A comparative analysis of SARS-CoV-2 viral load across different altitudes. Sci Rep 2022; 12:17179. [PMID: 36229507 PMCID: PMC9558017 DOI: 10.1038/s41598-022-20516-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 09/14/2022] [Indexed: 01/04/2023] Open
Abstract
SARS-CoV-2 has spread throughout the world, including areas located at high or very high altitudes. There is a debate about the role of high altitude hypoxia on viral transmission, incidence, and COVID-19 related mortality. This is the first comparison of SARS-CoV-2 viral load across elevations ranging from 0 to 4300 m. To describe the SARS-CoV-2 viral load across samples coming from 62 cities located at low, moderate, high, and very high altitudes in Ecuador. An observational analysis of viral loads among nasopharyngeal swap samples coming from a cohort of 4929 patients with a RT-qPCR test positive for SARS-CoV-2. The relationship between high and low altitude only considering our sample of 4929 persons is equal in both cases and not significative (p-value 0.19). In the case of low altitude, adding the sex variable to the analysis, it was possible to find a significative difference between men and women (p-value < 0.05). Considering initially sex and then altitude, it was possible to find a significative difference between high and low altitude for men (p-value 0.05). There is not enough evidence to state that viral load is affected directly by altitude range but adding a new variable as sex in the analysis shows that the presence of new variables influences the relationship of altitude range and viral load. There is no evidence that viral loads (Ct and copies/ml) differ at low or high altitude. Using sex as a co-factor, we found that men have higher viral loads than women at low and moderate altitude locations, while living at high altitude, no differences were found. When Ct values were aggregated by low, moderate, and high viral load, we found no significant differences when sex was excluded from the analysis. We conclude that viral load is not directly affected by altitude, but COVID-19 incidence and mortality are rather affected by socio-demographic and idiosyncratic dynamics.
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15
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Influence of weather factors on the incidence of COVID-19 in Spain. MEDICINA CLÍNICA (ENGLISH EDITION) 2022; 159:255-261. [PMID: 36060101 PMCID: PMC9425111 DOI: 10.1016/j.medcle.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/28/2021] [Indexed: 11/22/2022]
Abstract
Introduction Several studies have analyzed the influence of meteorological and geographical factors on the incidence of COVID-19. Seasonality could be important in the transmission of SARS-CoV-2. This study aims to evaluate the geographical pattern of COVID-19 in Spain and its relationship with different meteorological variables. Methods A provincial ecological study analyzing the influence of meteorological and geographical factors on the cumulative incidence of COVID-19 in the 52 (24 coastal and 28 inland) Spanish provinces during the first three waves was carried out. The cumulative incidence was calculated with data from the National Statistical Institute (INE) and the National Epidemiological Surveillance Network (RENAVE), while the meteorological variables were obtained from the Spanish Meteorological Agency (AEMET). Results The total cumulative incidence, in all three waves, was lower in the coastal provinces than in the inland ones (566 ± 181 vs. 782 ± 154; P = 2.5 × 10−5). The cumulative incidence correlated negatively with mean air temperature (r = −0.49; P = 2.2 × 10−4) and rainfall (r = −0.33; P = .01), and positively with altitude (r = 0.56; P = 1.4 × 10−5). The Spanish provinces with an average temperature <10 °C had almost twice the cumulative incidence than the provinces with temperatures >16 °C. The mean air temperature and rainfall were associated with the cumulative incidence of COVID-19, regardless of other factors (Beta Coefficient of −0.62; P = 3.7 × 10−7 and −0.47; P = 4.2 × 10−5 respectively) Conclusions Meteorological and geographical factors could influence the evolution of the pandemic in Spain. Knowledge regarding the seasonality of the virus would help to predict new waves of COVID-19 infections
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16
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Devaux CA, Raoult D. The impact of COVID-19 on populations living at high altitude: Role of hypoxia-inducible factors (HIFs) signaling pathway in SARS-CoV-2 infection and replication. Front Physiol 2022; 13:960308. [PMID: 36091390 PMCID: PMC9454615 DOI: 10.3389/fphys.2022.960308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Cases of coronavirus disease 2019 (COVID-19) have been reported worldwide. However, one epidemiological report has claimed a lower incidence of the disease in people living at high altitude (>2,500 m), proposing the hypothesis that adaptation to hypoxia may prove to be advantageous with respect to SARS-CoV-2 infection. This publication was initially greeted with skepticism, because social, genetic, or environmental parametric variables could underlie a difference in susceptibility to the virus for people living in chronic hypobaric hypoxia atmospheres. Moreover, in some patients positive for SARS-CoV-2, early post-infection ‘happy hypoxia” requires immediate ventilation, since it is associated with poor clinical outcome. If, however, we accept to consider the hypothesis according to which the adaptation to hypoxia may prove to be advantageous with respect to SARS-CoV-2 infection, identification of the molecular rational behind it is needed. Among several possibilities, HIF-1 regulation appears to be a molecular hub from which different signaling pathways linking hypoxia and COVID-19 are controlled. Interestingly, HIF-1α was reported to inhibit the infection of lung cells by SARS-CoV-2 by reducing ACE2 viral receptor expression. Moreover, an association of the rs11549465 variant of HIF-1α with COVID-19 susceptibility was recently discovered. Here, we review the evidence for a link between HIF-1α, ACE2 and AT1R expression, and the incidence/severity of COVID-19. We highlight the central role played by the HIF-1α signaling pathway in the pathophysiology of COVID-19.
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Affiliation(s)
- Christian Albert Devaux
- Aix-Marseille University, IRD, APHM, MEPHI, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
- Centre National de la Recherche Scientifique, Marseille, France
- *Correspondence: Christian Albert Devaux,
| | - Didier Raoult
- Aix-Marseille University, IRD, APHM, MEPHI, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
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17
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SARS-CoV-2 Viral Load Analysis at Low and High Altitude: A Case Study from Ecuador. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137945. [PMID: 35805606 PMCID: PMC9265329 DOI: 10.3390/ijerph19137945] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/03/2022] [Accepted: 06/02/2022] [Indexed: 12/24/2022]
Abstract
SARS-CoV-2 has spread throughout the world, including remote areas such as those located at high altitudes. There is a debate about the role of hypobaric hypoxia on viral transmission and COVID-19 incidence. A descriptive cross-sectional analysis of SARS-CoV-2 infection and viral load among patients living at low (230 m) and high altitude (3800 m) in Ecuador was completed. Within these two communities, the total number of infected people at the time of the study was 108 cases (40.3%). The COVID-19 incidence proportion at low altitude was 64% while at high altitude was 30.3%. The mean viral load from those patients who tested positive was 3,499,184 copies/mL (SD = 23,931,479 copies/mL). At low altitude (Limoncocha), the average viral load was 140,223.8 copies/mL (SD = 990,840.9 copies/mL), while for the high altitude group (Oyacachi), the mean viral load was 6,394,789 copies/mL (SD = 32,493,469 copies/mL). We found no statistically significant differences when both results were compared (p = 0.056). We found no significant differences across people living at low or high altitude; however, men and younger populations had higher viral load than women older populations, respectively.
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18
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Chakraborty S, Das U, Rathore U, Sarkhel P. Are High-Altitude Residents More Susceptible to Covid-19 in India? Findings and Potential Implications for Research and Policy. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2022; 52:455-469. [PMID: 35658732 PMCID: PMC9171131 DOI: 10.1177/00207314221104887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this paper, we study the incidence of COVID-19 and the associated fatality with altitude using high frequency, district level data from India. To understand the implications of the nationwide lockdown after the outbreak, we use data for about four months- two from the lockdown period starting from March 25 till May 31, 2020 and about two months after unlocking was initiated (June 1-July 26, 2020). The multivariate regression result indicates slower growth in average rate of infection during the lockdown period in hilly regions, the gains of which attenuated after the unlocking was initiated. Despite these early gains, the rate of fatalities is significantly higher during the lockdown period in comparison to the plains. The findings remain robust to multiple alternative specifications and methods including one that accounts for confounding possibilities via unobservable and provides consistent estimates of bias adjusted treatment effects. The evidence supports the need for provisioning of public health services and infrastructure upgradation, especially maintenance of adequate stock of life support devices, in high altitude regions. It also underscores the necessity for strengthening and revising the existing Hill Areas Development Programme and integrating important aspects of public health as part of this policy.
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Affiliation(s)
| | - Upasak Das
- Global Development Institute, 5292University of Manchester, Manchester, UK.,Centre for Social Norms and Behavioral Dynamics, 6572University of Pennsylvania, Philadelphia, PA, USA
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19
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Nicolaou L, Steinberg A, Carrillo-Larco RM, Hartinger S, Lescano AG, Checkley W. Living at High Altitude and COVID-19 Mortality in Peru. High Alt Med Biol 2022; 23:146-158. [PMID: 35483043 PMCID: PMC10024074 DOI: 10.1089/ham.2021.0149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Nicolaou, Laura, Anne Steinberg, Rodrigo M. Carrillo-Larco, Stella Hartinger, Andres G. Lescano, and William Checkley. Living at high altitude and COVID-19 mortality in Peru. High Alt Med Biol. 23:146-158, 2022. Background: Previous studies have reported a lower severity of COVID-19 infections at higher altitudes; however, this association may be confounded by various factors. We examined the association between living at altitude and COVID-19 mortality in Peru adjusting for population density, prevalence of comorbidities, indicators of socioeconomic status, and health care access. Methods: Utilizing administrative data across 196 provinces located at varying altitudes (sea level to 4,373 m), we conducted a two-stage analysis of COVID-19 deaths between March 19 and December 31, 2020, Peru's first wave. We first calculated cumulative daily mortality rate for each province and fit lognormal cumulative distribution functions to estimate total mortality rate, and start, peak, and duration of the first wave. We then regressed province-level total mortality rate, start, peak, and duration of the first wave as a function of altitude adjusted for confounders. Results: There were 93,528 recorded deaths from COVID-19 (mean age 66.5 years, 64.5% male) for a cumulative mortality of 272.5 per 100,000 population between March 19 and December 31, 2020. We did not find a consistent monotonic trend between living at higher altitudes and estimated total mortality rate for provinces at 500 - 1,000 m (-12.1 deaths per 100,000 population per 100 m, 95% familywise confidence interval -27.7 to 3.5) or > 1,000 m (-0.3, -2.7 to 2.0). We also did not find consistent monotonic trends for the start, peak, and duration of the first wave beyond the first 500 m. Conclusions: Our findings suggest that living at high altitude may not confer a lower risk of death from COVID-19.
