How to Tell If You Have a Serious Case of #Coronavirus #COVID19 and Whether You Should Go to the Hospital

An oxygen saturation monitor. Top number is O2 sat, bottom number is heart rate.

On Feb 26, 2020, I published and article on how to prepare your household for Coronavirus (COVID-19). I have a few more thoughts. How about an oxygen saturation monitor (aka pulse oximeter) and supplemental oxygen?

Most of the victims of this pandemic will be treating themselves at home. Just like most flu sufferers are treated at home, not the hospital, and do well. However, COVID-19 seems to be more serious if not lethal, particularly for those with particular pre-existing conditions.

A Little Cardiopulmonary Physiology

Your heart pumps blood to your lungs to blow off carbon dioxide and pick up oxygen for delivery to your tissues, to keep them alive and functioning well. Your arterial blood typically carries a lot of oxygen, but there’s a limit to how much it can hold. With a healthy cardiopulmonary system, your blood carries 94–99% of all the oxygen your blood could hold. That number is called your “oxygen saturation” or, among medical workers, “O2 sat.” Diseases in either the heart or lungs can impair your blood’s ability to carry oxygen, so your oxygen saturation may go down.

How Does COVID-19 Kill?

All the tissues in your body—some tissues more than others—need a steady supply of oxygen. Without oxygen, they die. Viral-induced inflammation in the lungs impairs oxygen delivery to your tissues. It’s not always that simple, but that’s all you need to know for now.

The earliest warnings of possible life-threatening coronavirus infection typically are shortness-of-breath and increased respiratory rate. Heart rate is usually higher, too. These are indicators that your body is working harder to get enough oxygen. That’s because the virus-induced lung inflammation partially blocks the transfer of oxygen from the atmosphere to the bloodstream.

Respiratory rate is your number of breaths per minute. A normal respiratory rate for an adult at rest is between 12 and 20. One breath is one inspiration and one expiration. Click to see a nurse teaching how to measure respiratory rate.

Artist’s rendition of coronavirus

How Do You Know If You Might Be Getting Into Serious Trouble With Coronavirus Or Any Other Lung Infection?

Your respiratory rate will be significantly elevated, approaching or above 30/minute, and/or your oxygen saturation will be under 92–93%. Your heart rate may be over 110 beats per minute, too. If you go to a hospital emergency department with breathing trouble, they will always check your oxygen saturation. If it’s under 92%, you’ll get supplemental oxygen to get you back up to at least 92%. And there’s a good chance you’ll be admitted to the hospital partly because it’s usually impossible to get oxygen delivered to the home in a timely fashion. If you have your own oxygen saturation monitor at home, you may be able to avoid an emergency department or urgent care visit if your O2 sat is over 92%.

What I’m reading online from other physicians is that COVID-19 patients tend to have lower O2 sats than they expected just from eyeballing the patient and looking at heart and respiratory rates.

If you have signs and symptoms of COVID-19 plus a respiratory rate 30 or higher, or oxygen saturation under 92-93%, seek medical attention immediately,

Emergency Departments and urgent care centers may soon be overwhelmed with coronavirus patients. Some will need to be admitted (assuming a bed is even available) and others can safely be sent home. In addition to vital signs and the overall appearance of the patient, a deciding factor for admission will often be oxygen saturation level. If too many patients that don’t need a hospital  level of care clog up the system, then other seriously ill folks will get delayed medical care, or none at all. 

That being said, if you think you need to go the emergency department or urgent care center, then go. Or talk to your personal physician first. I’m not your physician and don’t know the details of your case. I don’t want to be responsible for someone dying because they delayed or didn’t seek care because of what they read here.

What Can the Hospital Do For You If You Have COVID-19 Infection?

At first, it’s just going to be supplemental oxygen. That’s about it. We have no effective anti-viral drugs yet. Chloroquine, remdesivir, or other drugs might eventually pan out, but we don’t know as of March 20 2020. If things go south after admission, you’ll be put into a medically-induced coma and placed on a mechanical ventilator (if one’s even available), or get ECMO. Odds of death at this point are 50% or higher. If you go into shock (low blood pressure), drugs to raise blood pressure will be given, usually in the ICU (intensive care  unit), assuming a bed is available. Some COVID-19 patients will develop a bacterial infection on top of the virus, in which case antibiotics will be given.

So Is There Any Other Equipment I Need to Consider Acquiring In View of the Coronavirus Pandemic?

Yes….especially if you have risk factors for serious illness from COVID-19:

  1. A pulse oximeter. I mentioned this to my wife about six days ago, so she went online, checked reviews, and chose the Onyx Vantage model 9590 finger pulse oximeter by Nonin, in the photo above. This is not my personal endorsement. She got a great deal on ours, $30 or less, perhaps because I’m a medical professional. Not sure of her source (McKesson?). I just check the price at Amazon and was shocked to see it priced at $139. I know several hospital nurses that purchased their own oximeters at local pharmacies for $40 or less (before onset of the pandemic).
  2. A home oxygen supply. I know of only two options, One is an oxygen tank with nasal cannula tubing. Cost is unknown to me. I don’t know if you can get this without a doctor’s prescription. It’s dangerous if you don’t get instructions; you can blow yourself up or cause a fire. Oxygen is highly flammable. See the Apollo 1 conflagration of 1967. Option #2 is an oxygen concentrator device. The atmosphere is 21% oxygen; most of the rest is nitrogen. This device somehow concentrates oxygen and delivers it via nasal cannula at a concentration greater than 21%. I don’t know how much they cost, but I’m guessing several hundred or a thousand dollars. I don’t know if you can get one without a doctor’s prescription. Like oxygen from a tank, it can be dangerous if you don’t have instructions.

Stay tuned to various medical sources because the coronavirus situation changes on a daily basis.

May God bless us all, even if we don’t deserve it (and we don’t).

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

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