Edit: Sounds like this isn’t very useful because you’ll be able tell if you’re having trouble breathing? See comment below.
Advice: Get a pulse oximeter to be able to triage at home.
Reasoning: If you’re mildly sick, you probably don’t want to go to a medical office (both because you’ll be clogging up an overcrowded system, and because you’ll be around people who are even sicker). But you need to know when you’re sick enough to need medical care.
One way medical professionals triage is by vital signs. Most of them are obvious either to you or to other people (shortness of breath, paleness, dizziness, turning blue) but oxygen saturation (how well-oxygenated your blood is) is not. If you think you might have pneumonia (one of the common effects of coronavirus), low oxygen saturation is one of the things that would indicate that, and lower numbers should move you toward getting medical care. 95% and above is normal (at sea level) and lower numbers mean it’s likely your lungs aren’t working properly (with outcomes being worse the lower the number is).
The device is cheap and easy to use.
Note that you might still be very sick and need medical care even if your oxygen level is fine, so this is a way to rule in being sick enough to need medical care but doesn’t rule it out.
(I’m not a medical professional and would appreciate it if someone who is would double-check the logic here, or some risk I’m not thinking of in terms of people reading it wrong and coming to wrong conclusions)
TL;DR. If you have (slightly) low PaO2, but no trouble breathing, you probably don’t need to go to the hospital. And if you have trouble breathing, you should probably go to the hospital whether or not you have low PaO2. So testing for oxygen saturation doesn’t add much.
I had an online conversation with an intensive care physician. I sent him a translated version of juliawise’s text and he said he didn’t think buying the pulse oximeter would help and then sent me a 5 minute audio explaining why. The following text is his audio translated from Portuguese to English, I hope there are no wrong translations and I changed my mind after listening to him. Please also share what you think about his response:
“All pneumonia will desaturate the patient. O2 saturation is related to perfusion (gas exchange). Patient with acute respiratory syndrome (inflammation of the lungs by viral or bacterial infection) may course with poor tissue perfusion, that is, inadequate tissue oxygenation. One way to evaluate this is pulse oximetry, PaO2.
Patients with respiratory discomfort due to lung inflammation may or may not present desaturation. PaO2 < 90 indicates oxygen therapy. But perfusion and ARDS severity should be evaluated by the PaO2/FiO2 ratio (serum O2 concentration/offered amount of O2) to maintain good oxygenation.
What takes the patient to the emergency room is not the oxygen saturation level. You won’t see a patient say “I’m feeling bad, let me see my saturation level” and suddenly find 80 or 85. If you start running and put the oximeter on your finger you can easily find 91~92.
What takes the patient to the emergency room is respiratory distress. He will feel shortness of breath and we will evaluate this with the methods of severity assessment, which would be oxygen saturation. And we would see in more severe patients a value below 90%.
The clinical picture of pneumonia is coughing, shortness of breath, respiratory discomfort, pain and by doing an x-ray he will detect a pulmonary opacity. You’ll see a white field, where there should be air, there’ll be fluid. Then you diagnose pneumonia.
The medical reasoning is this: I think about pneumonia based on the symptoms, I observe the saturation and it correlates with pneumonia, I see the x-ray and it correlates with pneumonia so I start the protocol… actually when I do the physical exam and I think “ah, it’s an acute respiratory distress syndrome” I don’t even want to know what it is initially, I want to offer oxygen, guarantee the airways, improve the gas exchange and keep the patient alive until finally I can test for coronavirus.
In fact, the saturation will indicate a marker of severity in a dyspneic patient. Not a diagnostic marker. There is no way to observe a patient who is desaturating and give a diagnosis for coronavirus.
Many things change oxygen saturation. Like I told you, oxygen saturation measures the amount of oxygen inside the RBC, right? So if I have a RBC with low hemoglobin inside, like with an anemic patient, it changes the oxygen saturation. If the patient is not doing good gas exchange, it changes the oxygen saturation. For example, lowering of consciousness will give low saturation. Also if he is shocked, hypotensive or hypothermic. Another thing that also changes is the use of enamel on his fingers. “
Then I sent him an audio saying:
Me: “I got it. But let’s suppose we were in the following situation: there are 10,000 infected in the city, the government starts to declare quarantine. Suppose you’re home with a fever and another symptom like cough. You’re left wondering, “Should I go to the hospital and test for coronavirus?” But knowing there is an outbreak and that the hospital is crowded with people with the disease, chances are you will get the disease when you go to the hospital if you don’t have it. I am at home, isolated because I have the symptoms of the disease, but I am not sure if I have coronavirus and I do not know if I should really go to the hospital. How do I know if I should really go to the hospital? Should I wait until a respiratory problem like difficulty to breathe starts to appear? Is it possible that I take the measurement with the oximeter and it gives a low oxygen saturation before I even start having a breathing difficulty?