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Affiliation(s)
- Laura Nicolaou
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA.,Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, USA
| | - Anne Steinberg
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rodrigo M Carrillo-Larco
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Stella Hartinger
- UDIAS, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.,Clima, Latin American Center of Excellence in Climate Change and Health, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Andres G Lescano
- Clima, Latin American Center of Excellence in Climate Change and Health, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.,Emerge, Emerging Diseases, and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA.,Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, USA.,Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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20
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Rodriguez Lima DR, Pinzón Rondón ÁM, Rubio Ramos C, Pinilla Rojas DI, Niño Orrego MJ, Díaz Quiroz MA, Molano-González N, Ceballos Quintero JE, Arroyo Santos AF, Ruiz Sternberg ÁM. Clinical characteristics and mortality associated with COVID-19 at high altitude: a cohort of 5161 patients in Bogotá, Colombia. Int J Emerg Med 2022; 15:22. [PMID: 35597911 PMCID: PMC9123834 DOI: 10.1186/s12245-022-00426-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 05/08/2022] [Indexed: 01/08/2023] Open
Abstract
Background There are few data on the clinical outcomes of patients with coronavirus disease 2019 (COVID-19) in cities over 1000 m above sea level (masl). Objectives To describe the clinical characteristics and mortality of patients with COVID-19 treated at a high complexity hospital in Bogotá, Colombia, at 2640 masl. Methods This was an observational study of a cohort including 5161 patients with confirmed COVID-19 infection from 19 March 2020 to 30 April 2021. Demographic data, laboratory values, comorbidities, oxygenation indices, and clinical outcomes were collected. Data were compared between survivors and nonsurvivors. An independent predictive model was performed for mortality and invasive mechanical ventilation (IMV) using classification and regression trees (CART). Results The median cohort age was 66 years (interquartile range (IQR) 53–77), with 1305 patients dying (25%) and 3856 surviving (75%). The intensive care unit (ICU) received 1223 patients (24%). Of 898 patients who received IMV, 613 (68%) of them perished. The ratio of partial pressure arterial oxygen (PaO2) to fraction inspired oxygen (FiO2), or the P/F ratio, upon ICU admission was 105 (IQR 77–146) and 137 (IQR 91–199) in the deceased and survivors, respectively. The CART model showed that the need for IMV, age greater than 79 years, ratio of oxygen saturation (SaO2) to FiO2, or the S/F ratio, less than 259, and lactate dehydrogenase (LDH) greater than 617 U/L at admission were associated with a greater probability of death. Conclusion Among more than 5000 patients with COVID-19 treated in our hospital, mortality at hospital discharge was 25%. Older age, low S/F ratio, and high LDH at admission were predictors of mortality.
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Affiliation(s)
- David Rene Rodriguez Lima
- Critical and Intensive Care Medicine, Hospital Universitario Mayor-Méderi, Bogotá, Colombia. .,Grupo de Investigación Clínica, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.
| | - Ángela María Pinzón Rondón
- Grupo de Investigación Clínica, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Cristhian Rubio Ramos
- Critical and Intensive Care Medicine, Hospital Universitario Mayor-Méderi, Bogotá, Colombia
| | | | - Maria José Niño Orrego
- Grupo de Investigación Clínica, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Mateo Andrés Díaz Quiroz
- Grupo de Investigación Clínica, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Nicolás Molano-González
- Grupo de Investigación Clínica, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | | | | | - Ángela María Ruiz Sternberg
- Grupo de Investigación Clínica, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
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21
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Jibaja M, Roldan-Vasquez E, Rello J, Shen H, Maldonado N, Grunauer M, Díaz AM, García F, Ramírez V, Sánchez H, Barberán JL, Paredes JP, Cevallos M, Montenegro F, Puertas S, Briones K, Martínez M, Vélez-Páez J, Montalvo-Villagómez M, Herrera L, Garrido S, Sisa I. Effect of High Altitude on the Survival of COVID-19 Patients in Intensive Care Unit: A Cohort Study. J Intensive Care Med 2022; 37:1265-1273. [PMID: 35532089 PMCID: PMC9095997 DOI: 10.1177/08850666221099827] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose: The effect of high altitude ( ≥ 1500 m) and its potential association with mortality by COVID-19 remains controversial. We assessed the effect of high altitude on the survival/discharge of COVID-19 patients requiring intensive care unit (ICU) admission for mechanical ventilation compared to individuals treated at sea level. Methods: A retrospective cohort multi-center study of consecutive adults patients with a positive RT-PCR test for COVID-19 who were mechanically ventilated between March and November 2020. Data were collected from two sea-level hospitals and four high-altitude hospitals in Ecuador. The primary outcome was ICU and hospital survival/discharge. Survival analysis was conducted using semi-parametric Cox proportional hazards models. Results: Of the study population (n = 670), 35.2% were female with a mean age of 58.3 ± 12.6 years. On admission, high-altitude patients were more likely to be younger (57.2 vs. 60.5 years old), presented with less comorbidities such as hypertension (25.9% vs. 54.9% with p-value <.001) and diabetes mellitus (20.5% vs. 37.2% with p-value <.001), less probability of having a capillary refill time > 3 sec (13.7% vs. 30.1%, p-value <.001), and less severity-of-illness condition (APACHE II score, 17.5 ± 8.1 vs. 20 ± 8.2, p < .01). After adjusting for key confounders high altitude is associated with significant higher probabilities of ICU survival/discharge (HR: 1.74 [95% CI: 1.46-2.08]) and hospital survival/discharge (HR: 1.35 [95% CI: 1.18-1.55]) than patients treated at sea level. Conclusions: Patients treated at high altitude at any time point during the study period were 74% more likely to experience ICU survival/discharge and 35% more likely to experience hospital survival/discharge than to the sea-level group. Possible reasons for these findings are genetic and physiological adaptations due to exposure to chronic hypoxia.
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Affiliation(s)
- Manuel Jibaja
- Escuela de Medicina, Universidad Internacional del Ecuador UIDE, Quito, Ecuador
- Unidad de Cuidados Intensivos, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
| | - Estefania Roldan-Vasquez
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador
| | - Jordi Rello
- Vall d’Hebrón Institute of Research (VHIR), Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
- CHRU Nîmes, Nîmes, France
| | - Hua Shen
- Department of Mathematics and Statistics, University of Calgary, Calgary, Alberta, Canada
| | - Nelson Maldonado
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador
| | - Michelle Grunauer
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador
| | - Ana María Díaz
- Unidad de Cuidados Intensivos, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
| | - Fernanda García
- Unidad de Cuidados Intensivos, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
| | - Vanessa Ramírez
- Unidad de Cuidados Intensivos, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
| | - Hernán Sánchez
- Unidad de Cuidados Intensivos, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
| | - José Luis Barberán
- Unidad de Cuidados Intensivos, Hospital de Especialidades, Portoviejo, Ecuador
| | - Juan Pablo Paredes
- Unidad de Cuidados Intensivos, Hospital de Especialidades, Portoviejo, Ecuador
| | - Mónica Cevallos
- Unidad de Cuidados Intensivos, Hospital de Especialidades, Portoviejo, Ecuador
| | - Francisco Montenegro
- Unidad de Cuidados Intensivos, Hospital de Especialidades José Carrasco Arteaga, Cuenca, Ecuador
| | - Soraya Puertas
- Unidad de Cuidados Intensivos, Hospital de Especialidades José Carrasco Arteaga, Cuenca, Ecuador
| | - Killen Briones
- Unidad de Cuidados Intensivos, Hospital del IESS, Babahoyo, Ecuador
| | - Marlon Martínez
- Unidad de Cuidados Intensivos, Hospital del IESS, Babahoyo, Ecuador
| | - Jorge Vélez-Páez
- Unidad de Cuidados Intensivos, Hospital General Pablo Arturo Suárez, Quito, Ecuador
| | | | - Luis Herrera
- Unidad de Cuidados Intensivos, Hospital del IESS, Ibarra, Ecuador
| | - Santiago Garrido
- Unidad de Cuidados Intensivos, Hospital del IESS, Ibarra, Ecuador
| | - Ivan Sisa
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador
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22
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High-altitude is associated with better short-term survival in critically ill COVID-19 patients admitted to the ICU. PLoS One 2022; 17:e0262423. [PMID: 35358185 PMCID: PMC8970356 DOI: 10.1371/journal.pone.0262423] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 12/26/2021] [Indexed: 01/08/2023] Open
Abstract
Background Multiple studies have attempted to elucidate the relationship between chronic hypoxia and SARS-CoV-2 infection. It seems that high-altitude is associated with lower COVID-19 related mortality and incidence rates; nevertheless, all the data came from observational studies, being this the first one looking into prospectively collected clinical data from severely ill patients residing at two significantly different altitudes. Methods A prospective cohort, a two-center study among COVID-19 confirmed adult patients admitted to a low (sea level) and high-altitude (2,850 m) ICU unit in Ecuador was conducted. Two hundred and thirty confirmed patients were enrolled from March 15th to July 15th, 2020. Results From 230 patients, 149 were men (64.8%) and 81 women (35.2%). The median age of all the patients was 60 years, and at least 105 (45.7%) of patients had at least one underlying comorbidity, including hypertension (33.5%), diabetes (16.5%), and chronic kidney failure (5.7%). The APACHE II scale (Score that estimates ICU mortality) at 72 hours was especially higher in the low altitude group with a median of 18 points (IQR: 9.5–24.0), compared to 9 points (IQR: 5.0–22.0) obtained in the high-altitude group. There is evidence of a difference in survival in favor of the high-altitude group (p = 0.006), the median survival being 39 days, compared to 21 days in the low altitude group. Conclusion There has been a substantial improvement in survival amongst people admitted to the high-altitude ICU. Residing at high-altitudes was associated with improved survival, especially among patients with no comorbidities. COVID-19 patients admitted to the high-altitude ICU unit have improved severity-of-disease classification system scores at 72 hours.
