Unravelling the Pathogenesis of Severe COVID-19 Pneumonia: Are There Possible Insights From High Altitude ?

The global pandemic of coronavirus disease 2019 (COVID-19) continues to exact a heavy toll on human lives, fragile healthcare systems and international travel. Following its initial rapid spread via international travel routes,1 sustained community transmission is now the major route of infection worldwide. High rates of severe pneumonia requiring prolonged ventilation, pre-symptomatic viral shedding and a disproportionate burden of mortality in older populations, are among the most challenging features of this novel coronavirus infection. A clearer profile of the clinical evolution of the disease is beginning to emerge. Gaps in our understanding of its pathogenesis compromise efforts to deliver targeted therapies to the most severely ill patients, however. The authors have, between them, managed critically ill patients with COVID-19 disease and high altitude pulmonary oedema (HAPE). Arguments have recently been advanced in the medical literature to suggest that COVID-19 lung injury may share a common pathophysiology with HAPE2 and, indeed, intriguing similarities do exist in their clinical presentation. Here we explore the points of comparison and contrast between these discrete conditions