He: “Not under normal conditions. Under normal conditions, a patient with only a cough, fever, runny nose, or an upper airway condition will not change oxygen saturation. That wouldn’t make you think about going to the hospital, you’d stay home, like you did every time you had a common flu picture.
Even because you will not change the treatment. You will be treated as supportive therapy like all viral infections: H1N1, etc. But if you stay home without any signs of severity, it will resolve as if nothing had happened and the diagnosis would not be closed, you know? It would be a syndromic diagnosis… a flu picture, a common flu without any complications. What happens is that in the face of the epidemic, people are testing coronavirus for patients with acute respiratory syndrome, respiratory discomfort. Then, for fear of serious evolution, these patients are tested [for coronavirus] for early ventilatory support.”
Then I sent him this text message:
Me: “1) Fever → coughs → respiratory discomfort → recommend going to hospital to test for ncov and receive early ventilatory support.
Would the mistake in my reasoning be to assume that there would be low oxygen saturation before even presenting respiratory discomfort?”
He: “Yes.”
Thinking about it, now I believe if I have Fever → coughs → respiratory discomfort or shortness of breath → I should go to the hospital.
If I have Fever → coughs → NO respiratory discomfort and NO shortness of breath → check oxymeter and low PaO2 → Do not go to the hospital.
So having the oxymeter wouldn’t make me go to the hospital. So I don’t need an oxymeter.
If you have (slightly) low SpO2, but no trouble breathing, you probably don’t need to go to the hospital. And if you have trouble breathing, you should probably go to the hospital whether or not you have low SpO2. So testing for oxygen saturation doesn’t add much.
Is there any info the comment was meant to convey that that leaves out?
According to this NYT article, Covid pneumonia often (in most cases?) initially causes low blood oxygen without obvious respiratory discomfort or shortness of breath (“silent hypoxia”), and early detection of this can be critical. If true, it is a very strong argument in favor of pulse oximeter.
There seems to be a general variance in what pulse oximeters display when measuring healthy individuals with readings from 94% − 100%. I also seem to remember reading that they are sensitive to altitude, whether hands are cold etc (n.b typing on phone, can’t verify at the mo)
Talking to a doctor friend—in clinical settings if an oximeter shows a reading < 90%, it’s considered serious, but different people respond differently, but closely enough for the purposes of this discussion to fall into two groups. Either you develop a shortness of breath by the time its at 92%, for eg., and you have to go an ER anyway. Or you feel fine, but have less than 90% reading and you’ll end up going to the ER (because you’ve looked at the range of normal measurements)
If the suggestion of use of the pulse oximeter is supposed to be a diagnostic about whether you need to go to the ER or not (and thus avoid picking something up at the hospital), it doesn’t seem to help? It also doesn’t tell you anything specific to Covid-19, I mean, you could be short of breath for a variety of reaons (note: short of breath sustained for many minutes, not the kind where you are panting after climbing stairs for eg.)
It seems to me that the usefulness of a pulse oximeter depends on the progression of the disease. If “low osat” comes before “fever etc”, then a pulse oximeter would help you move from “low osat → fever etc. → see a doctor” to “low osat → see a doctor → fever etc.”. But if “fever etc.” comes first, I would think you would be at “fever etc. → see a doctor → get osat measured” regardless of whether you have a pulse oximeter, and so I don’t see how the pulse oximeter would be useful.
This is useful in case you have facing a choice of riding it out at home and going to a hospital with high probability of getting infected if you’re not already. E.g. if you have fever chances are still high you’re just experiencing regular flu, and should not go to the hospital, but if your oxigen starts dropping into the danger zone you need to go.
The logic is to “save you a trip to the doctor, or to support remote care via phone/video chat. ” Recommended diagnostic tools are digital thermometer, finger oximeter, blood pressure cuff, and stethoscope for lung sounds.
In order to avoid cross infection, it is a good idea to use telemedicine rather than emergency room or doctors’ offices.
Suggestion: research options for video chat, text messaging, or emailing doctors. Once you start to show symptoms, take critical measurements at regular intervals and log.
I saw an earlier recommendation and went to Amazon. They have pages of them, differentiated by color and style, which made me realize they are a commodity, in common use among a particular large population of at risk people. They’re not covered by health insurance, so there’s actual competition. Look at the ratings and use your usual yardsticks to pick ones that people who have bought before find to be reliable and useable.
Edit: Sounds like this isn’t very useful because you’ll be able tell if you’re having trouble breathing? See comment below.
Advice: Get a pulse oximeter to be able to triage at home.