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23
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Beni ZN, Beni AN, Samani FR, Dayani MA, Beni FN, Radmehr H, Noorshargh P. Multivariable analysis of clinical and laboratory data manifestations predicting severity and mortality risk in patients with Coronavirus disease 2019 in the mountainous west of Iran: a retrospective single-center study. ASIAN BIOMED 2022; 16:31-42. [PMID: 37551398 PMCID: PMC10321164 DOI: 10.2478/abm-2022-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Few reports have addressed the clinical and laboratory features of patients with coronavirus disease-2019 (COVID-19) in mountainous areas, especially in Iran. Objectives To report the clinical and laboratory data and manifestations predicting mortality of patients with COVID-19 in the west of Iran. Methods We conducted a retrospective cohort study of 286 patients hospitalized with COVID-19 between 25 February 2020 and 12 May 2020 to describe their clinical symptoms and laboratory test findings when they were admitted at the Hajar Hospital affiliated with the Shahrekord University of Medical Sciences, and a multivariable analysis of factors that predict their disease severity and mortality. Results After hospital admission, 18 patients died and 268 were discharged. Older age [odds ratio (OR) = 1.02, 95% confidence interval (CI) = 1.01-1.04, P = 0.001], presence of underlying diseases (OR = 1.86, 95% CI = 1.01-3.45, P = 0.04), elevated hematocrit (OR = 1.08, 95% CI = 1.03-1.13, P = 0.002), and increase in red blood cell distribution width (RDW) coefficient of variation (OR = 1.18, 95% CI = 1.02-1.36, P = 0.02) were significantly associated with disease severity. Older age (OR = 1.00, 95% CI = 1.00-1.07, P = 0.03), hypocalcemia (OR = 0.20, 95% CI = 0.09-0.58, P = 0.002), hypophosphatemia (OR = 0.50, 95% CI = 0.26-1.02, P = 0.04), and increase in platelet-larger cell ratio (P-LCR; OR = 1.10, 95% CI = 1.00-1.15, P = 0.04) were significantly associated with mortality. The areas under the receiver operating characteristic curves were as follows: calcium 0.759; lactate dehydrogenase (LDH) 0.731; phosphorus 0.725; bilirubin 0.689; C-reactive protein 0.679; and RDW - standard deviation (RDW-SD) 0.624. Conclusions Those who did not survive tended to be elderly and had a greater incidence of comorbidities. Elevated LDH, decreased levels of calcium and phosphorus, and anemia at diagnosis were associated with greater risk of death for these Iranian patients hospitalized with COVID-19. Regular assessment of these markers would help to manage patients with COVID-19.
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Affiliation(s)
- Zahra Naderi Beni
- Shahrekord University of Medical Sciences, Shahr-e Kord, Chaharmahal and Bakhtiari Province88167-54633, Iran
| | - Afsaneh Naderi Beni
- Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan81496-44874, Iran
| | - Fereidoun Rahmani Samani
- Shahrekord University of Medical Sciences, Shahr-e Kord, Chaharmahal and Bakhtiari Province88167-54633, Iran
| | - Mohammad Ali Dayani
- Shahrekord University of Medical Sciences, Shahr-e Kord, Chaharmahal and Bakhtiari Province88167-54633, Iran
| | - Fariba Naderi Beni
- Shahrekord University of Medical Sciences, Shahr-e Kord, Chaharmahal and Bakhtiari Province88167-54633, Iran
| | - Hamed Radmehr
- Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan81496-44874, Iran
| | - Pegah Noorshargh
- Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan81496-44874, Iran
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24
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COVID-19: Regional Differences in Austria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031644. [PMID: 35162665 PMCID: PMC8835493 DOI: 10.3390/ijerph19031644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/21/2022] [Accepted: 01/28/2022] [Indexed: 12/24/2022]
Abstract
In the turbulent year 2020, overshadowed by the global COVID-19 pandemic, Austria experienced multiple waves of increased case incidence. While governmental measures to curb the numbers were based on current knowledge of infection risk factors, a retrospective analysis of incidence and lethality at the district level revealed correlations of relative infection risk with socioeconomic, geographical, and behavioral population parameters. We identified unexpected correlations between political orientation and smoking behavior and COVID-19 infection risk and/or mortality. For example, a decrease in daily smokers by 2.3 percentage points would be associated with an increase in cumulative incidence by 10% in the adjusted model, and an increase in voters of the right-wing populist party by 1.6 percentage points with an increase in cumulative mortality by 10%. While these parameters are apparently only single elements of complex causal chains that finally lead to individual susceptibility and vulnerability levels, our findings might have identified ecological parameters that can be utilized to develop fine-tuned communications and measures in upcoming challenges of this and other pandemics.
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25
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Del Valle-Mendoza J, Tarazona-Castro Y, Merino-Luna A, Carrillo-Ng H, Kym S, Aguilar-Luis MA, Del Valle LJ, Aquino-Ortega R, Martins-Luna J, Peña-Tuesta I, Silva-Caso W. Comparison of cytokines levels among COVID-19 patients living at sea level and high altitude. BMC Infect Dis 2022; 22:96. [PMID: 35090394 PMCID: PMC8795933 DOI: 10.1186/s12879-022-07079-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 01/17/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND At the end of 2019, a novel coronavirus denominated SARS-CoV-2 rapidly spread through the world causing the pandemic coronavirus disease known as COVID-19. The difference in the inflammatory response against SARS-CoV-2 infection among people living at different altitudes is a variable not yet studied. METHODS A descriptive cross-sectional study was performed in two Peruvian cities at different altitudes for comparison: Lima and Huaraz. Five important proinflammatory cytokines were measured including: IL-6, IL-2, IL-10, IFN-γ and TNF-α using ELISA assays. RESULTS A total of 35 COVID-19 patients and 10 healthy subjects were recruited from each study site. The mean levels of IL-6 (p < 0.03) and TNF-α (p < 0.01) were significantly different among the study groups. In the case of IL-6, patients from Lima had a mean level of 16.2 pg/ml (healthy) and 48.3 pg/ml (COVID-19), meanwhile, patients from Huaraz had levels of 67.3 pg/ml (healthy) and 97.9 pg/ml (COVID-19). Regarding TNF-α, patients from Lima had a mean level of 25.9 pg/ml (healthy) and 61.6 pg/ml (COVID-19), meanwhile, patients from Huaraz had levels of 89.0 pg/ml (healthy) and 120.6 pg/ml (COVID-19). The levels of IL-2, IL-10 and IFN-γ were not significantly different in the study groups. CONCLUSION Patients with COVID-19 residing at high-altitude tend to have higher levels of inflammatory cytokines compared to patients living at sea level, particularly IL-6 and TNF-α. A better understanding of the inflammatory response in different populations can contribute to the implementation of therapeutic and preventive approaches. Further studies evaluating more patients, a greater variety of cytokines and their clinical impact are required.
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Affiliation(s)
- Juana Del Valle-Mendoza
- School of Medicine, Research Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.
- Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru.
- Universidad Peruana de Ciencias Aplicadas, Av. San Marcos Cuadra 2, Chorrillos, Lima, Peru.
| | - Yordi Tarazona-Castro
- School of Medicine, Research Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru
| | | | - Hugo Carrillo-Ng
- School of Medicine, Research Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru
| | - Sungmin Kym
- Korea International Cooperation for Infectious Diseases, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Miguel Angel Aguilar-Luis
- School of Medicine, Research Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru
| | - Luis J Del Valle
- Barcelona Research Center for Multiscale Science and Engineering, Departament d'Enginyeria Química, EEBE, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Ronald Aquino-Ortega
- School of Medicine, Research Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru
| | - Johanna Martins-Luna
- School of Medicine, Research Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru
| | - Isaac Peña-Tuesta
- School of Medicine, Research Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru
| | - Wilmer Silva-Caso
- School of Medicine, Research Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.
- Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru.
- Universidad Peruana de Ciencias Aplicadas, Av. San Marcos Cuadra 2, Chorrillos, Lima, Peru.
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Xu T, Cui Y. Seasonal Variation Analysis for Weekly Cases, Deaths, and Hospitalizations of COVID-19 in the United States. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022. [DOI: 10.1007/5584_2022_750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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27
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Ortiz-Saavedra B, Montes-Madariaga ES, Zafra-Tanaka JH, Moreno-Loaiza O. Re: "High-Altitude Environment and COVID-19: SARS-CoV-2 Seropositivity in the Highest City in the World," by Champigneulle et al. High Alt Med Biol 2021; 22:431-433. [PMID: 34905393 DOI: 10.1089/ham.2021.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brando Ortiz-Saavedra
- Facultad de Medicina, Universidad Nacional de San Agustín de Arequipa, Arequipa, Perú
| | | | - Jessica Hanae Zafra-Tanaka
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia (UPCH), Lima, Perú
| | - Oscar Moreno-Loaiza
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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28
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Ortiz-Prado E, Fernandez Naranjo RP, Vasconez E, Simbaña-Rivera K, Correa-Sancho T, Lister A, Calvopiña M, Viscor G. Analysis of Excess Mortality Data at Different Altitudes During the COVID-19 Outbreak in Ecuador. High Alt Med Biol 2021; 22:406-416. [PMID: 34905395 DOI: 10.1089/ham.2021.0070] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Ortiz-Prado, Esteban, Raul Patricio Fernandez Naranjo, Eduardo Vasconez, Katherine Simbaña-Rivera, Trigomar Correa-Sancho, Alex Lister, Manuel Calvopiña, and Ginés Viscor. Analysis of excess mortality data at different altitudes during the COVID-19 outbreak in Ecuador. High Alt Med Biol. 22:406-416, 2021. Background: It has been speculated that living at high altitude confers some risk reduction in terms of SARS-CoV-2 infection, reduced transmissibility, and arguable lower COVID-19-related mortality. Objective: We aim to determine the number of excess deaths reported in Ecuador during the first year of the COVID-19 pandemic in relation to different altitude categories among 221 cantons in Ecuador, ranging from sea level to 4,300 m above. Methods: A descriptive ecological country-wide analysis of the excess mortality in Ecuador was performed since March 1, 2020, to March 1, 2021. Every canton was categorized as lower (for altitudes 2,500 m or less) or higher (for altitudes >2,500 m) in a first broad classification, as well as in two different classifications: The one proposed by Imray et al. in 2011 (low altitude <1,500 m, moderate altitude 1,500-2,500 m, high altitude 2,500-3,500 m, or very high altitude 3,500-5,500 m) and the one proposed by Bärtsch et al. in 2008 (near sea level 0-500 m, low altitude 500-2,000 m, moderate altitude 2,000-3,000 m, high altitude 3,000-5,500 m, and extreme altitude 5,500 m). A Poisson fitting analysis was used to identify trends on officially recorded all-caused deaths and those attributed to COVID-19. Results: In Ecuador, at least 120,573 deaths were recorded during the first year of the pandemic, from which 42,453 were catalogued as excessive when compared with the past 3 years of averages (2017-2019). The mortality rate at the lower altitude was 301/100,000 people, in comparison to 242/100,000 inhabitants in elevated cantons. Considering the four elevation categories, the highest excess deaths came from towns located at low altitude (324/100,000), in contrast to the moderate altitude (171/100,000), high-altitude (249/100,000), and very high-altitude (153/100,000) groups. Conclusions: This is the first report on COVID-19 excess mortality in a high-altitude range from 0 to 4,300 m above sea level. We found that absolute COVID-19-related excess mortality is lower both in time and in proportion in the cantons located at high and very high altitude when compared with those cantons located at low altitude.
