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Posted: May 5, 2020 2:48:50 pm
A doctor looks at images of the lungs of an 81-year-old man suspected of having Covid-19, in Guayaquil, Ecuador, April 29, 2020. (Reuters file photo: Santiago Arcos)
As doctors around the world are busy treating people with Covid-19, many have reported a condition called “silent” or “happy” hypoxia, in which patients have extremely low blood oxygen levels, but show no signs of dyspnea.
The condition has puzzled doctors, and many now advocate early detection as a means of avoiding a deadly disease called Covid pneumonia.
What is hypoxia?
Hypoxia is a condition in which there is not enough oxygen available for blood and body tissues. Hypoxia can be generalized, affecting the entire body or local, affecting a region of the body.
According to the Mayo Clinic, an American nonprofit organization, normal arterial oxygen is about 75 to 100 millimeters of mercury (mm Hg), and normal pulse oximeter readings generally range from 95 to 100 percent. Values below 90 percent are considered low.
When levels drop below 90 percent, patients may begin to experience lethargy, confusion, or mental disorders due to insufficient amounts of oxygen reaching the brain. Levels below 80 percent can cause damage to vital organs.
What is silent hypoxia?
According to an opinion piece in The New York Times by physician and inventor Dr. Richard Levitan, Covid pneumonia, a serious medical condition found in critically ill patients with Covid-19, is preceded by “silent hypoxia”, a form of oxygen deprivation that is more difficult to detect than regular hypoxia.
In “silent” or “happy” hypoxia, patients appear to be less distressed. Many Covid-19 patients, despite having oxygen levels below 80 percent, look quite calm and alert, according to multiple reports. This phenomenon has puzzled several doctors.
In emergency rooms, doctors have reported that patients have oxygen levels of less than 80 or 70 percent, in some cases even less than 50 percent. Those with such low oxygen levels would normally appear extremely ill, but not in cases of silent hypoxia; Patients have been reported sitting in bed talking or operating mobile phones.
In many cases, Covid-19 patients with silent hypoxia exhibited no symptoms such as shortness of breath or cough until their oxygen dropped to very low levels, at which time there was a risk of acute respiratory distress (ARDS) and organ failure.
Silent hypoxia: what explains this phenomenon?
According to a report in The GuardianThe reason why people gasp is not because of falling oxygen levels per se, but because of increased carbon dioxide levels that occur at the same time, when the lungs are unable to expel this gas efficiently. This response does not appear to be working in some Covid-19 patients, according to the report.
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According to Dr. Levitan, this happens because in patients with Covid pneumonia, the virus causes the alveoli to drop, leading to a reduction in oxygen levels. However, the lungs initially do not become stiff or heavy with the fluid, and remain “compliant,” being able to expel carbon dioxide and prevent its accumulation. Therefore, patients do not feel short of breath.
At NYT piece, Levitan has said that a medical device called pulse oximeter– used to detect the level of oxygen in the blood – could help in the early detection of silent hypoxia.
Using the device, those who have Covid-19 or those suspected of having it, can check their oxygen levels from the start. A drop in oxygen levels, caused by silent hypoxia, can serve as a signal to seek further treatment immediately and not wait for a coronavirus test.
Others have expressed concern about this, saying that frequent use of the device would only increase anxiety among many.
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