Imagine you have mild or modest COVID-19 symptoms and are told to stay at home. How would you know if the infection had gotten worse and you needed to head to the hospital?
Doctors have been seeing what some are calling “happy hypoxics” -– individuals “appearing comfortable” with modest symptoms but suffering from greatly reduced blood oxygen saturation/lung function. Hypoxia is a is a “bright line” symptom requiring further evaluation. Even if most such hypoxia cases improve on their own, with COVID-19, it can transition rapidly to needing intubation and ventilation. Early intervention can often allow hospitals to treat hypoxia outside of the ICU with much simpler, non-invasive CPAP or BiPAP ventilators, the same class of devices used for sleep apnea.
In an April 24 Medscape article, “COVID-19: Home Pulse Oximeters Could be a Game Changer…” an ER doctor in New York points out, “Everyone is coming in too late,” and goes on to explain that the pulse oximeter is a key tool for assessing the severity of the COVID infection. The pulse oximeter is a small, fairly inexpensive, over-the-counter device that shines light through a fingertip to measure blood oxygen saturation (SpO2). Another doctor commented, “Relying on subjective telephone follow-ups consults to assess COVID outpatients can be falsely reassuring without pulse oximetry. And higher risk patients should have readings taken somehow.”
Exactly. So, the question needs to be asked, why can’t outpatients with COVID-19 be shown how to use -– and if necessary be loaned –- a $30 pulse oximeter? If outpatients can monitor their condition and if it worsens immediately seek advice or treatment, they can potentially preempt the need for intubation. The device also measures pulse rate; consistently high pulse is another symptom of pneumonia.
On April 6th, the Virginia Department of Health, updated its guidance to Long Term Care Facilities (LTCFs) to include daily screening for respiratory symptoms with a pulse oximeter.
If pulse oximeters are such a valuable tool, why haven’t Virginia doctors and public health officials been advocating for them all along? Obviously, there would not be nearly enough devices in the current supply channels for every household to buy one. And a recent CNN story explained that for most people, other symptoms will show up first, so it is not an ideal early detection tool. Doctors also worry that while pulse oximeters are easy to use, they can give false low readings because of something as simple as fingernail polish or even cold hands. So, there is a real risk of unnecessarily panicked citizens calling physicians or heading to an ER. Yet, having used a pulse oximeter, getting good, consistent readings is mostly a matter of simple training and level-headed use.
The value of pulse oximeters for COVID-19 patients has been actively debated since the beginning of the pandemic in January, as sales for the devices have repeatedly spiked and shelves at pharmacies have been cleaned out. (The devies are readily available on Amazon, but the prices have generally bumped up.) The consistent medical advice has been, “most people don’t need them.” That’s true. But fortunately, the guidance now is that monitoring their condition with a pulse oximeter is a reasonable precaution for COVID-19 patients.
A key part of making monitoring for hypoxia possible during an economic shut-down would be for public policy, insurers, and health care providers to ensure that the devices are made available and explained to individuals who have clear symptoms but are quarantining at home. At $30-$40 apiece, avoiding even one patient being intubated with an extended ICU stay could perhaps easily offset the cost of thousands of oximeters. Across the span of the pandemic, such monitoring would save lives, and potentially preempt tens of millions in health care costs.
Verhaal Kenner is the pseudonym of a Richmond-area resident whose career includes several years in consumer and implantable medical device development.