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Affiliation(s)
- Esteban Ortiz-Prado
- One Health Research Group, Faculty of Medicine, Universidad de las Americas, Quito, Ecuador.,Department of Cell Biology, Physiology and Immunology of the Faculty of Biology, Universitat de Barcelona, Barcelona, Spain
| | | | - Eduardo Vasconez
- One Health Research Group, Faculty of Medicine, Universidad de las Americas, Quito, Ecuador
| | | | - Trigomar Correa-Sancho
- One Health Research Group, Faculty of Medicine, Universidad de las Americas, Quito, Ecuador
| | - Alex Lister
- University Hospital Southampton NHS FT, Southampton, United Kingdom
| | - Manuel Calvopiña
- One Health Research Group, Faculty of Medicine, Universidad de las Americas, Quito, Ecuador
| | - Ginés Viscor
- Department of Cell Biology, Physiology and Immunology of the Faculty of Biology, Universitat de Barcelona, Barcelona, Spain
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Potential long-term effects of SARS-CoV-2 infection on the pulmonary vasculature: a global perspective. Nat Rev Cardiol 2021; 19:314-331. [PMID: 34873286 PMCID: PMC8647069 DOI: 10.1038/s41569-021-00640-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 12/13/2022]
Abstract
The lungs are the primary target of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with severe hypoxia being the cause of death in the most critical cases. Coronavirus disease 2019 (COVID-19) is extremely heterogeneous in terms of severity, clinical phenotype and, importantly, global distribution. Although the majority of affected patients recover from the acute infection, many continue to suffer from late sequelae affecting various organs, including the lungs. The role of the pulmonary vascular system during the acute and chronic stages of COVID-19 has not been adequately studied. A thorough understanding of the origins and dynamic behaviour of the SARS-CoV-2 virus and the potential causes of heterogeneity in COVID-19 is essential for anticipating and treating the disease, in both the acute and the chronic stages, including the development of chronic pulmonary hypertension. Both COVID-19 and chronic pulmonary hypertension have assumed global dimensions, with potential complex interactions. In this Review, we present an update on the origins and behaviour of the SARS-CoV-2 virus and discuss the potential causes of the heterogeneity of COVID-19. In addition, we summarize the pathobiology of COVID-19, with an emphasis on the role of the pulmonary vasculature, both in the acute stage and in terms of the potential for developing chronic pulmonary hypertension. We hope that the information presented in this Review will help in the development of strategies for the prevention and treatment of the continuing COVID-19 pandemic. In this Review, the authors discuss the potential causes of the heterogeneity of COVID-19 and summarize the pathobiology of the disease, with an emphasis on the role of the pulmonary vasculature in the acute stage and the potential for developing chronic pulmonary hypertension. A thorough understanding of the dynamic behaviour of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is essential to understanding its heterogeneous effects on the pulmonary vasculature in patients with coronavirus disease 2019 (COVID-19). The severity and clinical phenotype of COVID-19 are influenced by host factors, including socioeconomic factors and genetics. Silent hypoxia is a major and independent cause of lung damage in COVID-19; the use of modern imaging techniques is proving to be very valuable in identifying silent hypoxia. The pulmonary vascular system has a major role in the pathobiology of COVID-19. Both COVID-19 and chronic pulmonary hypertension are global diseases with a complex interaction.
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Valero C, Barba R, Marcos DP, Puente N, Riancho JA, Santurtún A. Influence of weather factors on the incidence of COVID-19 in Spain. Med Clin (Barc) 2021; 159:255-261. [PMID: 34887065 PMCID: PMC8590957 DOI: 10.1016/j.medcli.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/15/2021] [Accepted: 10/28/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Several studies have analyzed the influence of meteorological and geographical factors on the incidence of COVID-19. Seasonality could be important in the transmission of SARS-CoV-2. This study aims to evaluate the geographical pattern of COVID-19 in Spain and its relationship with different meteorological variables. METHODS A provincial ecological study analyzing the influence of meteorological and geographical factors on the cumulative incidence of COVID-19 in the 52 (24 coastal and 28 inland) Spanish provinces during the first three waves was carried out. The cumulative incidence was calculated with data from the National Statistical Institute (INE) and the National Epidemiological Surveillance Network (RENAVE), while the meteorological variables were obtained from the Spanish Meteorological Agency (AEMET). RESULTS The total cumulative incidence, in all three waves, was lower in the coastal provinces than in the inland ones (566±181 vs. 782±154; p=2.5×10-5). The cumulative incidence correlated negatively with mean air temperature (r=-0.49; p=2.2×10-4) and rainfall (r=-0.33; p=0.01), and positively with altitude (r=0.56; p=1. 4×10-5). The Spanish provinces with an average temperature <10°C had almost twice the cumulative incidence than the provinces with temperatures >16°C. The mean air temperature and rainfall were associated with the cumulative incidence of COVID-19, regardless of other factors (Beta Coefficient of -0.62; p=3.7×10-7 and -0.47; p=4.2×10-5 respectively). CONCLUSIONS Meteorological and geographical factors could influence the evolution of the pandemic in Spain. Knowledge regarding the seasonality of the virus would help to predict new waves of COVID-19 infections.
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Affiliation(s)
- Carmen Valero
- Departamento de Medicina Interna, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, España.
| | - Raquel Barba
- Unidad de Medicina Legal, Facultad de Medicina, Universidad de Cantabria, Santander, España
| | - Daniel Pablo Marcos
- Departamento de Medicina Interna, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, España
| | - Nuria Puente
- Departamento de Medicina Interna, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, España
| | - José Antonio Riancho
- Departamento de Medicina Interna, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, España
| | - Ana Santurtún
- Unidad de Medicina Legal, Facultad de Medicina, Universidad de Cantabria, Santander, España
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Campos A, Scheveck B, Parikh J, Hernandez-Bojorge S, Terán E, Izurieta R. Effect of altitude on COVID-19 mortality in Ecuador: an ecological study. BMC Public Health 2021; 21:2079. [PMID: 34772396 PMCID: PMC8589098 DOI: 10.1186/s12889-021-12162-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 11/01/2021] [Indexed: 01/20/2023] Open
Abstract
Background The SARS-CoV-2/COVID-19 pandemic has claimed nearly 900,000 lives worldwide and infected more than 27 million people. Researchers worldwide are studying ways to decrease SARS-CoV-2 transmission and COVID-19 related deaths. Several studies found altitude having a negative association with both COVID-19 incidence and deaths. Ecuadorian data was used to explore the relationship between altitude and COVID-19. Methods This is an ecological study examining province-level data. To explore a relationship between altitude and COVID-19, this study utilized publicly available COVID-19 data and population statistics. ANOVA, correlation statistics, and a multivariate linear model explored the relationship between different Ecuadorian altitudes against incidence, mortality, and case-fatality rates. Population statistics attributed to COVID-19 were included in the linear model to control for confounding factors. Results Statistically significant differences were observed in the regions of Amazónica, Sierra, Costa of Ecuador for incidence, mortality, and case fatality rates, suggesting an association between altitude and SARS-CoV-2 transmission and COVID-19 disease severity (p-value ≤0.05). In univariate analysis, altitude had a negative association to mortality rate with a 1-unit change in altitude resulting in the decrease of 0.006 units in mortality rate (p-value = 0.03). The multiple linear models adjusted for population statistics showed a statistically significant negative association of altitude with mortality rate (p-value = 0.01) with a 1-unit change in altitude resulting in the decrease in mortality rate by 0.015 units. Overall, the model helped in explaining 50% (R2 = 0.4962) of the variance in mortality rate. Conclusion Altitude may have an effect on COVID-19 mortality rates. However, based on our model and R2 value, the relationship between our variables of interest and COVID-19 mortality may be nonlinear. More research is needed to understand why altitude may have a protective effect against COVID-19 mortality and how this may be applicable in a clinical setting.
