Coronavirus at high altitude – a “blank spot“

The stupa of Boudhanath in Kathmandu

Nepal is also sealing itself off because of the Corona crisis. Freedom of movement was restricted throughout the country for an initial week. As of today, only those who absolutely have to go to work, shop or see a doctor are allowed to move outside the door. The borders to India and China remain closed, only goods transports are allowed to pass through. The airspace over Nepal is closed for international and domestic flights. An exception is made for aircraft of the security forces.

A similar lockdown also came into force on Monday in the Pakistani province of Gilgit-Pakistan to prevent the rapid spread of the coronavirus. All five eight-thousanders of Pakistan are located in the province – in Nepal another eight of the 14 highest mountains in the world, of which two (Mount Everest and Cho Oyu) have a Tibetan side and one (Kangchenjunga) an Indian side. Shishapangma is located entirely in Tibet.

The mountain regions have in common that the medical infrastructure there is underdeveloped. It seems rather unlikely that corona tests really do reach the remote valleys of the Himalayas and the Karakoram. Seriously ill people would have to be transported to the larger cities to receive intensive medical care.

Chronic bronchitis as a risk factor

The village of Thame in the Khumbu region

I was wondering whether the coronavirus might have an “easier game” in regions of very high altitude, because the organism is highly stressed by the thin air anyway. “Nobody in the world knows anything about this. There are no data available,” answers Professor Thomas Küpper, an internationally renowned high-altitude physician from the University of Aachen. “Locals at high altitude are indirectly endangered, if at all: Because of the living conditions – wood fires in the houses, therefore especially affecting women – most of them have COPD (chronic obstructive pulmonary disease), and this is a risk factor for corona.”

Dr. Ulf Gieseler also points out the higher susceptibility of the local population to chronic bronchitis, aggravated by the cold, dry air at high altitude. The internist and cardiologist from Heidelberg is himself a mountaineer and expedition doctor and is involved in the German Society for Mountain and Expedition Medicine (BExMed).

“Closing off is reasonable”

Trekking in Nepal (here in the Dolpo region)

Gieseler warns mountain enthusiasts not to take the pandemic lightly. “To go trekking or expedition with a corona infection, because you were without symptoms before, would be fatal for the affected person and the base camp. At high altitudes, even banal infections such as colds, coughs or bronchitis and diarrhoea heal only with great difficulty, if at all”, the doctor writes to me. “High altitude mountaineering is always accompanied by a decrease in the body’s immune defenses. I think a coronavirus infection would often be fatal at high altitude. Therefore, closing off areas for trekking and expeditions is very reasonable.”

Do mountaineers or hikers who have already suffered from life-threatening high altitude pulmonary edema (HAPE) at high altitude belong to the corona risk group? “When a HAPE has completely healed, which is usually the case, there is actually no reason to assume an increased corona risk,” Professor Küppers answers. Dr. Gieseler shares this opinion. “At least I don’t see any connection there today. But of course there is no data available to date.” The novel coronavirus is still a largely blank spot in altitude medicine. 

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