The Silent Infection Making Coronavirus Worse

Dr. Richard Levitan, an emergency doctor with more than 30 years of experience, published an opinion piece in the New York Times on April 20, 2020. In the piece, he described an “infection” that is furtively killing COVID-19 patients: silent hypoxia. (1)

As New York City was being overwhelmed by COVID-19 cases, Levitan offered to work at Bellevue Hospital for 10 days. He said that almost all of the patients he treated had pneumonia caused by COVID-19. But what was surprising was that people that hadn’t communicated about any breathing problems had the infection too. (1)

Levitan realized that many COVID-19 patients are experiencing “silent hypoxia”, which keeps them from seeking help earlier. They often don’t come to the hospital until the virus has advanced so far that they need a ventilator, putting stress on hospitals and making it harder for the patients to recover. (1)

Silent Hypoxia

Hypoxia occurs when your body can’t get enough oxygen. Low oxygen levels in your blood results in low oxygen in your tissues. People with hypoxia usually experience shortness of breath, wheezing, and other breathing issues. (2)

Usually, pneumonia patients experience those breathing problems, as well as chest discomfort and pain with breathing. But, according to Levitan, many COVID-19 pneumonia patients don’t show shortness of breath, even though their oxygen levels are decreasing. While most people have an oxygen saturation of 94% to 100%, the oxygen saturation for patients with COVID-19 pneumonia could drop to 50%. (1)

Levitan wrote that many of his patients had been experiencing other symptoms for about a week: fever, cough, fatigue, upset stomach. They hadn’t noticed any breathing problems until the day they decided to come to the hospital. (1)

But while patients may not notice their low oxygen levels, they are certainly being affected by them. The devious nature of silent hypoxia means that patients could have COVID-19 pneumonia for days without knowing it. By the time they go to the hospital, they are in serious need of medical assistance. (1)

Silent hypoxia happens in COVID-19 patients because the virus harms pulmonary cells that produce surfactant. According to Levitan’s New York Times piece, “This substance helps the air sacs in the lungs stay open between breaths and is critical to normal lung function.” (1)

COVID pneumonia causes inflammation, which leads to the collapse of the lung’s air sacs and decreased oxygen levels. But the lungs don’t become stiff, and patients can continue to breathe out carbon dioxide. Too much carbon dioxide in the lungs is what causes shortness of breath. (1)

Patients don’t notice that their oxygen levels have dropped because they have an automatic physiological response. They breathe faster and deeper to make up for the low oxygen in their blood. But this actually causes more inflammation and more lung sacs to cave in. Their pneumonia worsens until their oxygen levels are so low that they notice and go to the hospital. (1)

Using a Pulse Oximeter to Detect Silent Hypoxia

Levitan said that COVID-19 patients who experience silent hypoxia will likely require a ventilator by the time they go to the hospital. It will be more difficult for them to recover than if they had sought medical attention earlier. Many will not be able to recover. (1)

Patients with COVID-19 pneumonia can avoid being put on a ventilator and have a better chance of recovering if they get treatment before their pneumonia advances too far. This will also free up ventilators, of which there is a shortage, as well as other hospital resources needed to care for critically ill coronavirus patients. (1)

Levitan proposes a common tool to help us find and treat COVID pneumonia patients earlier: the pulse oximeter. You don’t need a prescription to buy a pulse oximeter, and you can find them at pharmacies and online. (1)

To use a pulse oximeter, turn the device on and place it over your fingertip. You will get two readings: your oxygen saturation and pulse rate. If you noticed a decreased oxygen saturation and increased pulse rate, you should reach out to your doctor. They can advise you on whether or not it’s time to go to the hospital. (1)

Using a pulse oximeter daily will give you crucial information, allowing you to detect silent hypoxia, whether you are displaying COVID-19 symptoms or not. Catching it the infection early could save your life. (1)

“We must direct resources to identifying and treating the initial phase of COVID-19 pneumonia earlier by screening for silent hypoxia,” Levitan wrote. “It’s time to get ahead of this virus instead of chasing it.” (1)