When Jennifer Reed, an epidemiologist with the Vermont health department, first started sifting through the records of COVID-19 deaths, she noticed an unusual trend.
Seemingly, stable people who had been talking and laughing just moments before were suddenly collapsing.
“Sometimes they were still talking when they hit the ground,” she said.
Doctors around the country noticed the same thing, including Richard Levitan, an emergency medicine physician from Littleton. While he was volunteering at a hospital in New York City, patients showed up at the emergency room completely alert – scrolling through their phones or talking calmly to nurses – with oxygen levels he described as “not compatible with life.”
“It’s not like what we see in most situations,” he said. “If you choke, you pass out because your oxygen gets acutely low. If you have terrible bacterial pneumonia, your oxygen level goes down and you become unconscious.”
Physicians began to realize the virus deprived the body of oxygen so slowly and insidiously, the brain was able to adapt to each slight drop. Over time, that meant people could be dying of hypoxia without even realizing it. Doctors dubbed the phenomenon ‘silent hypoxia.’
The solution, Levitan thought, was relatively simple and inexpensive.
Distributing pulse oximeters, small clothespin-like devices that measure oxygen saturation would allow patients to monitor their vitals and quickly get to the hospital if they noticed a dip before they became irreversibly ill.
“If you come in with this being advanced, you’re in deep trouble,” he said. “You may survive with supportive care but your mortality, even now, is about 6% among these really sick people. If you come in early before you have serious lung injury, almost of all the patients we’ve seen like this have had short hospitalizations on the order of three to five days.”
This is partly why some of the world’s most powerful COVID-19 patients, like Boris Johnson or Donald Trump, faired well despite their comorbidities, he said.
Vermont became the first state to adopt a plan like this in June when it announced it would provide pulse oximeters to every resident that tested positive for COVID-19. Reed estimates the health department has distributed close to a thousand oximeters since then.
She said it’s too soon to say definitively if the program has made a significant difference but there have been several patients who have been referred to the hospital after their oximeter reported low oxygen saturation levels. The New York City Health Department and several of the country’s top pulmonary hospitals like Mayo Clinic and Mount Sinai have implemented similar programs.
Levitan said these programs save not only lives but millions of dollars. Once patients need a breathing tube and ventilator, they usually require multiple IV pumps for sedation and blood pressure support, a catheter, tubes in their stomach and bladder, and eight staff members to turn them over twice a day.
“The resources involved are staggering,” he said. “Each of these people who landed in the ICU is probably a million-dollar hit or more.”
A pulse oximeter retails for around $20.
Levitan has tried to get other states, including New Hampshire, to follow Vermont’s lead and do universal pulse oximetry monitoring. His pleas have largely been met with silence. He said it seems like most health officials are focused on the vaccine. In the meantime, nearly 2,000 people are predicted to die of COVID-19 by April in New Hampshire, according to the Institute for Health Metrics and Evaluation.
Levitan compares the current situation to a 200-car collision he witnessed early in his career.
“I’m running around trying to care for all these people who are just getting killed in this pile on,” he said. “That’s where we are with COVID. It’s like standing on the median and watching the cars pile up.”