Should You Use a Simple Pulse Oximeter to Detect COVID-19 Symptoms?
Patients who are having trouble breathing from a COVID-19 infection are showing up at the hospital long after a normal pneumonia infection is detected. That trend means more ventilators need to be used and more people are dying from the infection than need to. Lives could be saved if the infections were caught earlier. Now, an emergency doctor says in The New York Times that a simple pulse oximeter could slow down the number of patients needing ventilators and succumbing to the disease.
The opinion piece by Dr. Richard Levitan argues that since many patients have COVID-19 pneumonia but have not complained of breathing problems, they are not aware that something is slowly attacking their lungs. The infection is causing something called "silent hypoxia," a form of oxygen deprivation that is difficult to detect.
"But when COVID pneumonia first strikes, patients don't feel short of breath, even as their oxygen levels fall," Levitan wrote. "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."
He says that a simple, over the counter pulse oximeter will detect silent hypoxia. He argues that the simple device is reliable, simple to use — just attach it to a fingertip and turn the machine on — and "could provide an early warning system for the kinds of breathing problems associated with COVID pneumonia."
"When we see low oxygen readings, we would bring patients in [and] we would treat them with oxygen. And a variety of positioning maneuvers where we lay people on their stomach," Levitan said to CBS Boston. "We monitor their blood tests for inflammatory markers and we would reach many more patients earlier in the disease."
Pulse oximeters usually run from $25 to $100 and work by passing a small beam of light through your finger to measure how much oxygen your blood is carrying, according to Consumer Reports. When your blood oxygen levels start to trend downwards, it could be a sign that your lungs are faltering.
"In COVID-19 patients, we often see that they look comfortable, but their oxygen saturation is significantly worse than normal," said Elissa Perkins, M.D., associate professor of emergency medicine at Boston Medical Center, to Consumer Reports. For that reason a home pulse oximeter "could provide valuable additional information about their disease."
However, the American Thoracic Society and the American Lung Association feel that most people do not actually need one, but should have one if they have specific respiratory conditions that would require it. In the absence of those conditions, frequently checking a pulse oximeter could lead to increased anxiety, according to ABC News.
"There is no good role for a pulse oximeter for an otherwise healthy person who doesn't have access to [supplemental] oxygen," said Jamie Garfield, a volunteer medical spokesperson at the American Lung Association and an interventional pulmonologist at the Temple Lung Center in Philadelphia, as Quartz reported.
Some doctors warn that the value of a pulse oximeter during the pandemic is limited. Furthermore, most are not intended for medical use and have not been put through the same rigorous testing and review as medical-grade oximeters, according to Lex Schultheis, M.D., research professor of bioengineering at the University of Maryland in College Park, who spoke to Consumer Reports.
"Most infected people will survive this infection, and will never need a visit with their doctor, let alone hospitalization," said Mark Levy, a family physician in Seattle, to Quartz. "For those who are sicker, monitoring pulse, respiratory rate, and other low-tech things like how someone looks and feels may be all that is needed."
For his part, Levitan recognized some of those problems. "People using the devices at home would want to consult with their doctors to reduce the number of people who come to the E.R. unnecessarily because they misinterpret their device," he wrote. He believes that everyone who has tested positive for COVID-19 should have pulse oximetry for two weeks to see if an acute lung infection develops.
He added, "All persons 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, because those tests are only about 70 percent accurate. A vast majority of Americans who have been exposed to the virus don't know it."
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By Simon Montlake
For more than a decade, Susan Jane Brown has been battling to stop a natural gas pipeline and export terminal from being built in the backcountry of Oregon. As an attorney at the nonprofit Western Environmental Law Center, she has repeatedly argued that the project's environmental, social, and health costs are too high.
All that was before this month's deadly wildfires in Oregon shrouded the skies above her home office in Portland. "It puts a fine point on it. These fossil fuel projects are contributing to global climate change," she says.
Moderates Feeling the Heat<p>If elected, Mr. Biden has vowed to stop new drilling for oil and gas on federal land and in federal waters and to rejoin the 2015 Paris climate accord that President Donald Trump gave notice of quitting. He would reinstate Obama-era regulations of greenhouse gas emissions, including methane, the largest component of natural gas.</p><p>The Biden climate platform also states that all federal infrastructure investments and federal permits would need to be assessed for their climate impacts. Analysts say such a test could impede future LNG plants and pipelines, though not those that already have federal approval. </p><p>Climate change activists who pushed for that language say much depends on who would have oversight of federal agencies that regulate the industry. Some are wary of Biden's reliance on advice from Obama-era officials, including former Energy Secretary Ernest Moniz, who is now on the board of Southern Company, a utility, and a former Obama environmental aide, Heather Zichal, who has served on the board of Cheniere Energy, an LNG exporter. </p>
The Push for U.S. Fuel Exports<p>As vice president, Biden was part of an administration that pushed hard for global climate action while also promoting U.S. oil and gas exports to its allies and trading partners. As fracking boomed, Obama ended a 40-year ban on crude oil exports. In Europe, LNG was touted both as an alternative to coal and as strategic competition with Russian pipelines.</p><p>That much, at least, continued with President Trump. Under Energy Secretary Rick Perry, the agency referred to liquified U.S. hydrocarbons as "<a href="https://www.nytimes.com/2019/05/29/us/freedom-gas-energy-department.html" target="_blank">freedom gas</a>."</p><p>Mr. Trump has also championed the interests of coal, oil, and gas while denigrating the findings of government climate scientists. He rejected the Paris accord as unfair to the U.S. and detrimental to its economy, but has offered no alternative path to emissions cuts. </p><p>Still, Trump's foreign policy has not always served the LNG industry: Tariffs on foreign steel drove up pipeline costs, and a trade war with China stayed the hand of Chinese LNG importers wary of reliance on U.S. suppliers. </p><p>Even his regulatory rollbacks could be a double-edged sword. By relaxing curbs last month on methane leaks, the U.S. has ceded ground to European regulators who are drafting emissions standards that LNG producers are watching closely. "That's a precursor of fights that will be fought in all the rest of the developed world," says Mr. Hutchison. </p><p>Indeed, some oil-and-gas exporters had urged the Trump administration not to abandon the tougher rules, since they undercut their claim to offer a cleaner-burning way of producing heat and electricity. "U.S. LNG is not going to be able to compete in a world that's focused on methane emissions and intensity," says Erin Blanton, a senior research scholar at the Center on Global Energy Policy at Columbia University. </p>
Stepping on the Gas<p>In July, the Department of Energy issued an export license to Jordan Cove's developer, Canada's Pembina Pipeline Corp. In a statement, Energy Secretary Dan Brouillette said the project would provide "reliable, affordable, and cleaner-burning natural gas to our allies around the world."</p><p>As a West Coast terminal, Jordan Cove offers a faster route to Asia where its capacity of 7.8 million tons of LNG a year could serve to heat more than 15 million homes. At its peak, its construction would also create 6,000 jobs, the company says, in a stagnant corner of Oregon.</p><p>But the project still lacks multiple local and state permits, and its biggest asset – a Pacific port – has become its biggest handicap, says Ms. Blanton. "They are putting infrastructure in a state where there's no political support for the pipeline or the terminal, unlike in Louisiana or Texas," she says. </p><p>Ms. Brown, the environmental lawyer, says she wants to see Jordan Cove buried, not just mothballed until natural gas prices recover. But she knows that it's only one among many LNG projects and that others will likely get built, even if Biden is elected in November, despite growing evidence of the harm caused by methane emissions. </p>
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