Filenews 18 December 2021
A study of 1,095 patients hospitalized for COVID-19 found that two easily measurable signs—the rate of breathing and the saturation of oxygen in the blood—are fairly distinct signs of predicting higher mortality. Remarkably, according to the authors, it is that in this way, anyone who receives a positive diagnosis for COVID-19 can easily follow these two signs of health from home.
This framework is missing from the current guidelines of the Centres for Disease Control and Prevention (CDC), which guide people to seek medical attention when they experience symptoms such as shortness of breath and persistent pain or pressure in the chest. These, however, are signs that may be absent even when breathing and oxygen in the blood reach dangerous levels, argue experts in the relevant publication in Influenza and Other Respiratory Viruses.
"These findings relate to the experiences of the majority of COVID-19 patients, who when they are at home, feel stressed and wonder how they can know if the disease is progressing and when they should go to the hospital," says Dr. Yiannis. Neal Chatterjee from the School of Medicine of the University of Washington.
The findings suggest that for some COVID-19 patients, the moment they feel bad enough to go to the hospital may already be too late for early medical intervention.
"Initially, most COVID-19 patients do not experience difficulty breathing. They may have low oxygen saturation and remain asymptomatic. If patients follow the current guidance, because they may not have shortness of breath until the oxygen in the blood is too low, doctors lose the opportunity to intervene early for a treatment that may save their lives," the experts point out.
The researchers looked at the cases of 1,095 patients over the age of 18 who were admitted with COVID-19 to U.S. hospitals from March 1 to June 8, 2020. Although patients often had hypoxemia (low blood oxygen saturation, 91% or lower during the study) or tachypnea (rapid, shallow breathing, 23 breaths per minute during the study), few reported shortness of breath or cough regardless of oxygen in the blood.
The first measure of the study was inpatient mortality from all causes. In total, 197 patients died inside the hospital. Compared to those admitted with normal oxygen into the blood, hypoxemic patients had a mortality risk of 1.8 to 4 times greater, depending on their blood oxygen levels. In contrast, other clinical signs at admission, such as temperature, heart rate and blood pressure, were not associated with mortality.
Almost all patients with hypoxemia and tachypnea needed mechanical oxygen support, which, when combined with inflammation-inducing glucocorticoids, can effectively treat severe cases of COVID-19.
"We give oxygen support to patients to keep the blood oxygen saturation at 92%-96%. It is important to note that only patients with oxygen support benefit from the life-saving effects of glucocorticoids. On average, hypoxemic patients had oxygen saturation at 91% when they were admitted to the hospital, so a large number of them were already lower than where we would have begun to administer life-saving measures. For them, the treatment was delayed," the scientists explain.
The findings are relevant to family doctors and remote care providers, who are usually at the forefront of contacts for people who receive a positive diagnosis for COVID-19 and want to monitor significant symptoms.
"We recommend that the CDC and the World Health Organization consider updating their guidelines to take into account the population of asymptomatic people who really need hospitalization and medical attention," dr. Chatterjee.
Scientists recommend that people with a positive coronavirus diagnosis , especially those at higher risk of adverse effects due to advanced age or obesity, it is advisable to have an oximeter to monitor oxygen in their blood when it falls below 92%.
"An even simpler measure is a respiratory rate – that is, how many breaths one takes in a minute. Have a friend or family member watch you for a minute while not paying attention to your breathing and if you take 23 breaths a minute, you should contact your doctor," the experts conclude.
