There are other stories to review this morning, but Dr. Richard Levitan’s April 20 New York Times op-ed could save your life.
Levitan has practiced emergency medicine for 30 years. He volunteered at New York’s Bellevue Hospital in March. There he discovered patients arriving at the hospital with advanced “Covid pneumonia” and extremely low blood oxygen levels without “any sensation of breathing problems.” They’d been sick for days but only sought medical help when shortness of breath came on rapidly. Patients arriving with other illnesses and injuries also had Covid pneumonia without knowing it. Levitan calls this “silent hypoxia” insidious:
Pneumonia is an infection of the lungs in which the air sacs fill with fluid or pus. Normally, patients develop chest discomfort, pain with breathing and other breathing problems. But when Covid pneumonia first strikes, patients don’t feel short of breath, even as their oxygen levels fall. And by the time they do, they have alarmingly low oxygen levels and moderate-to-severe pneumonia (as seen on chest X-rays). Normal oxygen saturation for most persons at sea level is 94 percent to 100 percent; Covid pneumonia patients I saw had oxygen saturations as low as 50 percent.
To my amazement, most patients I saw said they had been sick for a week or so with fever, cough, upset stomach and fatigue, but they only became short of breath the day they came to the hospital. Their pneumonia had clearly been going on for days, but by the time they felt they had to go to the hospital, they were often already in critical condition.
Without knowing it.
The “vast majority” of patients Levitan saw showed no signs of extreme duress yet “dangerously low oxygen levels and terrible pneumonia on chest X-rays.” They were even talking on their cell phones. By the time they arrived at the hospital, many had severe lung damage and would require a ventilator which introduces its own set of medical complications. Levitan describes the mechanics in the article.
Silent hypoxia progressing rapidly to respiratory failure explains cases of Covid-19 patients dying suddenly after not feeling short of breath. (It appears that most Covid-19 patients experience relatively mild symptoms and get over the illness in a week or two without treatment.)
A major reason this pandemic is straining our health system is the alarming severity of lung injury patients have when they arrive in emergency rooms. Covid-19 overwhelmingly kills through the lungs. And because so many patients are not going to the hospital until their pneumonia is already well advanced, many wind up on ventilators, causing shortages of the machines. And once on ventilators, many die.
Levitan says there is a simple device (although not free — FDA-approved models start at around $45) for detecting low O2 levels at home with a pulse oximeter available at the drug store or online. These are those little devices that clamp to your finger and read out your pulse. They also read oxygen saturation in the blood.
Several of the highest-rated consumer models are already sold out on Amazon. (See image above.)
Early detection of the pneumonia can improve survival rates. Levitan suggests people who detect low oxygen levels check with their doctors before rushing to emergency rooms. Misinterpretation of readings or unrecognized chronic lung issues could be involved. But patients who test positive for COVID-19 should monitor themselves for two weeks. Others with “cough, fatigue and fevers should also have pulse oximeter monitoring even if they have not had virus testing, or even if their swab test was negative.” The tests are only about 70 percent accurate.
There are 260,000 people in my county and 48 lab-confirmed positive COVID-19 cases as of Tuesday. How is it my wife and I can know three ill with the virus? Because they aren’t included in that count, like many Americans who are ill but untested. Levitan reminds readers a majority of Americans already exposed to the virus don’t know it. Just like those who don’t know they have pneumonia.
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For The Win, 3rd Edition is ready for download. Request a copy of my free countywide GOTV mechanics guide at ForTheWin.us. This is what winning looks like.
Note: The pandemic will upend standard field tactics in 2020. If enough promising “improvisations” come my way by June, perhaps I can issue a COVID-19 supplement.