SEATTLE, Wash. — Finding out you’re COVID-19-positive can be a frightening moment, even if you have no symptoms of the virus. Although most patients will remain asymptomatic until the illness clears, a new study finds the public doesn’t have all the facts about who should or should not seek immediate treatment for coronavirus. Researchers at the University of Washington School of Medicine say two important health factors people can measure on their own at home are key to revealing who is at risk of dying from the virus.
In a review of nearly 1,100 hospitalized COVID patients, study authors discovered respiration rate and blood-oxygen levels are both crucial in predicting risk of death during the pandemic. Despite this, the team notes the Centers for Disease Control and Prevention currently tell people with COVID-19 to seek medical care when they start having “trouble breathing” and “persistent pain or pressure in the chest.”
Unfortunately, researchers explain that some patients may not have these symptoms and still be in serious danger. In fact, by the time these patients reach a hospital, the opportunity to prevent life-threatening complications may have passed.
“These findings apply to the lived experience of the majority of patients with COVID-19: being at home, feeling anxious, wondering how to know whether their illness will progress and wondering when it makes sense to go to the hospital,” says Dr. Neal Chatterjee in a university release.
“Initially, most patients with COVID don’t have difficulty breathing. They can have quite low oxygen saturation and still be asymptomatic,” adds Dr. Nona Sotoodehnia. “If patients follow the current guidance, because they may not get short of breath until their blood oxygen is quite low, then we are missing a chance to intervene early with life-saving treatment.”
Revealing the real warning signs of fatal COVID cases
Study authors examined 1,095 adult COVID patients hospitalized in Seattle and Chicago between March 1 and June 8, 2020. Their findings reveal many patients were experiencing hypoxemia, low blood-oxygen saturation (below 91% in this study). The group also frequently experienced tachypnea, which is fast or shallowing breathing (averaging around 23 breaths per minute). However, researchers say few people ever reported feeling short of breath or coughing as a symptom.
Overall, 197 patients died while in the hospital for COVID-19. The results show those who experienced hypoxemia had a risk of death 1.8 to four times greater than patients with normal blood-oxygen levels. Researchers add patients who experienced shallowing breathing were two to three times more likely to die than COVID patients with normal respiratory rates. The team did not find any significant link between body temperature, heart rate, or blood pressure and a COVID patient’s risk of death.
Study authors say nearly every patient with hypoxemia and tachypnea needed oxygen after entering the hospital. Doctors discovered pairing oxygen therapy with glucocorticoid medications, a type of inflammation-reducing steroid hormone, effectively treated patients with severe COVID-19 cases.
“We give supplemental oxygen to patients to maintain blood oxygen saturation of 92% to 96%. It’s important to note that only patients on supplemental oxygen benefit from the life-saving effects of glucocorticoids,” Sotoodehnia explains. “On average our hypoxemic patients had an oxygen saturation of 91% when they came into the hospital, so a huge number of them were already well below where we would’ve administered life-saving measures. For them, that care was delayed.”
Monitoring these vital signs can be cheap and easy
Dr. Sotoodehnia says, for people testing positive for COVID-19, those who are older or obese should monitor these levels closely. However, that doesn’t mean running to the doctor every day to measure blood-oxygen and breathing rates. In fact, clip devices which fit over the fingertip and monitor your pulse and blood-oxygen are available for under $20. Sotoodehnia recommends COVID patients seeing a blood-oxygen saturation below 92 percent seek medical care quickly.
“An even simpler measure is respiratory rate – how many breaths you take in a minute. Ask a friend or family member to monitor you for a minute while you’re not paying attention to your breathing, and if you hit 23 breaths per minute, you should contact your physician,” the cardiologist adds.
“We recommend that the CDC and [World Health Organization] consider recasting their guidelines to account for this population of asymptomatic people who actually merit hospital admission and care,” Chatterjee concludes. “But people don’t walk around knowing WHO and CDC guidelines; we get this guidance from our physicians and news stories.”
The study appears in the journal Influenza and Other Respiratory Viruses.