If you are single I suggest going to extraordinary lengths to protect yourself if you have to self-isolate with COVID-19.
You may have heard about the tragic death of a young surgical trainee who died alone at home from COVID-19 in Belfast last week. He probably died from pulmonary complications of COVID-19 that had gradually crept up on him and by the time he needed hospitalisation and ventilatory support he was probably too unwell to do anything about it. A big issue is that as you become hypoxic (lack of oxygen) your thought processes become clouded and your ability to make a judgement about your own health become erratic.
I know of two close colleagues who self-isolated with COVID-19 and both of them developed severe exertional shortness of breath at the height of their infection. My one colleague said he could barely make it from his bed to the toilet due to shortness of breath. Fortunately, both have made a recovery now and are doing well.
A third colleague who has recently recovered from COVID-19 was bed-bound for two weeks and was on the verge of calling an ambulance, but decided against it. Fortunately, his wife is a GP and was monitoring him at home with a pulse oximeter, a device to measure how much oxygen is in your blood, that she uses for home visits. This colleague tells me that he did try and call 111 and after waiting 90 minutes hung-up. Waiting ninety minutes or longer for advice and to then be told to call an ambulance could be the difference between life and death.
When we do our ward rounds on patients with COVID-19 we don’t have to examine them, we mainly assess how well their lungs are functioning based on their oxygen saturation in their blood relative to how much oxygen they are getting, be it from room air (21% oxygen) or via a nasal cannula or face mask. When we use nasal cannula or a face mark we deliver oxygen at different flow rates and this is also taken into account.
In general, most people have an oxygen saturation rate above 94%. It does vary with age and altitude. It is relatively easy to measure yourself, but you need to have a pulse oximeter. In early COVID-19 pneumonia, exertional oxygen saturation levels fall first, i.e. if you attempt to walk or exercise and your blood saturation levels fall, for example, below 90% despite being normal at rest. This would indicate that your lungs are in trouble and that you probably need to go to hospital. People with COVID-19 can deteriorate very rapidly, i.e. within hours, so having an early warning system should help.
I wonder if the young surgeon above had been monitoring himself with a pulse oximeter and had notice that his exertional blood oxygen saturation levels dropped with exertion (walking in his home) he would have gotten himself to hospital and survived?
I personally think the Government’s and NICE’s guidance on when to be admitted to a hospital is potentially dangerous. The NICE guidance suggests using the following symptoms and signs to help identify who has more severe COVID-19 and may need admission to hospital:
- severe shortness of breath at rest or difficulty breathing
- coughing up blood
- blue lips or face
- feeling cold and clammy with pale or mottled skin
- collapse or fainting (syncope)
- new confusion
- becoming difficult to rouse
- little or no urine output
Can you imagine trying to pick these symptoms and signs up if you live alone and are self-isolated? I am sure self-monitoring of your peripheral blood oxygen saturation levels, in particular documenting their deterioration, will save lives during the COVID-19 pandemic.
So after reading about the tragic case of the young surgeon dying alone at home, I purchased my own pulse oximeter online. It is an insurance policy for my family and any of my neighbours or friends who may get COVID-19 and have to self-isolate and self-monitor. I think the NHS or local communities should arrange for pulse oximeters to be dropped off for single people with COVID-19 who are self-isolating and given guidance on how to use them and at what point to call 999. I am sure home pulse oximetry will take some pressure off the 111 services and save lives. The sceptics will say that as home self-monitoring of oxygen saturations is an untested technology we would need to study this intervention first before recommending it at a population level. I would say bollocks. My sister has a progressive interstitial lung disease and is on 24-hour home oxygen therapy. She and her cohort of fellow patients all manage their home oxygen therapy using pulse oximeters. If she can use a pulse oximeter so can most people in the general population. In fact, technology companies should think about building pulse oximetry into the next versions of their smartwatches and make the technology ubiquitous.
I am not saying that everyone should purchase a pulse oximeter, but if you are single and live alone without someone to monitor your status when you get COVID-19 it would be advisable to have one. I am convinced that my two colleagues who struggled through self-isolation at home would have been better off if they had known their own peripheral blood oxygen saturation levels, both on exertion and at rest. I suspect if they had they may. or at least one of them may, have been admitted to hospital for observation.
Do you agree with me that we should add access to home pulse oximetry, particularly if you are single, to my list of things to do to prepare for getting COVID-19?
CoI: none