This article was first published in The Montreal Gazette.
Normally there’s no harm in thinking out loud. Unfortunately when you’re in a pandemic, idle speculation can spiral out of control into a full-blown conspiracy theory. That’s how I received the rather unexpected question of whether COVID-19 was really due to high altitude sickness and whether it could be treated with diamox. It isn’t and it can’t.
This whole thing started with an interesting observation. A very bad pneumonia can turn into a syndrome called ARDS, acute respiratory distress syndrome. While many diseases can cause ARDS, the end result is the same. Inflammation attacks the lung tissue, makes the lungs stiffer, and makes it harder for the body to get in oxygen and get rid of carbon dioxide.
Patients who get very sick from COVID-19 have a slightly different problem. Early in the disease, some patients seem to have an atypical form of ARDS where oxygen levels are very low but the lungs are very compliant and not stiff. Handling these patients requires slightly different ventilator strategies. You may have heard that intubated patients with COVID-19 are sometimes placed on their stomachs to help oxygen delivery to the lungs.
Unfortunately, this aspect of COVID-19 care has led the internet down a particularly bizarre rabbit hole of conspiracy theories. It seems to have started with a video posted by a New York emergency room physician who said that COVID-19 patients on a ventilator looked more like high altitude illness than classic ARDS.
High altitude illness occurs when people (for reasons I admire but do not fully understand) decide to climb a mountain or otherwise ascend to new heights. As we get further away from sea level, the atmosphere thins out, which means there is less ambient oxygen for us to breathe in. The lower the oxygen content of the air, the less oxygen we absorb into our blood. Less oxygen in our blood causes blood vessels in the lungs to constrict which raises pulmonary pressures. So while there is a similarity between COVID-19 and high altitude sickness patients in that they both have low oxygen levels, the nature of the disease is entirely different.
In and of itself, this comparison would be interesting, but of no real consequence. But since people with altitude sickness rarely need to be ventilated, this led some to extrapolate and say that people with COVID-19 don’t really need to be put on ventilators. Online this quickly mutated into the idea that ventilators are making COVID-19 patients worse. That ultimately degenerated into the conspiracy theory that ventilators don’t work in COVID-19 patients because the virus doesn’t exist and this whole thing is a hoax, which for some reason was perpetrated by Bill Gates.
None of this is true. COVID-19 is only very superficially similar to altitude sickness. Biopsies have shown that the lungs of COVID-19 patients have the same diffuse alveolar damage of early phase ARDS patients. The pathology of COVID-19 and altitude sickness are totally different and any claims that you can treat COVID-19 with medications like Diamox that we use to prevent altitude sickness have no evidence to back them up. Diamox actually makes the blood more acidic and can worsen renal function, so while it is useful for preventing altitude sickness it could be very dangerous if given to an ICU patient.
COVID-19 may indeed behave slightly differently from a classical pneumonia. But all diseases behave slightly differently from each other and this is not particularly helpful information.
The best way to treat COVID-19 is not to get it. The best way to avoid it is to avoid other people, which ironically enough you might be able to do if you were to climb a mountain. But a simpler solution would be to just stay home and wash your hands.
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