{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T16:34:48Z","timestamp":1788971688122,"version":"build-2803163510"},"reference-count":49,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2022,11,8]],"date-time":"2022-11-08T00:00:00Z","timestamp":1667865600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Universidad de las Am\u00e9ricas"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Several reports from around the world have reported that some patients who have recovered from COVID-19 have experienced a range of persistent or new clinical symptoms after a SARS-CoV-2 infection. These symptoms can last from weeks to months, impacting everyday functioning to a significant number of patients. Methods: A cross-sectional analysis based on an online, self-reporting questionnaire was conducted in Ecuador from April to July 2022. Participants were invited by social media, radio, and TV to voluntarily participate in our study. A total of 2103 surveys were included in this study. We compared socio-demographic variables and long-term persisting symptoms at low (&lt;2500 m) and high altitude (&gt;2500 m). Results: Overall, 1100 (52.3%) responders claimed to have Long-COVID symptoms after SARS-CoV-2 infection. Most of these were reported by women (64.0%); the most affected group was young adults between 21 to 40 years (68.5%), and most long-haulers were mestizos (91.6%). We found that high altitude residents were more likely to report persisting symptoms (71.7%) versus those living at lower altitudes (29.3%). The most common symptoms were fatigue or tiredness (8.4%), hair loss (5.1%) and difficulty concentrating (5.0%). The highest proportion of symptoms was observed in the group that received less than 2 doses. Conclusions: This is the first study describing post-COVID symptoms\u2019 persistence in low and high-altitude residents. Our findings demonstrate that women, especially those aging between 21\u201340, are more likely to describe Long-COVID. We also found that living at a high altitude was associated with higher reports of mood changes, tachycardia, decreased libido, insomnia, and palpitations compared to lowlanders. Finally, we found a greater risk to report Long-COVID symptoms among women, those with previous comorbidities and those who had a severer acute SARS-CoV-2 infection.<\/jats:p>","DOI":"10.3390\/ijerph192214673","type":"journal-article","created":{"date-parts":[[2022,11,9]],"date-time":"2022-11-09T02:34:52Z","timestamp":1667961292000},"page":"14673","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Long COVID at Different Altitudes: A Countrywide Epidemiological Analysis"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1178-0546","authenticated-orcid":false,"given":"Juan S.","family":"Izquierdo-Condoy","sequence":"first","affiliation":[{"name":"One Health Research Group, Faculty of Health Science, Universidad de Las Americas, Quito 170137, Ecuador"},{"name":"Health Management and Research Area, Department of Health Sciences, Universidad Internacional Iberoamericana, Arecibo, PR 00613, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4875-9652","authenticated-orcid":false,"given":"Raul","family":"Fernandez-Naranjo","sequence":"additional","affiliation":[{"name":"One Health Research Group, Faculty of Health Science, Universidad de Las Americas, Quito 170137, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4573-6217","authenticated-orcid":false,"given":"Eduardo","family":"Vasconez-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"One Health Research Group, Faculty of Health Science, Universidad de Las Americas, Quito 170137, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Cordovez","sequence":"additional","affiliation":[{"name":"One Health Research Group, Faculty of Health Science, Universidad de Las Americas, Quito 170137, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Tello-De-la-Torre","sequence":"additional","affiliation":[{"name":"One Health Research Group, Faculty of Health Science, Universidad de Las Americas, Quito 170137, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1106-9567","authenticated-orcid":false,"given":"Clara","family":"Paz","sequence":"additional","affiliation":[{"name":"One Health Research Group, Faculty of Health Science, Universidad de Las Americas, Quito 170137, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Delgado-Moreira","sequence":"additional","affiliation":[{"name":"One Health Research Group, Faculty of Health Science, Universidad de Las Americas, Quito 170137, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Carrington","sequence":"additional","affiliation":[{"name":"Lugar, Medio y Sociedad Research Group, School of Economics, Universidad de Las Am\u00e9ricas, Quito 170124, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4942-2346","authenticated-orcid":false,"given":"Gin\u00e9s","family":"Viscor","sequence":"additional","affiliation":[{"name":"Departament de Biologia Cel\u00b7lular, Fisiologia i Immunologia, Universitat de Barcelona, 08028 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1895-7498","authenticated-orcid":false,"given":"Esteban","family":"Ortiz-Prado","sequence":"additional","affiliation":[{"name":"One Health Research Group, Faculty of Health Science, Universidad de Las Americas, Quito 170137, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1126\/science.abp8715","article-title":"The Huanan Seafood Wholesale Market in Wuhan was the early epicenter of the COVID-19 pandemic","volume":"377","author":"Worobey","year":"2022","journal-title":"Science"},{"key":"ref_2","unstructured":"Chippa, V., Aleem, A., and Anjum, F. 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