Dr. Levitan, an emergency physician with 20 years of experience teaching airway procedures to physicians, wrote about his time volunteering for 10 days at New York City-based Bellevue Hospital in March. Almost all Bellevue emergency room patients had COVID pneumonia, even those without respiratory complaints, Dr. Levitan wrote. These patients didn’t report breathing problems, despite below-normal oxygen levels and chest X-rays revealing severe pneumonia.
COVID pneumonia can cause “silent hypoxia,” a form of oxygen deprivation that is difficult to detect. Most of the patients Dr. Levitan treated had been sick with fever, cough, upset stomach and fatigue for about a week, only experiencing shortness of breath the day they came to the ER.
By the time patients with respiratory issues present to the hospital, many will ultimately require a ventilator. The severity of lung injury patients have when they arrive in ERs is a major reason the pandemic is straining the U.S. health system, Dr. Levitan said.
Pulse oximeters, small devices placed on a fingertip, are very reliable detecting oxygenation problems and elevated heart rates. Dr. Levitan argued that widespread pulse oximetry screening, whether at home or in clinics, could provide an early warning for the breathing problems associated with COVID pneumonia.
All COVID-19 patients should have pulse oximetry monitoring for two weeks, according to Dr. Levitan. All individuals with cough, fatigue and fevers should also have pulse oximeter monitoring even if they have not had virus testing or their test was negative.
Though pulse oximeters are not 100 percent accurate and there will be unavoidable deaths, Dr. Levitan argued that the U.S. health system could perform better than it currently is.
“We must direct resources to identifying and treating the initial phase of COVID pneumonia earlier by screening for silent hypoxia,” Dr. Levitan concluded. “It’s time to get ahead of this virus instead of chasing it.”
More articles on patient safety and outcomes:
One-third of COVID-19 patients in New York study received invasive ventilation
Ventilators should be used sparingly for COVID-19 patients, researchers warn
What EHR data reveals about ventilated COVID-19 patients at 12 New York hospitals
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