Reasoning: If you’re mildly sick, you probably don’t want to go to a medical office (both because you’ll be clogging up an overcrowded system, and because you’ll be around people who are even sicker). But you need to know when you’re sick enough to need medical care.
One way medical professionals triage is by vital signs. Most of them are obvious either to you or to other people (shortness of breath, paleness, dizziness, turning blue) but oxygen saturation (how well-oxygenated your blood is) is not. If you think you might have pneumonia (one of the common effects of coronavirus), low oxygen saturation is one of the things that would indicate that, and lower numbers should move you toward getting medical care. 95% and above is normal (at sea level) and lower numbers mean it’s likely your lungs aren’t working properly (with outcomes being worse the lower the number is).
The device is cheap and easy to use.
Note that you might still be very sick and need medical care even if your oxygen level is fine, so this is a way to rule in being sick enough to need medical care but doesn’t rule it out.
Guide to using and what levels are normal
More detailed instructions for troubleshooting
Article on lower oxygen saturation meaning worse outcomes for pneumonia
(I’m not a medical professional and would appreciate it if someone who is would double-check the logic here, or some risk I’m not thinking of in terms of people reading it wrong and coming to wrong conclusions)
TL;DR. If you have (slightly) low PaO2, but no trouble breathing, you probably don’t need to go to the hospital. And if you have trouble breathing, you should probably go to the hospital whether or not you have low PaO2. So testing for oxygen saturation doesn’t add much.
I had an online conversation with an intensive care physician. I sent him a translated version of juliawise’s text and he said he didn’t think buying the pulse oximeter would help and then sent me a 5 minute audio explaining why. The following text is his audio translated from Portuguese to English, I hope there are no wrong translations and I changed my mind after listening to him. Please also share what you think about his response:
“All pneumonia will desaturate the patient. O2 saturation is related to perfusion (gas exchange). Patient with acute respiratory syndrome (inflammation of the lungs by viral or bacterial infection) may course with poor tissue perfusion, that is, inadequate tissue oxygenation. One way to evaluate this is pulse oximetry, PaO2.
Patients with respiratory discomfort due to lung inflammation may or may not present desaturation. PaO2 < 90 indicates oxygen therapy. But perfusion and ARDS severity should be evaluated by the PaO2/FiO2 ratio (serum O2 concentration/offered amount of O2) to maintain good oxygenation.
What takes the patient to the emergency room is not the oxygen saturation level. You won’t see a patient say “I’m feeling bad, let me see my saturation level” and suddenly find 80 or 85. If you start running and put the oximeter on your finger you can easily find 91~92.
What takes the patient to the emergency room is respiratory distress. He will feel shortness of breath and we will evaluate this with the methods of severity assessment, which would be oxygen saturation. And we would see in more severe patients a value below 90%.
The clinical picture of pneumonia is coughing, shortness of breath, respiratory discomfort, pain and by doing an x-ray he will detect a pulmonary opacity. You’ll see a white field, where there should be air, there’ll be fluid. Then you diagnose pneumonia.
The medical reasoning is this: I think about pneumonia based on the symptoms, I observe the saturation and it correlates with pneumonia, I see the x-ray and it correlates with pneumonia so I start the protocol… actually when I do the physical exam and I think “ah, it’s an acute respiratory distress syndrome” I don’t even want to know what it is initially, I want to offer oxygen, guarantee the airways, improve the gas exchange and keep the patient alive until finally I can test for coronavirus.
In fact, the saturation will indicate a marker of severity in a dyspneic patient. Not a diagnostic marker. There is no way to observe a patient who is desaturating and give a diagnosis for coronavirus.
Many things change oxygen saturation. Like I told you, oxygen saturation measures the amount of oxygen inside the RBC, right? So if I have a RBC with low hemoglobin inside, like with an anemic patient, it changes the oxygen saturation. If the patient is not doing good gas exchange, it changes the oxygen saturation. For example, lowering of consciousness will give low saturation. Also if he is shocked, hypotensive or hypothermic. Another thing that also changes is the use of enamel on his fingers. “
Then I sent him an audio saying:
Me: “I got it. But let’s suppose we were in the following situation: there are 10,000 infected in the city, the government starts to declare quarantine. Suppose you’re home with a fever and another symptom like cough. You’re left wondering, “Should I go to the hospital and test for coronavirus?” But knowing there is an outbreak and that the hospital is crowded with people with the disease, chances are you will get the disease when you go to the hospital if you don’t have it. I am at home, isolated because I have the symptoms of the disease, but I am not sure if I have coronavirus and I do not know if I should really go to the hospital. How do I know if I should really go to the hospital? Should I wait until a respiratory problem like difficulty to breathe starts to appear? Is it possible that I take the measurement with the oximeter and it gives a low oxygen saturation before I even start having a breathing difficulty?
