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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, 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 from the highlands, we perform a perspective analysis of hypoxic diseases treated at high altitude and compare them to Covid-19. Oxygen transport physiology, SARSCov-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.
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