Breathing difficulty, oxygen level and Covid-19

A doctor checks the oxygen level of a man suffering from coronavirus disease (COVID-19) as he sits outside an emergency room in Kathmandu. (Photo: China Daily)

Dr Subash Pyakurel

  • Read Time 3 min.

Needless to say oxygen is life’s elixir. We cannot compare the value of oxygen with any other matter in the whole universe. Oxygen has to reach every tissue and cell of the body in order to keep ourselves alive.

Existence and function of any organ largely depends on the oxygen supplied to the same. In other words, disturbance in oxygen supply in the organs and low level of oxygen in blood will have a marked presentation through various symptoms and signs. Simply put, degree of reduction in level of oxygen, or hypoxia which means ‘low oxygen’ in Latin language, is directly proportional to the symptoms like difficulty in breathing or labored breathing, fatigue, weakness, altered state of consciousness, bluish discoloration of face, lips and fingers and state of gasping (air hunger).

Disease in itself means ‘not ease’ or ‘not comfortable stage’. When our body is not at ease, this has to be revealed through some signs and symptoms so that we can find that state easily and take means of intervention accordingly. Signs and symptoms of any disease per say are like notifications or alerts we receive in our mobile phones, denoting that some steps have to be taken and some response made after getting the alerts. These show the disease and predict the real gravity of the disease. For example, fever is there to reflect infection in the body. If fever was not there as a symptom, no one could have judged the reality and provided the care and cure for infection.

Covid-19 and oxygen

COVID-19 hits in the lungs leading to lowering of oxygen level in the blood, thereby in organs and tissues. Through an inherent pathophysiology or rule of the body, this should cause various symptoms as stated earlier.

Degree of reduction in oxygen level is directly proportional to the symptoms like difficulty in breathing, fatigue, weakness, state of gasping (air hunger) etc. But some may not develop such symptoms due to ‘silent hypoxemia.’

But some may not develop such symptoms due to what is called ‘happy hypoxia’ or ‘silent hypoxemia’ which is the term used to denote a mismatch of low level of oxygen saturation with no or less degree of presentation or manifestation in the form of signs and symptoms. As a result, they do not get alarmed until the disease has progressed to cause massive damage to the lungs.

At the time doctors or nurses were predicting the state of gasping, many patients are still found to be talking normally, playing with the mobile and showing very ordinary behavior. If the symptoms are compared with oxygen level in pulse oximetry reading or say radiological findings of those patients, there is a remarkable gap. This disconnect or mismatch strikingly affects the clinical judgment and treatment decision.

By rule, the normal oxygen level measured as percentage value through pulse oximeters is more than 95 percent. And, usually breathlessness and chest discomfort start when the level goes below 90 percent creating a proportionate severity of symptoms along with every percentage of oxygen level going down. In various studies and observations in the USA and India, many patients, in particular youngsters and children, are found to be not showing any alarming symptoms even though they have an oxygen level of 75 percent.

Why this is alarming

First, this is the problem mainly seen among children and youngsters. Erosion of their health, and loss of their lives inflict deep psychological impacts in the family members and it is a huge loss for the families and the nation.

Second, this phenomenon of ‘silent hypoxia’ creates a ground of confusion in patients barring them from prompt and proper treatment by badly pushing the chance of timely admission and timely treatment. The consequence can be sudden deterioration of the condition giving no or little time for intervention and doctors won’t be able to do anything but say ‘sorry, it’s too late’.

The people who have been exposed to Covid patients need to test their oxygen level without waiting for severe symptoms to appear.

The second wave of the COVID pandemic has been affecting the younger age group of the population more probably due to the condition of ‘silent hypoxia.’

What should we learn?

Medical practitioners have to be more aware in judging the situation and taking decisions. They need to consider other markers as well apart from signs and symptoms. Likewise, the people who have been exposed to Covid patients also need to be alert. They need to test and get diagnosed on time and need to screen their oxygen level more frequently without waiting for severe symptoms to appear.

Concealed things can have more dangerous attacks than what is revealed. Let’s be aware and let’s make all aware.

Dr. Subash Pyakurel, Medical Editor of Swasthya Khabar, is the founder and CEO of Health Concern.