He: “Not under normal conditions. Under normal conditions, a patient with only a cough, fever, runny nose, or an upper airway condition will not change oxygen saturation. That wouldn’t make you think about going to the hospital, you’d stay home, like you did every time you had a common flu picture.
Even because you will not change the treatment. You will be treated as supportive therapy like all viral infections: H1N1, etc. But if you stay home without any signs of severity, it will resolve as if nothing had happened and the diagnosis would not be closed, you know? It would be a syndromic diagnosis… a flu picture, a common flu without any complications. What happens is that in the face of the epidemic, people are testing coronavirus for patients with acute respiratory syndrome, respiratory discomfort. Then, for fear of serious evolution, these patients are tested [for coronavirus] for early ventilatory support.”
Then I sent him this text message:
Me: “1) Fever → coughs → respiratory discomfort → recommend going to hospital to test for ncov and receive early ventilatory support.
Would the mistake in my reasoning be to assume that there would be low oxygen saturation before even presenting respiratory discomfort?”
He: “Yes.”
Thinking about it, now I believe if I have Fever → coughs → respiratory discomfort or shortness of breath → I should go to the hospital.
If I have Fever → coughs → NO respiratory discomfort and NO shortness of breath → check oxymeter and low PaO2 → Do not go to the hospital.
So having the oxymeter wouldn’t make me go to the hospital. So I don’t need an oxymeter.
This comment could maybe use a tl;dr saying:
Is there any info the comment was meant to convey that that leaves out?
Thanks for the suggestion, ESRogs. I’m adding the shortened version now.
According to this NYT article, Covid pneumonia often (in most cases?) initially causes low blood oxygen without obvious respiratory discomfort or shortness of breath (“silent hypoxia”), and early detection of this can be critical. If true, it is a very strong argument in favor of pulse oximeter.
There seems to be a general variance in what pulse oximeters display when measuring healthy individuals with readings from 94% − 100%. I also seem to remember reading that they are sensitive to altitude, whether hands are cold etc (n.b typing on phone, can’t verify at the mo)
Talking to a doctor friend—in clinical settings if an oximeter shows a reading < 90%, it’s considered serious, but different people respond differently, but closely enough for the purposes of this discussion to fall into two groups. Either you develop a shortness of breath by the time its at 92%, for eg., and you have to go an ER anyway. Or you feel fine, but have less than 90% reading and you’ll end up going to the ER (because you’ve looked at the range of normal measurements)
If the suggestion of use of the pulse oximeter is supposed to be a diagnostic about whether you need to go to the ER or not (and thus avoid picking something up at the hospital), it doesn’t seem to help? It also doesn’t tell you anything specific to Covid-19, I mean, you could be short of breath for a variety of reaons (note: short of breath sustained for many minutes, not the kind where you are panting after climbing stairs for eg.)
It seems to me that the usefulness of a pulse oximeter depends on the progression of the disease. If “low osat” comes before “fever etc”, then a pulse oximeter would help you move from “low osat → fever etc. → see a doctor” to “low osat → see a doctor → fever etc.”. But if “fever etc.” comes first, I would think you would be at “fever etc. → see a doctor → get osat measured” regardless of whether you have a pulse oximeter, and so I don’t see how the pulse oximeter would be useful.
I googled around and don’t have a great sense of what the progression is, but it seems that the fever comes before the more serious respiratory stuff (source: https://www.businessinsider.com/coronavirus-covid19-day-by-day-symptoms-patients-2020-2?op=1).
This is useful in case you have facing a choice of riding it out at home and going to a hospital with high probability of getting infected if you’re not already. E.g. if you have fever chances are still high you’re just experiencing regular flu, and should not go to the hospital, but if your oxigen starts dropping into the danger zone you need to go.
This site provides link for medical kit. You can copy and paste the supply list rather than purchase, or follow link to each item.
The logic is to “save you a trip to the doctor, or to support remote care via phone/video chat. ” Recommended diagnostic tools are digital thermometer, finger oximeter, blood pressure cuff, and stethoscope for lung sounds.
In order to avoid cross infection, it is a good idea to use telemedicine rather than emergency room or doctors’ offices.
Suggestion: research options for video chat, text messaging, or emailing doctors. Once you start to show symptoms, take critical measurements at regular intervals and log.
Where would you buy one and what brand?
I saw an earlier recommendation and went to Amazon. They have pages of them, differentiated by color and style, which made me realize they are a commodity, in common use among a particular large population of at risk people. They’re not covered by health insurance, so there’s actual competition. Look at the ratings and use your usual yardsticks to pick ones that people who have bought before find to be reliable and useable.