Vikas Bansal, MPH, MBBS
Research Fellow
Mayo Clinic
Rochester, Minnesota
Disclosure information not submitted.
Romil Singh, MD
Resident
n/a
Rochester, Minnesota, United States
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Mayank Sharma, MBBS
Research Fellow
n/a, Minnesota, United States
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Marija Bogojevic, MD,
Resident Physician
Montefiore New Rochelle Hospital, Minnesota, United States
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Neha Deo, BS
Medical Student
Mayo Clinic Alix School of Medicine
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Allison LeMahieu, BS, MS
Biostatistician
Mayo Clinic
Rochester, Minnesota, United States
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Andrew Hanson, MS
Biostatistician
Mayo Clinic
Rochester, Minnesota, United States
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Phillip Schulte, MD
Senior Associate Consultant II
n/a
Rochester, Minnesota, United States
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Amy Christie, MD
Surgical Critical Care Physician
Atrium Health Navicent, United States
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Uluhan Sili, MD, PhD
Dr.
Marmara University School of Medicine, Istanbul, Turkey, United States
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Harry Anderson, MD
Physician
Baptist Health South Florida, United States
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Vishakha Kumar, MD, MBA
Society of Critical Care Medicine
Mount Prospect, Illinois
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Allan Walkey, MD (he/him/his)
Professor of Medicine
Boston University
Boston, Massachusetts, United States
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Ognjen Gajic, MD
Professor
Mayo Clinic
Rochester, Minnesota, United States
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Juan Pablo Domecq Garces, MD
Assistant Professor of Medicine
Mayo Clinic College of Medicine
North Mankato, Minnesota, United States
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Rahul Kashyap, MD, MBA,
Medical Director Research
Wellspan Health-York Hospital
York, Pennsylvania
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Title: Association of Latitude and Altitude with COVID-19 Symptoms: SCCM Discovery VIRUS Registry Analysis
Introduction: Better delineation of COVID-19 presentations in different climatological conditions might assist with prompt diagnosis and isolation of patients. In this study, we aimed to investigate the association of latitude and altitude with COVID-19 symptomatology.
Methods: This was a retrospective, observational, registry-based cohort study including hospitalized adult patients from 181 hospitals in 24 countries within the SCCM Discovery VIRUS: COVID-19 Registry. Latitudes were determined as per the distance to the Equator and altitudes were noted as meters above the sea level (m.a.s.l.), both based on hospital locations. To minimize the impact of missing data, institutions that had < 75% of patients with symptom data available were excluded. The outcome was symptoms at the time of admission, categorized as respiratory, gastrointestinal, neurological, mucocutaneous, cardiovascular, and constitutional. Any other symptoms were grouped as atypical. Multivariable regression modeling was performed, adjusting for age, sex, and comorbidities. Models were fitted using generalized estimating equations to account for clustering of patients within sites.
Results: A total of 12267 patients were included in the analysis, the median (IQR) age was 62 (49 – 73) years, with 57% males. The median age and percentage of patients with comorbidities increased with higher latitude. Conversely, patients with comorbidities decreased with elevated altitudes. The most common symptoms were respiratory (80%), followed by constitutional (75%), and gastrointestinal (35%). Presentation with respiratory symptoms was not associated with location. When adjusted for baseline differences, at lower latitudes ( < 30º) patients presented less commonly with gastrointestinal symptoms (p < 0.001, odds ratios for latitudes 15º, 25º, and 30º: 0.32, 0.81, and 0.98, respectively). Atypical symptoms were present in 21% of the patients and showed an association with altitude (p=0.026, compared to reference level of 175 m.a.s.l., odds ratios for altitudes 75, 125, 400, and 600 m.a.s.l were: 0.44, 0.60, 0.84, and 0.77, respectively).
In conclusion, in a large international database, we observed geographic variability in symptoms of COVID-19 patients. Healthcare providers should be mindful of variable symptomatology based on climatological factors.