“It’s like nothing I’ve ever seen before.” ER physician – New York

The world’s medical systems were hardly ready for COVID-19. It turns out that our bodies, in a new and strange way, were unprepared as well.  A viral trickster, COVID-19 appears to be doing something no other virus has done.

It’s creating a condition called “silent hypoxia” which has become a major killer with COVID-19.

In A New York Times piece, “The Infection That’s Silently Killing Coronavirus Patients“, an ER doctor in New York describes a strange scene.  COVID-19 patients without breathing problems have been shocking doctors by walking in to the ER with full-blown pneumonia. The ER rooms in NYC have been overwhelmed primarily because of the “alarming severity of (the) lung injury” the virus has been producing.

Damage to the lungs is driving many of the ER visits from COVID-19 (mage-by-Clker-Free-Vector-Images-from-Pixabay

Damage to the lungs is driving many of the ER visits from COVID-19. Image-by-Clker-Free-Vector-Images-from-Pixabay

Pneumonia refers to a viral or bacterial infection which almost always causes shortness of breath, pain when taking a deep breath and/or rapid, shallow breathing,  Not this time.

The lungs’ main function is gas exchange: the air sacs or alveoli in the lungs expand to take in oxygen and then expel CO2 when they deflate. During most cases of pneumonia the air sacs become inflamed and fill up with fluid, causing problems with both oxygen extraction and CO2 release.

The shortness of breath and the rapid, shallow breathing pattern seen, though, are initiated not to increase oxygen uptake, but to facilitate removal of the toxic CO2 molecules that have been building up.

COVID-19 can cause blood oxygen levels to fall dramatically and produce moderate to severe pneumonia before the normal signs of pneumonia such as shortness of breath and chest pain occur. This is causing some COVID-19 patients to become dangerously ill without knowing it.

Normal oxygen saturation for most people is 94-100% but the ER doctor reported that a “vast majority” of COVID-19 patients seen at the hospital had “remarkably low oxygen saturations”. Some COVID-19 patients, with oxygen levels so low that they seemed “incompatible with life”, were still using their cell phones! Some have had oxygen saturation levels – the level of oxygen in their blood – as low as 50%. (Normal is 94-100%).

(This seems eerily reminiscent of people with ME/CFS with seemingly life-threatening low levels of blood volume, or blood pressure.)

How are COVID-19 patients managing to get so ill without their knowing it? Probably because of the way the virus attacks the air sacs or alveoli in the lungs.  Initially, COVID-19 prevents these air sacs from expanding to take in oxygen, but until the inflammation cuts in, their air sacs are still able to expel CO2 – and it’s the buildup of CO2 that leaves us short of breath, not low amounts of oxygen.

People with COVID-19 are compensating for the damage to their air sacs by taking faster, deeper breaths – not knowing that doing so causes more inflammation, more damage to the air sacs, and ultimately, a faster progression of their pneumonia.

By the time some people actually have trouble breathing, their lungs have been so damaged that they have to immediately go on a ventilator. So much damage can unknowingly occur that some COVID-19 patients die shortly after experiencing shortness of breath. The CDC warns that anyone with bluish lips or face should get immediate medical attention.

The New Normal: A Pulse Oximeter in Your Medicine Kit

pulse oximeter for oxygen saturation testing

An ER doc recommends that everyone have a pulse oximeter.

The ER doctor asserted that much of the damage associated with the epidemic of “silent hypoxia” (hypoxia refers to low oxygen levels) could be prevented if people with COVID-19 could be seen before their pneumonia became severe.

Thankfully, there’s a cheap and easy way to do that – it’s called a pulse oximeter which can be purchased for as little as $30.

“(That) … requires detecting silent hypoxia early through a common medical device that can be purchased without a prescription at most pharmacies: a pulse oximeter.


Widespread pulse oximetry screening for Covid pneumonia — whether people check themselves on home devices or go to clinics or doctors’ offices — could provide an early warning system for the kinds of breathing problems associated with Covid pneumonia.”

He recommended that everyone with symptoms of the disease (cough, fever, fatigue, etc.) should have a pulse oximeter.

The doctor noted the pulse oximeters are not 100% accurate but that they are “extremely reliable”.

If you have COVID-19 symptoms you should also, whether you’ve been tested positive for it or not, lie on your stomach and sides – not your back. Simply doing that may be able to help many avoid ventilators.

The doctor’s advice flies in the face of Dr. Albert Rizzo, the chief medical officer for the American Lung Association. He doesn’t believe that most people need a pulse oximeter. He says it can help, but “monitoring your symptoms—cough, shortness of breath, chest discomfort—those are the main things.”

Rizzo apparently didn’t know of the silent hypoxia that is causing lung damage prior to symptoms like chest discomfort or shortness of breath showing up.

Dr. Klimas reported that ERs in her area are setting an alarm level of about 92%. She recommends that people with ME/CFS get up and walk around the room before taking the oxygen saturation levels.

The American Thoracic Society reports that “most people need an oxygen saturation level of at least 89% to keep their cells healthy”. They state that wearing nail polish, having artificial nails, cold hands, smoking, having poor circulation or dark skin can affect the accuracy of pulse oximeters. (Smoking artificially elevates it). The sensor should be placed at the base of the nail. If you have artificial nails, you can trying putting the probe on sideways, or use a toe instead.

The best readings are produced when your hand is warm, relaxed, and held below the level of your heart.


Accuracy Issues

A study indicated that pulse oximeters are not always precise, and that expensive ones are not necessarily better than cheap ones.  All the pulse oximeters tested in one study, however, were accurate (within 2% of real values) when blood saturations were >90%. – which is around the level we’re concerned with.

The Contec CMS50DL and Beijing Choice C20 worked superbly down to 70% saturation levels. Accuracy diminished below that for some models but was generally within 3%. If your measurement is in the 80’s, knowing your exact saturation level isn’t your priority, though: at that point you need to see a doctor.

The TempIR-Oxy, Jumper JPD-500A and Nonin Vantage 9590 also did well in another study. 

Pulse oximeters cost from $30 to well over $100, with most on Amazon clocking in around $50. Delivery times lagged at Amazon but I was able to get one delivered from Walmart fairly quickly.

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