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Affiliation(s)
- Adriana Campos
- University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, U.S..
| | - Bridget Scheveck
- University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, U.S
| | - Jeegan Parikh
- University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, U.S
| | | | - Enrique Terán
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Campus Cumbayá, Diego de Robles s/n, Quito, 170901, Quito, Ecuador
| | - Ricardo Izurieta
- University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, U.S
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Tomas-Grau RH, Ploper D, Ávila CL, Vera Pingitore E, Maldonado Galdeano C, Chaves S, Socias SB, Stagnetto A, Navarro SA, Chahla RE, Aguilar López M, Llapur CJ, Aznar P, Alcorta ME, Costas D, Flores I, Heinze D, Apfelbaum G, Mostoslavsky R, Mostoslavsky G, Cazorla SI, Perdigón GDV, Chehín R. Elevated Humoral Immune Response to SARS-CoV-2 at High Altitudes Revealed by an Anti-RBD " In-House" ELISA. Front Med (Lausanne) 2021; 8:720988. [PMID: 34722566 PMCID: PMC8551828 DOI: 10.3389/fmed.2021.720988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 09/21/2021] [Indexed: 12/23/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has caused a global pandemic with dramatic health and socioeconomic consequences. The Coronavirus Disease 2019 (COVID-19) challenges health systems to quickly respond by developing new diagnostic strategies that contribute to identify infected individuals, monitor infections, perform contact-tracing, and limit the spread of the virus. In this brief report, we developed a highly sensitive, specific, and precise “In-House” ELISA to correctly discriminate previously SARS-CoV-2-infected and non-infected individuals and study population seroprevalence. Among 758 individuals evaluated for anti-SARS-CoV-2 serology in the province of Tucumán, Argentina, we found a weak correlation between antibodies elicited against the RBD, the receptor-binding domain of the Spike protein, and the nucleocapsid (N) antigens of this virus. Additionally, we detected mild levels of anti-RBD IgG antibodies in 33.6% of individuals diagnosed with COVID-19, while only 19% showed sufficient antibody titers to be considered as plasma donors. No differences in IgG anti-RBD titers were found between women and men, neither in between different age groups ranging from 18 to 60. Surprisingly, individuals from a high altitude village displayed elevated and longer lasting anti-RBD titers compared to those from a lower altitude city. To our knowledge, this is the first report correlating altitude with increased humoral immune response against SARS-CoV-2 infection.
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Affiliation(s)
- Rodrigo Hernán Tomas-Grau
- Instituto de Medicina Molecular y Celular Aplicada, Universidad Nacional de Tucumán-Consejo Nacional de Investigación Científicas y Técnicas- Sistema Provincial de Salud (UNT-CONICET-SIPROSA), Tucumán, Argentina
| | - Diego Ploper
- Instituto de Medicina Molecular y Celular Aplicada, Universidad Nacional de Tucumán-Consejo Nacional de Investigación Científicas y Técnicas- Sistema Provincial de Salud (UNT-CONICET-SIPROSA), Tucumán, Argentina
| | - César Luis Ávila
- Instituto de Medicina Molecular y Celular Aplicada, Universidad Nacional de Tucumán-Consejo Nacional de Investigación Científicas y Técnicas- Sistema Provincial de Salud (UNT-CONICET-SIPROSA), Tucumán, Argentina
| | - Esteban Vera Pingitore
- Instituto de Medicina Molecular y Celular Aplicada, Universidad Nacional de Tucumán-Consejo Nacional de Investigación Científicas y Técnicas- Sistema Provincial de Salud (UNT-CONICET-SIPROSA), Tucumán, Argentina
| | - Carolina Maldonado Galdeano
- Centro de Referencia para Lactobacilos, Consejo Nacional de Investigación Científicas y Técnicas (CONICET), Tucumán, Argentina
| | - Silvina Chaves
- Instituto de Medicina Molecular y Celular Aplicada, Universidad Nacional de Tucumán-Consejo Nacional de Investigación Científicas y Técnicas- Sistema Provincial de Salud (UNT-CONICET-SIPROSA), Tucumán, Argentina
| | - Sergio Benjamín Socias
- Instituto de Medicina Molecular y Celular Aplicada, Universidad Nacional de Tucumán-Consejo Nacional de Investigación Científicas y Técnicas- Sistema Provincial de Salud (UNT-CONICET-SIPROSA), Tucumán, Argentina
| | - Agustín Stagnetto
- Instituto de Medicina Molecular y Celular Aplicada, Universidad Nacional de Tucumán-Consejo Nacional de Investigación Científicas y Técnicas- Sistema Provincial de Salud (UNT-CONICET-SIPROSA), Tucumán, Argentina
| | - Silvia Adriana Navarro
- Instituto de Medicina Molecular y Celular Aplicada, Universidad Nacional de Tucumán-Consejo Nacional de Investigación Científicas y Técnicas- Sistema Provincial de Salud (UNT-CONICET-SIPROSA), Tucumán, Argentina
| | | | - Mónica Aguilar López
- Laboratorio de Salud Pública, Sistema Provincial de Salud, Hospital Néstor Kirchner, Tucumán, Argentina
| | - Conrado Juan Llapur
- Departamento de Residencias, Dirección General de Recursos Humanos (DGRRHH), Ministerio de Salud, Tucumán, Argentina
| | - Patricia Aznar
- Laboratorio de Salud Pública, Sistema Provincial de Salud, Hospital Néstor Kirchner, Tucumán, Argentina
| | - María Elena Alcorta
- Laboratorio de Salud Pública, Sistema Provincial de Salud, Hospital Néstor Kirchner, Tucumán, Argentina
| | - Dardo Costas
- Laboratorio de Salud Pública, Sistema Provincial de Salud, Hospital Néstor Kirchner, Tucumán, Argentina
| | - Isolina Flores
- Laboratorio de Salud Pública, Sistema Provincial de Salud, Hospital Néstor Kirchner, Tucumán, Argentina
| | - Dar Heinze
- Section of Gastroenterology, Department of Medicine, Center for Regenerative Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Gabriela Apfelbaum
- Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Raul Mostoslavsky
- The Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, United States
| | - Gustavo Mostoslavsky
- Section of Gastroenterology, Department of Medicine, Center for Regenerative Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Silvia Inés Cazorla
- Centro de Referencia para Lactobacilos, Consejo Nacional de Investigación Científicas y Técnicas (CONICET), Tucumán, Argentina
| | - Gabriela Del Valle Perdigón
- Centro de Referencia para Lactobacilos, Consejo Nacional de Investigación Científicas y Técnicas (CONICET), Tucumán, Argentina
| | - Rosana Chehín
- Instituto de Medicina Molecular y Celular Aplicada, Universidad Nacional de Tucumán-Consejo Nacional de Investigación Científicas y Técnicas- Sistema Provincial de Salud (UNT-CONICET-SIPROSA), Tucumán, Argentina
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Ilias I, Kaltsas G, Barkas K, Chrousos GP. Inherited/Genetically-Associated Pheochromocytoma/ Paraganglioma Syndromes and COVID-19. ACTA ACUST UNITED AC 2021; 57:medicina57101033. [PMID: 34684070 PMCID: PMC8538054 DOI: 10.3390/medicina57101033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 12/04/2022]
Abstract
In some subjects with inherited pheochromocytoma/paraganglioma (PPG) syndromes, hypoxia-inducible factor 1 alpha (HIF1α) stabilization/activation could lead to an increase in angiotensin converting enzymes (ACE). This would result in the stimulation of angiotensin (AT) II production and, hence, reduce the availability of ACE 2. The latter would provide decreased numbers of binding sites for the spike protein of SARS-CoV-2 and, therefore, result in less points of viral entry into cells. Thus, subjects with HIF1α-associated PPG syndromes may benefit from an inherent protective effect against COVID-19. Such an implication of HIF1α vis-à-vis COVID-19 could open ways of therapeutic interventions.
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Affiliation(s)
- Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, “Elena Venizelou” Hospital, GR-11521 Athens, Greece
- Correspondence: ; Tel.: +30-2132051389
| | - Gregory Kaltsas
- 1st Department of Propaedeutic and Internal Medicine, National and Kapodistrian University of Athens, GR-11527 Athens, Greece;
| | - Konstantinos Barkas
- Department of Neurosurgery, “Agios Panteleimon” General Hospital of Nikaia-Pireas, GR-12351 Athens, Greece;
| | - George P. Chrousos
- University Research Institute of Maternal and Child Health & Precision Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, GR-11527 Athens, Greece;
- UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, GR-11527 Athens, Greece
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van Veelen MJ, Voegele A, Rauch S, Kaufmann M, Brugger H, Strapazzon G. COVID-19 Pandemic in Mountainous Areas: Impact, Mitigation Strategies, and New Technologies in Search and Rescue Operations. High Alt Med Biol 2021; 22:335-341. [PMID: 34319777 PMCID: PMC8558066 DOI: 10.1089/ham.2020.0216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/29/2021] [Indexed: 12/03/2022] Open
Abstract
van Veelen, Michiel J., Anna Voegele, Simon Rauch, Marc Kaufmann, Hermann Brugger, and Giacomo Strapazzon. COVID-19 pandemic in mountainous areas: impact, mitigation strategies, and new technologies in search and rescue operations. High Alt Med Biol. 22:335-341, 2021.-Mitigating the spread of COVID-19, an airborne infection, can lead to delays in the prehospital response and impair the performance of search and rescue (SAR) services in mountainous and remote areas. We provide an overview of the developing epidemiological situation related to the COVID-19 pandemic in mountainous areas and review current protocols to determine their suitability for mountain rescue teams. We also discuss using novel technologies to reduce the adverse effects caused by COVID-19 mitigation strategies such as delays caused by donning personal protective equipment (PPE) and reduced rescuer performance due to impaired movement and ventilation. COVID-19 has spread even in mountainous and remote locations. Dedicated protocols for the use of PPE appropriate for SAR rescuers exerting physical effort in remote areas and using technologies such as drones, telemedicine, and localization and contact tracing applications could contribute to an effective and timely emergency response in mountainous and remote settings.
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Affiliation(s)
- Michiel J. van Veelen
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Emergency Medical Services (COVID-1 Intermediate Care Unit), Bolzano Hospital, Bolzano, Italy
| | - Anna Voegele
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Simon Rauch
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Anesthesia and Intensive Care, “F. Tappeiner” Hospital, Merano, Italy
| | - Marc Kaufmann
- Emergency Medical Services (COVID-1 Intermediate Care Unit), Bolzano Hospital, Bolzano, Italy
- Emergency Medical Services 112, Health Care System Alto Adige, Bolzano, Italy
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
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Das A, Patra M, Dhangadamajhi G. Association of rs11549465 (C1772T) variant of hypoxia-inducible factor-1α with Covid-19 susceptibility. A population-based epidemiological study. Hum Cell 2021; 34:1937-1940. [PMID: 34426956 PMCID: PMC8382105 DOI: 10.1007/s13577-021-00601-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/19/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Anamika Das
- Agricultural and Food Engineering Department, Indian Institute of Technology, Kharagpur, 721302, West Bengal, India
| | - Maheswari Patra
- Department of Biotechnology, Maharaja Sriram Chandra Bhanjadeo University, Baripada, 757003, Odisha, India
| | - Gunanidhi Dhangadamajhi
- Department of Biotechnology, Maharaja Sriram Chandra Bhanjadeo University, Baripada, 757003, Odisha, India.
