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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After decades on the political periphery, the climate movement is entering the mainstream in 2020, with young leaders at the fore. The Sunrise Movement now includes more than 400 local groups educating and advocating for political action on climate change. Countless students around the world have clearly communicated what's at stake for their futures, notably Swedish activist Greta Thunberg, who just finished her yearlong school strike for climate. Youth activists have been praised for their flexible, big-picture thinking and ability to harness social media to deliver political wins, as Sunrise recently did for U.S. Sen. Ed Markey's primary campaign. They necessarily challenge the status quo.
A Convergence of Issues<p>The unequal impacts of a changing climate have become extremely clear in 2020, so equity has come to the fore of climate conversations in every corner of the country. A global deadly pandemic continues to rage out of control in the U.S., heat waves are setting new temperature records, wildfires are scorching American Western states, and the hurricane season has already made it to the end of the alphabet for naming storms. In all cases, low-income, Black, Latinx, and Indigenous communities are bearing a disproportionate amount of the impacts.</p><p>"Today, the scab is off, the ugly reality of injustice is hitting us up close and personal, made more realistic by this COVID pandemic," Bullard says.</p><p>This year the decidedly youthful focus on intersectionality is a big part of what defines the transformation of the climate movement. Climate is not just an environmental issue, according to youth activists. It's also a racial justice issue, an economic issue, and an access-to-health care issue.</p><p>"Environmental justice is really seeing the intersection of these issues," says Alex Rodriguez, a community organizer with the Connecticut League of Conservation Voters, which aims to make environmental issues a priority for the state's elected leaders. The group is now focusing their efforts on the coming election and recently succeeded in persuading the state to allow absentee voting in November. "We want people to be safe when casting their vote," says Rodriguez, 26, whose fellow grassroots committee members range from age 16 to 60.</p><p>Rodriguez, who also serves on the equity and environmental justice working group for the Governor's Council on Climate Change, says, "We see our programmatic work as a way to help lawmakers see what they can do to improve the dignity of those suffering from environmental racism, systematic racism, and economic oppression."</p><p>Seeing the overlap and bringing these issues together is a strength that Bullard says was missing from the civil rights organizing he was involved with in the 1960s. He says 2020 is unique in many ways.</p><p>"The number of marchers is unprecedented, from different economic, ethnic, and racial groups—an awakening unlike any that I've seen on this Earth in over 70 years," Bullard says. "Today, the different movements are converging, and I think that convergence makes for greater potential for success."</p>
Young and Old<p>But young people are one essential demographic among many when it comes to climate action. With all that's on the line for climate in the coming elections, up and down the ballot, collaboration becomes key. Bullard says previous generations of climate activists can now play the critical role of mentoring, assisting, and supporting. Standing with, not in front of, youth.</p><p>"Youth are leading us and taking on frontline activity," says Jayce Chiblow, the community engagement lead for Indigenous Climate Action, a Canadian organization that works for Indigenous-led climate justice solutions. But in doing so, she says many young Indigenous activists are experiencing the trauma of violence, getting arrested, and being taken away from their land. "All of our older people are supporting those youth: Elders, mentors, people trained in nonviolent action," Chiblow says. "The youth aren't alone."</p><p>That support can go a long way. "There's a lot of anger and a lot of fear, and that's understandable," says Wazer of Sunrise Connecticut. "I definitely feel those things, too, just considering the ways that our future has been threatened and kind of trashed by older generations."</p><p>Under the Trump administration, the number of environmental rollbacks alone can be disheartening, not to mention new <a href="https://www.yesmagazine.org/video/arctic-national-wildlife-refuge/" target="_blank">drilling permits in the Alaska National Wildlife Refuge going up for auction</a>.</p><p>Wazer is frank about the risks of burnout, depression, and anxiety from the stress of it all, but draws inspiration from the example of the late U.S. representative and lifelong civil rights activist John Lewis. "That forgiveness and that ability to keep fighting and stay motivated … I think that that is something really powerful to learn from older generations."</p><p>An intergenerational approach can leverage the individual strengths of youth and older people in all their diversity.</p><p>"The elders hold our stories," says Chiblow, who is Anishinaabe from Garden River First Nation, Ontario. Those stories include lived experiences, culture, history, and generations of adapting to changes in climate. Such collective experience continues to inform Indigenous knowledge and connections to the land, as well as how people manage and govern themselves in relation to it. This knowledge is passed on through relationship-building and storytelling.</p><p>"Every time you hear that story, you're at a different point in your life, and you'll pick up something else … something new," Chiblow says.</p><p>Changes in perspectives that come with time and experience are among the reasons why intergenerational learning and coalitions are critical to the climate movement. To combine that living and learning is to expand the reach and meaning of the message exponentially. As part of her research for her master's degree, Chiblow brought together youth, community leaders, and knowledge keepers in her community to workshop climate action. "Those relationships are vital to keep that movement going," Chiblow says.</p>
