Covid-19 -- does altitude matter?

 Another week, more insights! Here we go:

1.  Does altitude matter? Data suggests lower rates of transmission of Covid-19 at higher altitudes. Cusco, Peru – elevation 11,152 feet -- had three fatalities of tourists from Mexico, China and England between March 23 and April 3, raising fears that a major outbreak would occur there. To everyone’s surprise, there have been no further deaths in that region though over 4,000 deaths have been reported in Peru. Also, the case rate has been far lower in that elevated region with only 916 of Peru’s 141,000 cases. This suggests a contagion rate 80% lower than the national average. An article in the journal Respiratory Physiology showed lower levels of infections in people living above 9,800 feet in Bolivia, Ecuador and Tibet. It is not yet understood if the virus is less efficient at high altitude or if there is something about the physiology of people living at high altitude that makes them more immune.
2.  Highest infection rate in the United States. Sadly, the Navajo Nation in Arizona bears the unfortunate distinction of having the highest Covid-19 infection rate in the country, as reported by Nicholas Kristof of The New York Times. Even before the pandemic, the Navajo had a shorter life expectancy (72) than people in Guatemala (74). Life expectancy in the United States is currently 78.9 years. The forces and effects of poverty fuel the fire – people live in crowded conditions and 40% of people lack running water, making hand washing near impossible. Only 53% of children graduate from High School and only 25% have internet at home to allow home schooling during the pandemic. The Indian Health Service reports that 28 percent of tests have come back positive for Covid-19, similar to the very high rate in Chelsea, Massachusetts – the highest rate in my state. In the Navajo Nation the high prevalence of diabetes, hypertension and heart disease has caused more serious cases of Covid-19 in more younger patients.
3.  New vaccine made him ill… Ian Haydon is a 29-year-old man living in Seattle who was one of three people who had an adverse reaction to the new mRNA vaccine produced by the Cambridge, MA biotech company Moderna. Twelve hours after receiving the standard second dose of the vaccine he spiked a fever to over 103 degrees and sought care at a local urgent care facility. He went home, vomited, fainted and then recovered uneventfully. Haydon hoped his speaking out would not spook people against vaccines in general and said, “As we rush to get a vaccine developed as quickly as possible, the reality of vaccine development is that it can only be rushed so much and the trial still needs to take place.” In the 45-person Moderna study, four participants had “Grade 3” side effects that are severe but not life threatening. Prior to participating in the trial, Mr. Haydon had a physical exam and signed a 20-page consent form, explaining that the vaccine could potentially cause severe anaphylactic shock. Of course, I hope the vaccine will be successful, but note that several Moderna executives exercised their stock options when the trial was reported and before any side effect data was presented…
4.  Pediatric Multi-system inflammatory syndrome update Some critical care pediatricians caring for children with MIS-C have raised the possibility that this illness is a reaction not to the virus, but to the child’s own antibodies against the virus. This is very important as it could have serious implications for the safety of a vaccine. In other words, if a successful vaccine works via stimulating uninfected people to make antibodies against the virus, is there a risk that a small percentage of people could develop a MIS-C type syndrome? This is just one of many concerns regarding new vaccine development and this is why experienced vaccine researchers and immunologists caution us all not to rush a vaccine. Only in larger trials do we figure out is any vaccine (or any drug for that matter) really safe.
5.  How is mask decontamination going? We were heartened to learn a couple of weeks ago that the shortage of high-quality masks could be ameliorated by decontaminating personal masks. A company called Battelle operating in an old K-Mart facility in Somerville, MA has used vapor phase hydrogen peroxide to clean thousands of masks for reuse. Last month the National Institute of Health deemed this method the best of several. The gas is pumped into a large container surrounding the masks for several hours. The facility runs 24 hours per day. Battelle also has facilities in Washington and New York states. Ultraviolet (UV) irradiation of masks is also being used. Some healthcare providers have expressed concern that reusing masks is not adequately safe despite assurances. Hopefully, we can get ahead with mask manufacturing so as to minimize the need for mask recycling.