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Bhattacharya S, Agarwal S, Shrimali NM, Guchhait P. Interplay between hypoxia and inflammation contributes to the progression and severity of respiratory viral diseases. Mol Aspects Med 2021; 81:101000. [PMID: 34294412 PMCID: PMC8287505 DOI: 10.1016/j.mam.2021.101000] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/07/2021] [Accepted: 07/16/2021] [Indexed: 02/07/2023]
Abstract
History of pandemics is dominated by viral infections and specifically respiratory viral diseases like influenza and COVID-19. Lower respiratory tract infection is the fourth leading cause of death worldwide. Crosstalk between resultant inflammation and hypoxic microenvironment may impair ventilatory response of lungs. This reduces arterial partial pressure of oxygen, termed as hypoxemia, which is observed in a section of patients with respiratory virus infections including SARS-CoV-2 (COVID-19). In this review, we describe the interplay between inflammation and hypoxic microenvironment in respiratory viral infection and its contribution to disease pathogenesis.
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Affiliation(s)
- Sulagna Bhattacharya
- Regional Centre for Biotechnology, National Capital Region Biotech Science Cluster, Faridabad, India; School of Biotechnology, Kalinga Institute of Industrial Technology, Orissa, India
| | - Sakshi Agarwal
- Regional Centre for Biotechnology, National Capital Region Biotech Science Cluster, Faridabad, India
| | - Nishith M Shrimali
- Regional Centre for Biotechnology, National Capital Region Biotech Science Cluster, Faridabad, India
| | - Prasenjit Guchhait
- Regional Centre for Biotechnology, National Capital Region Biotech Science Cluster, Faridabad, India.
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Champigneulle B, Hancco I, Renan R, Doutreleau S, Stauffer E, Pichon A, Brugniaux JV, Péré H, Bouzat P, Veyer D, Verges S. High-Altitude Environment and COVID-19: SARS-CoV-2 Seropositivity in the Highest City in the World. High Alt Med Biol 2021. [PMID: 34197184 DOI: 10.1089/ham.2021.0020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Champigneulle, Benoit, Ivan Hancco, Richard Renan, Stéphane Doutreleau, Emeric Stauffer, Aurélien Pichon, Julien V. Brugniaux, Hélène Péré, Pierre Bouzat, David Veyer, and Samuel Verges. High-altitude environment and COVID-19: SARS-CoV-2 seropositivity in the highest city in the world. High Alt Med Biol. 22: 000-000, 2021. Background: A reduced coronavirus disease 2019 (COVID-19) diffusion has been suggested in high-altitude areas but remained questionable. Aims of this study were to estimate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity as well as the risk factors associated in La Rinconada, the highest city in the world (5,100-5,300 m), a gold-mining town located in southeastern Peru where >50,000 dwellers live in precarious sanitary conditions. Materials and Methods: We performed a cross-sectional study during a 1-week period in October 2020, using point-of-care lateral flow serological assays allowing detection of antibodies directed against SARS-CoV-2 among voluntary dwellers in La Rinconada. Participants were also questioned about potential occupational and environmental risk factors of COVID-19 occurrence. Results: In a sample of 159 dwellers tested in La Rinconada, 48.4% [95% confidence interval, CI: 40.5-56.4] were seropositive for the SARS-CoV-2. Occurrence of at least one symptom compatible with the COVID-19 over the past 6 months remained the only significant factor associated with SARS-CoV-2 seropositivity (adjusted odds ratio: 3.27; [95% CI: 1.70-6.44]; p < 0.001). Conclusions: The high rate of SARS-CoV-2 seropositivity observed in this small sample of highlanders does not support a protective effect of high-altitude against the COVID-19 spread and demonstrates its large dissemination in vulnerable populations. Clinical Trial Registration number: NCT04604249.
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Affiliation(s)
- Benoit Champigneulle
- HP2 Laboratory, INSERM U1300, Grenoble Alpes University, CHU Grenoble Alpes, Grenoble, France
| | - Ivan Hancco
- HP2 Laboratory, INSERM U1300, Grenoble Alpes University, CHU Grenoble Alpes, Grenoble, France
| | - Richard Renan
- Asociación Científica de Estudiantes de Medicina (ACEM-UNA), Universidad Nacional del Altiplano (UNA), Puno, Perú
| | - Stéphane Doutreleau
- HP2 Laboratory, INSERM U1300, Grenoble Alpes University, CHU Grenoble Alpes, Grenoble, France
| | - Emeric Stauffer
- Laboratory LIBM EA7424, Team "Vascular Biology and Red Blood Cell," University of Lyon 1, Lyon, France
- Exploration Fonctionnelle Respiratoire, Médecine du Sport et de l'activité Physique, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Lyon, France
| | - Aurélien Pichon
- Laboratoire Move EA 6314, Faculté des Sciences du Sport, Université de Poitiers, Poitiers, France
| | - Julien V Brugniaux
- HP2 Laboratory, INSERM U1300, Grenoble Alpes University, CHU Grenoble Alpes, Grenoble, France
| | - Hélène Péré
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- Unité de Génomique Fonctionnelle des Tumeurs Solides, Centre de Recherche des Cordeliers, INSERM, Université de Paris, Paris, France
| | - Pierre Bouzat
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - David Veyer
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- Unité de Génomique Fonctionnelle des Tumeurs Solides, Centre de Recherche des Cordeliers, INSERM, Université de Paris, Paris, France
| | - Samuel Verges
- HP2 Laboratory, INSERM U1300, Grenoble Alpes University, CHU Grenoble Alpes, Grenoble, France
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Characteristics and Clinical Course of Adult in Patients with SARS-CoV-2 Pneumonia at High Altitude. Can Respir J 2021; 2021:5590879. [PMID: 34122677 PMCID: PMC8189806 DOI: 10.1155/2021/5590879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/06/2021] [Accepted: 05/29/2021] [Indexed: 12/15/2022] Open
Abstract
Background SARS-CoV-2 has spread worldwide with different dynamics in each region. We aimed to describe the clinical characteristics and to explore risk factors of death, critical care admission, and use of invasive mechanical ventilation in hospitalized patients with SARS-CoV-2 pneumonia in a high-altitude population living in Bogotá, Colombia. Methods We conducted a concurrent cohort study of adult patients with laboratory-confirmed SARS-CoV-2 pneumonia. Demographic, clinical, and treatment data were extracted from electronic records. Univariate and multivariable methods were performed to investigate the relationship between each variable and outcomes at 28 days of follow-up. Results 377 adults (56.8% male) were included in the study, of whom 85 (22.6%) died. Nonsurvivors were older on average than survivors (mean age, 56.7 years [SD 15.8] vs. 70.1 years [SD 13.9]; p ≤ 0.001) and more likely male (28 [32.9%] vs. 57 [67.1%]; p=0.029). Most patients had at least one underlying disease (333 [88.3%]), including arterial hypertension (149 [39.5%]), overweight (145 [38.5%]), obesity (114 [30.2%]), and diabetes mellitus (82 [21.8%]). Frequency of critical care admission (158 [41.9%]) and invasive mechanical ventilation (123 [32.6%]) was high. Age over 65 years (OR 9.26, 95% CI 3.29-26.01; p ≤ 0.001), ICU admission (OR 12.37, 95% CI 6.08-25.18; p ≤ 0.001), and arterial pH higher than 7.47 (OR 0.25, 95% CI 0.08-0.74; p=0.01) were independently associated with in-hospital mortality. Conclusions In this study of in-hospital patients with SARS-CoV-2 pneumonia living at high altitude, frequency of death was similar to what has been reported. ICU admission and use of invasive mechanical ventilation were high. Risk factors as older age, ICU admission, and arterial pH were associated with mortality.
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39
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Cardenas L, Valverde‐Bruffau V, Gonzales GF. Altitude does not protect against SARS-CoV-2 infections and mortality due to COVID-19. Physiol Rep 2021; 9:e14922. [PMID: 34110706 PMCID: PMC8191172 DOI: 10.14814/phy2.14922] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/08/2021] [Accepted: 05/15/2021] [Indexed: 01/15/2023] Open
Affiliation(s)
- Laura Cardenas
- Laboratories of Investigation and Development (LID)Faculty of Sciences and PhilosophyUniversidad Peruana Cayetano HerediaLimaPeru
| | - Valeria Valverde‐Bruffau
- Laboratories of Investigation and Development (LID)Faculty of Sciences and PhilosophyUniversidad Peruana Cayetano HerediaLimaPeru
| | - Gustavo F. Gonzales
- Laboratories of Investigation and Development (LID)Faculty of Sciences and PhilosophyUniversidad Peruana Cayetano HerediaLimaPeru
- High Altitude Research InstituteUniversidad Peruana Cayetano HerediaLimaPeru
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40
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Samillan VJ, Flores-León D, Rojas E, Zutta BR. Environmental and climatic impact on the infection and mortality of SARS-CoV-2 in Peru. J Basic Clin Physiol Pharmacol 2021; 32:935-942. [PMID: 34018379 DOI: 10.1515/jbcpp-2021-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/21/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The role of the environment and climate in the transmission and case fatality rates of SARS-CoV-2 is still being investigated a year into the pandemic. Elevation and air quality are believed to be significant factors in the development of the pandemic, but the influence of additional environmental factors remains unclear. METHODS We explored the relationship between the cumulative number of infections and mortality cases with climate (temperature, precipitation, solar radiation, water vapor pressure, wind), environmental data (elevation, normalized difference vegetation index or NDVI, particulate matter at 2.5 μm or PM2.5 and NO2 concentration), and population density in Peru. We use confirmed cases of infection from 1,287 districts and mortality in 479 districts, we used Spearman's correlations to assess the bivariate correlation between environmental and climatic factors with cumulative infection cases, cumulative mortality and case-fatality rate. We explored district cases within the ecozones of coast, sierra, high montane forest and lowland rainforest. RESULTS Multiple linear regression models indicate elevation, mean solar radiation, air quality, population density and green vegetation cover, as a socioeconomic proxy, are influential factors in the distribution of infection and mortality of SARS-CoV-2 in Peru. Case-fatality rate was weakly associated with elevation. CONCLUSIONS Our results also strongly suggest that exposure to poor air quality is a significant factor in the mortality of individuals below the age of 30. We conclude that environmental and climatic factors do play a significant role in the transmission and case fatality rates in Peru, however further study is required to see if these relationships are maintained over time.
