Altitude and excess mortality during COVID-19 pandemic in Peru

Abstract

We have read with interest the short communication published by Segovia-Juarez et al., 2020 in Respiratory Physiology & Neurobiology establishing that high altitude reduces the infection rate of COVID-19 but not the case fatality rate in the Peruvian setting. We support this hypothesis, however there could be an important number of under registered deaths on account of a low rate of diagnostic tests performed per inhabitant and mostly in symptomatic patients (Pasquariello and Stranges, 2020). It has been estimated that in Peru, 4 tests are performed per 1000 inhabitants; a fairly low figure compared to other countries in the region such as Chile and the United States, who perform 30 and 51 tests per 1000 inhabitants, respectively (Our World in Data, 2020). Furthermore, in Peru, only patients that tested positive for SARS-CoV-2 are labeled as COVID-19 deaths. Following this consideration, we would like to add the importance to evaluate the excess mortality (EM). In Peru, EM registered between March to May was 13,000 more deaths than expected for that period, of which, only 3000 were positive for SARS-CoV-2. This represents an EM of 54 %, which was the highest reported compared to 20 countries (Mundo, 2020). We would like to highlight the relation between EM rate and altitude per district in Peru during COVID-19 pandemic.