Background: Critical hypoxia in this COVID-19 pandemic results in high mortality and
economic loss worldwide. Initially, this disease’ pathophysiology was poorly understood and interpreted
as a SARS (Severe Acute Respiratory Syndrome) pneumonia. The severe atypical lung CAT
scan images alerted all countries, including the poorest, to purchase lacking sophisticated ventilators.
However, up to 88% of the patients on ventilators lost their lives. It was suggested that
COVID-19 could be similar to a High-Altitude Pulmonary Edema (HAPE). New observations and
pathological findings are gradually clarifying the disease.
Methods: As high-altitude medicine and hypoxia physiology specialists working and living in the
highlands for over 50 years, we perform a perspective analysis of hypoxic diseases treated at high
altitudes and compare them to Covid-19. Oxygen transport physiology, SARS-Cov-2 characteristics,
and its transmission, lung imaging in COVID-19, and HAPE, as well as the causes of clinical
signs and symptoms, are discussed.
Results: High-altitude oxygen transport physiology has been systematically ignored. COVID-19
signs and symptoms indicate a progressive and irreversible failure in the oxygen transport system,
secondary to pneumolysis produced by SARS-Cov-2’s alveolar-capillary membrane “attack”.
HAPE’s pulmonary compromise is treatable and reversible. COVID-19 is associated with several
diseases, with different individual outcomes, in different countries, and at different altitudes.
Conclusions: The pathophysiology of High-altitude illnesses can help explain COVID-19 pathophysiology,
severity, and management. Early diagnosis and use of EPO, acetylsalicylic-acid, and
other anti-inflammatories, oxygen therapy, antitussives, antibiotics, and the use of Earth open-circuit-
astronaut-resembling suits to return to daily activities, should all be considered. Ventilator use
can be counterproductive. Immunity development is the only feasible long-term survival tool.