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Affiliation(s)
| | | | - Eduardo Rojas
- School of Geography and History, University of Barcelona, Barcelona, Spain
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41
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Abdelsalam M, Althaqafi RMM, Assiri SA, Althagafi TM, Althagafi SM, Fouda AY, Ramadan A, Rabah M, Ahmed RM, Ibrahim ZS, Nemenqani DM, Alghamdi AN, Al Aboud D, Abdel-Moneim AS, Alsulaimani AA. Clinical and Laboratory Findings of COVID-19 in High-Altitude Inhabitants of Saudi Arabia. Front Med (Lausanne) 2021; 8:670195. [PMID: 34055842 PMCID: PMC8149591 DOI: 10.3389/fmed.2021.670195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 03/23/2021] [Indexed: 01/08/2023] Open
Abstract
Background: SARS-CoV-2, the causative agent of COVID-19, continues to cause a worldwide pandemic, with more than 147 million being affected globally as of this writing. People's responses to COVID-19 range from asymptomatic to severe, and the disease is sometimes fatal. Its severity is affected by different factors and comorbidities of the infected patients. Living at a high altitude could be another factor that affects the severity of the disease in infected patients. Methods: In the present study, we have analyzed the clinical, laboratory, and radiological findings of COVID-19-infected patients in Taif, a high-altitude region of Saudi Arabia. In addition, we compared matched diseased subjects to those living at sea level. We hypothesized that people living in high-altitude locations are prone to develop a more severe form of COVID-19 than those living at sea level. Results: Age and a high Charlson comorbidity score were associated with increased numbers of intensive care unit (ICU) admissions and mortality among COVID-19 patients. These ICU admissions and fatalities were found mainly in patients with comorbidities. Rates of leukocytosis, neutrophilia, higher D-dimer, ferritin, and highly sensitive C-reactive protein (CRP) were significantly higher in ICU patients. CRP was the most independent of the laboratory biomarkers found to be potential predictors of death. COVID-19 patients who live at higher altitude developed a less severe form of the disease and had a lower mortality rate, in comparison to matched subjects living at sea level. Conclusion: CRP and Charlson comorbidity scores can be considered predictive of disease severity. People living at higher altitudes developed less severe forms of COVID-19 disease than those living at sea level, due to a not-yet-known mechanism.
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Affiliation(s)
- Mostafa Abdelsalam
- Alameen Hospital, Taif, Saudi Arabia.,Mansoura Nephrology and Dialysis Unit, Internal Medicine Department, College of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Sara A Assiri
- College of Medicine, Taif University, Taif, Saudi Arabia
| | | | - Saleh M Althagafi
- General Department of Medical Services, Security Forces Hospital, Mecca, Saudi Arabia
| | - Ahmed Y Fouda
- Alameen Hospital, Taif, Saudi Arabia.,Anesthesiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Ramadan
- Alameen Hospital, Taif, Saudi Arabia.,Radiology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Mohammed Rabah
- Alameen Hospital, Taif, Saudi Arabia.,Radiology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Reham M Ahmed
- Alameen Hospital, Taif, Saudi Arabia.,Albbassia Chest Hospital, Cairo, Egypt
| | - Zein S Ibrahim
- Department of Physiology, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
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42
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Wing PAC, Keeley TP, Zhuang X, Lee JY, Prange-Barczynska M, Tsukuda S, Morgan SB, Harding AC, Argles ILA, Kurlekar S, Noerenberg M, Thompson CP, Huang KYA, Balfe P, Watashi K, Castello A, Hinks TSC, James W, Ratcliffe PJ, Davis I, Hodson EJ, Bishop T, McKeating JA. Hypoxic and pharmacological activation of HIF inhibits SARS-CoV-2 infection of lung epithelial cells. Cell Rep 2021; 35:109020. [PMID: 33852916 PMCID: PMC8020087 DOI: 10.1016/j.celrep.2021.109020] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/28/2021] [Accepted: 03/31/2021] [Indexed: 12/15/2022] Open
Abstract
COVID-19, caused by the novel coronavirus SARS-CoV-2, is a global health issue with more than 2 million fatalities to date. Viral replication is shaped by the cellular microenvironment, and one important factor to consider is oxygen tension, in which hypoxia inducible factor (HIF) regulates transcriptional responses to hypoxia. SARS-CoV-2 primarily infects cells of the respiratory tract, entering via its spike glycoprotein binding to angiotensin-converting enzyme 2 (ACE2). We demonstrate that hypoxia and the HIF prolyl hydroxylase inhibitor Roxadustat reduce ACE2 expression and inhibit SARS-CoV-2 entry and replication in lung epithelial cells via an HIF-1α-dependent pathway. Hypoxia and Roxadustat inhibit SARS-CoV-2 RNA replication, showing that post-entry steps in the viral life cycle are oxygen sensitive. This study highlights the importance of HIF signaling in regulating multiple aspects of SARS-CoV-2 infection and raises the potential use of HIF prolyl hydroxylase inhibitors in the prevention or treatment of COVID-19.
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Affiliation(s)
- Peter A C Wing
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Chinese Academy of Medical Sciences (CAMS) Oxford Institute (COI), University of Oxford, Oxford, UK
| | - Thomas P Keeley
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Ludwig Institute for Cancer Research, University of Oxford, Oxford, UK
| | - Xiaodong Zhuang
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jeffrey Y Lee
- Department of Biochemistry, University of Oxford, Oxford, UK
| | - Maria Prange-Barczynska
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Ludwig Institute for Cancer Research, University of Oxford, Oxford, UK
| | - Senko Tsukuda
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sophie B Morgan
- Respiratory Medicine Unit and National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), Nuffield Department of Medicine, Experimental Medicine, University of Oxford, Oxford, UK
| | - Adam C Harding
- Sir William Dunn School of Pathology, University of Oxford, Oxford OX1 3RE, UK
| | | | - Samvid Kurlekar
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Marko Noerenberg
- Department of Biochemistry, University of Oxford, Oxford, UK; MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Craig P Thompson
- Peter Medawar Building for Pathogen Research, Department of Zoology, University of Oxford, Oxford, UK
| | - Kuan-Ying A Huang
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Peter Balfe
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Koichi Watashi
- Department of Virology II, National Institute of Infectious Diseases, Tokyo 162-8640, Japan; Department of Applied Biological Science, Tokyo University of Science, Noda 278-8510, Japan
| | - Alfredo Castello
- Department of Biochemistry, University of Oxford, Oxford, UK; MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Timothy S C Hinks
- Respiratory Medicine Unit and National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), Nuffield Department of Medicine, Experimental Medicine, University of Oxford, Oxford, UK
| | - William James
- Sir William Dunn School of Pathology, University of Oxford, Oxford OX1 3RE, UK
| | - Peter J Ratcliffe
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Ludwig Institute for Cancer Research, University of Oxford, Oxford, UK; Francis Crick Institute, London, UK
| | - Ilan Davis
- Department of Biochemistry, University of Oxford, Oxford, UK
| | - Emma J Hodson
- Francis Crick Institute, London, UK; Department of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK
| | - Tammie Bishop
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Ludwig Institute for Cancer Research, University of Oxford, Oxford, UK
| | - Jane A McKeating
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Chinese Academy of Medical Sciences (CAMS) Oxford Institute (COI), University of Oxford, Oxford, UK.
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43
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Machado BH, Paton JFR. Relevance of carotid bodies in COVID-19: A hypothetical viewpoint. Auton Neurosci 2021; 233:102810. [PMID: 33894532 PMCID: PMC8052558 DOI: 10.1016/j.autneu.2021.102810] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 12/27/2022]
Abstract
We have considered some of the available evidence to account for the impact of SARS-CoV on the regulatory control of the autonomic nervous and respiratory systems. Apart from stimulating general interest in the subject, our hope was to provide putative explanations for some of the patients' symptoms based on described physiological and pathophysiological mechanisms seen in other diseases. Herein, we have focused on the carotid bodies. In this hypothetical viewpoint, we have discussed the plasticity of the carotid body chemoreflex and made a comparison between acute and chronic exposures to high altitude with COVID-19. From these discussions, we have postulated that the sensitivity of the hypoxic ventilatory response may well determine the outcome of disease severity and those that live at high altitude may be more resistant. We have provided insight into silent hypoxia and attempted to explain an absence of ventilatory drive and anxiety yet maintenance of consciousness. In an attempt to discover more about the mysteries of COVID-19, we conclude with questions and some hypothetical studies that may answer them.
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Affiliation(s)
- Benedito H Machado
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil.
| | - Julian F R Paton
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil.