The Unique Value Proposition of Elders<p>Older activists bring unique strengths to the table, according to gerontologist Mick Smyer, who designs strategies to move people from anxiety to action on climate. He calls himself "the aging whisperer to climate groups" and "the climate whisperer to aging groups." He is quick to point out that the learning can go in both directions.</p><p>"I think older adults are untapped resources," Smyer says. "Older adults bring several resources, one of which is their circles of influence. Just by virtue of having lived longer, older adults are going to have denser and richer networks," Smyer says. "The second is, when it comes to voting and civic engagement, older adults, as an age group, outperform all other age groups."</p><p>He uses the 2016 presidential election to illustrate his point: "The older age groups, 70% of them voted. Nobody [else] came close." He is cautious about making sweeping statements about older people broadly, but he says that ageism is alive and well. And that can deter the kind of collaboration that would beget necessary progress on climate action.</p><p>As the twin global patterns of an aging population and a changing climate continue arm in arm, Smyer says a good place for starting this work is within one's family.</p><p>"We each have that power to use in our circles of influence, particularly in our families, and we don't realize it," Smyer says. Whether it's via Zoom or FaceTime or a phone call or a chat in the living room, Smyer says, family members have a superpower: They will listen to each other, and they'll at least start the conversation.</p><p> "Intergenerational collaboration around climate issues, particularly in this election season, starts at home, and then goes to the polling booth," he says.</p>
Speaking the Same Language<p>As an individual's network of family, friends, and connections becomes wider and more diverse, the more work will need to be done to have them all working toward the same goals. That is equally true for the climate movement at large.</p><p>In bridging the gaps among baby boomers, Gen Xers, and millennials, Bullard says, "Each generation will have some idiosyncrasy and uniqueness about it that another generation will not understand or comprehend."</p><p>If everybody in a group or institution is similar, then there's no need to explain a lot, Bullard says. There's usually a fair amount of shared knowledge and values. But the more diverse that group gets, in age, race, gender, or culture, he says, the greater the potential for making mistakes, stepping on people's culture, and causing pain. But the potential for learning also increases exponentially.</p><p>Chiblow says successful collaboration comes down to being able to speak in shared concepts. The term "justice," for example, is an English word that's hard to translate into the Anishinaabe language. Chiblow says that because her community sees itself as belonging to the land, and being part of the land, the Anishinaabe worldview, and therefore their understanding of justice, is necessarily more holistic than the mainstream.</p><p>"Indigenous people have been feeling [the effects of climate change] for so long," Chiblow says. Today, as wildfires rage across the West, the mantra of "I can't breathe" is being driven home on a grand scale. For better and worse, climate justice is finally a front-page story.</p><p>"It's affecting the broader society," Chiblow says. "We're finally at the turning point where we could start to make real change because … people are really starting to feel that urgency."</p><p>The urgency will be tantamount in the coming election. A lot is at stake, says Chiblow: "Incentives, funding, all-around agreement, and also the way we're able to manage our lands and ourselves as people."</p><p>Bullard, too, is insistent on urgency. "This election is one of the most important elections of a generation, because there's so many things at stake," he says. "We can't wait another 40 years on climate. We don't have that much time. We don't have 40 years to get justice."</p><p>Issues of climate justice will be on the ballot in state and local elections this fall, such as Nevada's proposed renewable energy standards and Louisiana's proposed disaster funding. And the topic has finally made it onto the national stage. Joe Biden called Trump a "climate arsonist" for not acting on or even admitting that the wildfires in California are clearly climate-related. The frequency and intensity of such disasters is indisputable.</p><p>"Hurricanes don't swerve to avoid red states or blue states. Wildfires don't skip towns that voted a certain way," Biden <a href="https://abcnews.go.com/Politics/biden-address-west-coast-fires-confront-growing-threat/story?id=73000218" target="_blank">said in a speech on Sept. 14</a>. "The impacts of climate change don't pick and choose. That's because it's not a partisan phenomenon."</p><p>In many ways, the results of the upcoming elections will reflect the ways youth activists and older activists are able come to a common understanding of what climate justice means and what they want the future world to look like. </p><p>"There's a lot of knowledge built up in experience, and there's a lot of energy that's stored in young people," Bullard says. "When you put those two together, you have … an excellent recipe for potential success."</p>
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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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