Please outline the American Lung Association's advice on hypoxia and COVID-19. What has led to your advice being stated?
The main advice with certainly COVID-19 and really any condition at all that causes symptoms is that we always encourage patients to recognize that something is different and to communicate this with their healthcare provider. This can be through telemedicine, for example, a phone call, rather than going into the office.
In the US particularly, there have been a number of articles talking about a pulse oximeter being used as a device at home for patients to help screen for COVID-19.
The problem with this is that the pulse oximeter by itself should not be used as the first step in having a patient contact their healthcare provider because the symptoms of COVID-19 normally predate the low oxygen level.
It is important to recognize symptoms such as the fevers, cough, malaise, things that seem out of the ordinary, and not just to rely on a number such as a pulse ox to be your first warning that something is wrong. COVID-19 should ideally be recognized before the point of hypoxia. Prior signals should be causing you to call your physician.
The message is to notice what your symptoms are, compare these to CDC guidelines (found on their website), and communicate these with your healthcare provider. That will then prompt an evaluation that will include pulse oximetry.
We do not recommend using pulse oximeters as an initial screen for self-diagnosis of COVID-19 for many reasons. First of all, oxygen levels can drop for other reasons besides COVID-19 such as blood clots, other types of infection, or cardiac issues that can develop. Having a pulse oximeter means you should understand what its role is and what its limitations are, depending on what your health condition is in the first place.
We understand some people do buy them and that they can use them as another tool in their medicine cabinet, along with thermometers and blood pressure cups. However, we really want people to rely on other symptoms that seem to occur earlier. The earlier those symptoms are identified and intervention is initiated by the patient and their physician, the better.
Then, if you do have this style of hypoxemia, it will be recognized and further steps will be taken to treat you. Many patients with COVID-19, probably up to 80%, have very mild disease, and do not demonstrate hypoxemia. That other 20%, once they are identified as having COVID-19 and a lower oxygen level than they should, are considered more severe. In many cases that is where the decision to hospitalize and give further therapy is taken.