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44
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Thomson TM, Casas F, Guerrero HA, Figueroa-Mujíca R, Villafuerte FC, Machicado C. Potential Protective Effect from COVID-19 Conferred by Altitude: A Longitudinal Analysis in Peru During Full Lockdown. High Alt Med Biol 2021; 22:209-224. [PMID: 33780636 DOI: 10.1089/ham.2020.0202] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Thomson, Timothy M., Fresia Casas, Harold Andre Guerrero, Rómulo Figueroa-Mujíca, Francisco C. Villafuerte, and Claudia Machicado. Potential protective effect from COVID-19 conferred by altitude: A longitudinal analysis in Peru during full lockdown. High Alt Med Biol. 22: 209-224, 2021. Background: The COVID-19 pandemic had a delayed onset in America. Despite the time advantage for the implementation of preventative measures to contain its spread, the pandemic followed growth rates that paralleled those observed before in Europe. Objectives: To analyze the temporal and geographical distribution of the COVID-19 pandemic at district-level in Perú during the full lockdown period in 2020. Methods: Analysis of publicly available data sets, stratified by altitude and geographical localization. Correlation tests of COVID-19 case and death rates to population prevalence of comorbidities. Results: We observe a strong protective effect of altitude from COVID-19 mortality in populations located above 2,500 m. We provide evidence that internal migration through a specific land route is a significant factor progressively overriding the protection from COVID-19 afforded by high altitude. This protection is independent of poverty indexes and is inversely correlated with the prevalence of hypertension and hypercholesterolemia. Discussion: Long-term adaptation to residency at high altitude may be the third general protective factor from COVID-19 severity and death, after young age and female sex. Multisystemic adaptive traits or acclimatization processes in response to chronic hypobaric hypoxia may explain the apparent protective effect of high altitude from COVID-19 death.
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Affiliation(s)
- Timothy M Thomson
- Institute for Molecular Biology, National Science Council (IBMB-CSIC), Barcelona, Spain.,Networked Center for Biomedical Research in Hepatic and Digestive Diseases (CIBER-EHD), Instituto Nacional de la Salud Carlos III, Madrid, Spain
| | - Fresia Casas
- Laboratory of Translational Research and Computational Biology, Facultad de Ciencias y Filosofía-LID, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Harold Andre Guerrero
- Laboratory of Translational Research and Computational Biology, Facultad de Ciencias y Filosofía-LID, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Rómulo Figueroa-Mujíca
- Laboratorio de Fisiología del Transporte de Oxígeno, Facultad de Ciencias y Filosofía-LID, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Francisco C Villafuerte
- Laboratorio de Fisiología del Transporte de Oxígeno, Facultad de Ciencias y Filosofía-LID, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Claudia Machicado
- Laboratory of Translational Research and Computational Biology, Facultad de Ciencias y Filosofía-LID, Universidad Peruana Cayetano Heredia, Lima, Perú.,Institute for Biocomputation and Physics of Complex Systems (BIFI), Zaragoza, Spain
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45
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Arias-Reyes C, Carvajal-Rodriguez F, Poma-Machicao L, Aliaga-Raduán F, Marques DA, Zubieta-DeUrioste N, Accinelli RA, Schneider-Gasser EM, Zubieta-Calleja G, Dutschmann M, Soliz J. Decreased incidence, virus transmission capacity, and severity of COVID-19 at altitude on the American continent. PLoS One 2021; 16:e0237294. [PMID: 33780470 PMCID: PMC8006995 DOI: 10.1371/journal.pone.0237294] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 03/02/2021] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) outbreak in North, Central, and South America has become the epicenter of the current pandemic. We have suggested previously that the infection rate of this virus might be lower in people living at high altitude (over 2,500 m) compared to that in the lowlands. Based on data from official sources, we performed a new epidemiological analysis of the development of the pandemic in 23 countries on the American continent as of May 23, 2020. Our results confirm our previous finding, further showing that the incidence of COVID-19 on the American continent decreases significantly starting at 1,000 m above sea level (masl). Moreover, epidemiological modeling indicates that the virus transmission rate is lower in the highlands (>1,000 masl) than in the lowlands (<1,000 masl). Finally, evaluating the differences in the recovery percentage of patients, the death-to-case ratio, and the theoretical fraction of undiagnosed cases, we found that the severity of COVID-19 is also decreased above 1,000 m. We conclude that the impact of the COVID-19 decreases significantly with altitude.
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Affiliation(s)
- Christian Arias-Reyes
- Faculty of Medicine, Université Laval, Institute Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Québec, Quebec City, Canada
| | - Favio Carvajal-Rodriguez
- Faculty of Medicine, Université Laval, Institute Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Québec, Quebec City, Canada
| | - Liliana Poma-Machicao
- Faculty of Medicine, Université Laval, Institute Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Québec, Quebec City, Canada
| | - Fernanda Aliaga-Raduán
- Faculty of Medicine, Université Laval, Institute Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Québec, Quebec City, Canada
| | - Danuzia A. Marques
- Faculty of Medicine, Université Laval, Institute Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Québec, Quebec City, Canada
| | | | | | | | | | - Mathias Dutschmann
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jorge Soliz
- Faculty of Medicine, Université Laval, Institute Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Québec, Quebec City, Canada
- High Altitude Pulmonary and Pathology Institute (HAPPI-IPPA), La Paz, Bolivia
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46
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Castilla J, Fresán U, Trobajo-Sanmartín C, Guevara M. Altitude and SARS-CoV-2 Infection in the First Pandemic Wave in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052578. [PMID: 33806642 PMCID: PMC7967395 DOI: 10.3390/ijerph18052578] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 12/11/2022]
Abstract
After the first pandemic wave, a nationwide survey assessed the seroprevalence of SARS-CoV-2 antibodies in Spain and found notable differences among provinces whose causes remained unclear. This ecological study aimed to analyze the association between environmental and demographic factors and SARS-CoV-2 infection by province. The seroprevalence of SARS-CoV-2 antibodies by province was obtained from a nationwide representative survey performed in June 2020, after the first pandemic wave in Spain. Linear regression was used in the analysis. The seroprevalence of SARS-CoV-2 antibodies of the 50 provinces ranged from 0.2% to 13.6%. The altitude, which ranged from 5 to 1131 m, explained nearly half of differences in seroprevalence (R2 = 0.47, p < 0.001). The seroprevalence in people residing in provinces above the median altitude (215 m) was three-fold higher (6.5% vs. 2.1%, p < 0.001). In the multivariate linear regression, the addition of population density significantly improved the predictive value of the altitude (R2 = 0.55, p < 0.001). Every 100 m of altitude increase and 100 inhabitants/km2 of increase in population density, the seroprevalence rose 0.84 and 0.63 percentage points, respectively. Environmental conditions related to higher altitude in winter–spring, such as lower temperatures and absolute humidity, may be relevant to SARS-CoV-2 transmission. Places with such adverse conditions may require additional efforts for pandemic control.
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Affiliation(s)
- Jesús Castilla
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (U.F.); (M.G.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Navarre Institute for Health Research (IdiSNA), 31008 Pamplona, Spain;
- Correspondence:
| | - Ujué Fresán
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (U.F.); (M.G.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Instituto de Salud Global (ISGlobal), 08036 Barcelona, Spain
| | - Camino Trobajo-Sanmartín
- Navarre Institute for Health Research (IdiSNA), 31008 Pamplona, Spain;
- Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
| | - Marcela Guevara
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (U.F.); (M.G.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Navarre Institute for Health Research (IdiSNA), 31008 Pamplona, Spain;
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47
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Weather variability and transmissibility of COVID-19: a time series analysis based on effective reproductive number. EXPERIMENTAL RESULTS 2021; 2:e15. [PMID: 34192228 PMCID: PMC8007945 DOI: 10.1017/exp.2021.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 12/24/2022] Open
Abstract
COVID-19 is causing a significant burden on medical and healthcare resources globally due to high numbers of hospitalisations and deaths recorded as the pandemic continues. This research aims to assess the effects of climate factors (i.e., daily average temperature and average relative humidity) on effective reproductive number of COVID-19 outbreak in Wuhan, China during the early stage of the outbreak. Our research showed that effective reproductive number of COVID-19 will increase by 7.6% (95% Confidence Interval: 5.4% ~ 9.8%) per 1°C drop in mean temperature at prior moving average of 0-8 days lag in Wuhan, China. Our results indicate temperature was negatively associated with COVID-19 transmissibility during early stages of the outbreak in Wuhan, suggesting temperature is likely to effect COVID-19 transmission. These results suggest increased precautions should be taken in the colder seasons to reduce COVID-19 transmission in the future, based on past success in controlling the pandemic in Wuhan, China.
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48
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Woolcott OO, Bergman RN. Response to Zubieta-Calleja et al., Re: "Mortality Attributed to COVID-19 in High-Altitude Populations". High Alt Med Biol 2021; 22:109. [PMID: 33567229 DOI: 10.1089/ham.2020.0220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Orison O Woolcott
- Sports Spectacular Diabetes and Obesity Wellness and Research Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Richard N Bergman
- Sports Spectacular Diabetes and Obesity Wellness and Research Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
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49
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Zubieta-Calleja G, Merino-Luna A, Zubieta-DeUrioste N, Armijo-Subieta NF, Soliz J, Arias-Reyes C, Escalante-Kanashiro R, Carmona-Suazo JA, López-Bascope A, Calle-Aracena JM, Epstein M, Maravi E. Re: "Mortality Attributed to COVID-19 in High-Altitude Populations" by Woolcott and Bergman. High Alt Med Biol 2021; 22:102-104. [PMID: 33567217 DOI: 10.1089/ham.2020.0195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gustavo Zubieta-Calleja
- High Altitude Pulmonary and Pathology Institute (HAPPI-IPPA), Pulmonary Department, La Paz, Bolivia
| | | | | | | | - Jorge Soliz
- High Altitude Pulmonary and Pathology Institute (HAPPI-IPPA), Pulmonary Department, La Paz, Bolivia.,Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, Québec, Canada
| | - Christian Arias-Reyes
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, Québec, Canada
| | - Raffo Escalante-Kanashiro
- Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Perú.,Unidad de Cuidados Intensivos Instituto Nacional de Salud del Niño, Lima, Perú
| | | | | | | | - Murray Epstein
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Enrique Maravi
- Prof. Emeritus, Intensive Care, Complejo Hospitalario de Navarra-O, Universidad de Navarra, Pamplona, España
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Typical environmental factors of high-altitude areas: Possible inactivation mechanisms of severe acute respiratory syndrome coronavirus 2. Med J Armed Forces India 2021; 77:S525-S526. [PMID: 33519046 PMCID: PMC7831662 DOI: 10.1016/j.mjafi.2020.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/30/2020] [Indexed: 11/25/2022] Open
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