key: cord-1038735-lt1h0b6j
authors: Valverde-Bruffau, Valeria Janice; Cárdenas, Laura; Gonzales, Gustavo F.
title: The Pathogenicity of COVID-19 Is Independent of Increasing Altitude: The Case of Colombia
date: 2021-02-03
journal: Am J Trop Med Hyg
DOI: 10.4269/ajtmh.20-1465
sha: eeac6337fbe3523273b71304f825e72eea4cd540
doc_id: 1038735
cord_uid: lt1h0b6j

nan

21,406,305 inhabitants, and 586 municipalities from 1,000 to 3,259 m, with an area of 208,952 km 2 and a population of 22,761,341 inhabitants. Bogotá, the capital of Colombia, located at 2,630 m above sea level, has an area of 1,623 km 2 and a population of 7,200,000 inhabitants.

As of November 1, 2020, Colombia has recorded 1,073,123 SARS-CoV-2 infections and 31,312 COVID-19 deaths, with a CFR (deaths/cases × 100) of 2.9%. The municipalities located below 1,000 m altitude have recorded 442,795 SARS-CoV-2 infections and 16,691 COVID-19 deaths, with a CFR of 3.8%, whereas municipalities located from 1,000 to 3,259 m have recorded 632,410 SARS-CoV-2 infections and 14,621 COVID-19 deaths, with a CFR of 2.3%. Data from < 1,000 m altitude and from ³ 1,000 to 3,259 m were assessed by the Spearman correlation, Pearson correlation, and Poisson regression analysis. Data from Poisson regression analysis were presented as adjusted R 2 with its P-value and included the β coefficient and its P-value.

The results after Spearman's analysis showed a significant negative correlation between both SARS-CoV-2 infections and COVID-19 deaths and altitude < 1,000 m (P < 0.05), whereas no significant difference was seen for altitudes between 1,000 and 3,259 m (P > 0.05). The CFR decreased as the altitude of residence increased for both groups (< 1,000 m and ³ 1,000 m) (P < 0.05) ( Table 1) .

According to the Pearson correlation, the only significant difference was observed for SARS-CoV-2 infections and COVID-19 deaths at altitudes < 1,000 m. However, the slope was close to zero, and biological significance is likely negligible (Figures 1A-F).

Poisson regression was performed with only altitude in the model, only population density in a second model, and including altitude and population density in a third model. With only altitude in the model, a positive association was observed between infections and deaths in both altitude groups (P < 0.05). However, the CFR showed a negative association with altitude only in the group living at between 1,000 and 3,259 m (P < 0.05).

When only population density was incorporated in the model, more confirmed infections and deaths occurred as population density increased in both altitudinal groups (P < 0.05). The CFR decreased as population density increased in both altitudinal groups (P < 0.05).

In the third model, altitude and the population density were associated with dependent variables (infections, deaths, and CFR) for each altitudinal group. Positive associations were observed between infections and deaths in both altitudinal groups (P < 0.05), and for β coefficients for density (P < 0.05) and altitude (P < 0.05) variables. Case fatality rate had a negative association with density (P < 0.05) in both groups; however, no significant association was observed between increasing altitude and CFR in both altitudinal groups (P > 0.05).

In conclusion, data from Colombia show that there is no altitude gradient that is protective against SARS-CoV-2 infection or COVID-19 mortality. 

Negative correlation between altitude and COVID-19 pandemic in Colombia: a preliminary report

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

High altitude reduces infection rate of COVID-19 but not case-fatality rate

Letter to the editor: COVID-19 infections do not change with increasing altitudes from 1,000 to 4,700 m

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