HIGHLIGHTS
- It's a conglomeration of symptoms that leads the patient to the hospital: Dr Hemant Thacker
- If the patient is short of breath and unable to talk, you might need oxygen inhalation: Dr Viny Kantroo
- Studies in Europe have shown that steroid inhalers have worked very well for Covid patients: Dr Bela Sharma
As India logs more than 3 lakh daily Covid-19 cases on the second consecutive day, India Today TV Consulting Editor Rajdeep Sardesai spoke to top doctors who answer all your frequently asked questions (FAQs) about the safe oxygen levels, besides the role of oximeters, oxygen concentrators and steroid inhalers in fighting the pandemic.
As India logs more than 3 lakh daily Covid-19 cases on the second consecutive day, India Today TV Consulting Editor Rajdeep Sardesai spoke to top doctors who answer all your frequently asked questions (FAQs) about the safe oxygen levels, besides the role of oximeters, oxygen concentrators and steroid inhalers in fighting the pandemic.
Q: Should I be at home unless my oxygen level drops very sharply?
- HEMANT THACKER, CONSULTANT PHYSICIAN & CARDIOMETABOLIC SPECIALIST, BREACH CANDY, JASLOK, BHATIA AND RELIANCE HOSPITALS, MUMBAI:
Covid cannot be treated by one pulse-oximeter alone. You look at the patient as a whole. If by the fifth or the sixth day, the fever is unrelenting, which is more than 100.5 and above; if the patient's appetite is dropping; if the patient's oxygenation, which to begin with was 97-98, is going down gradually; if the cough is absolutely chronic and not settling down — treat the patient as a whole. You don't wait for only one parameter.
But having said that, if everything else is alright and the saturation suddenly drops under 92-91, when the patient has cleared his throat, taken a deep breath and rechecked his saturation, yes, you have to quickly think of going to the hospital.
The warning here is: a lot of people sleep in AC rooms. They leave their arms outside the blanket and the fingers get cold. They get up at night and put on the saturation meter and they see 88 or 86. Please don't panic. Rub your fingers properly, turn off the AC, look at it on multiple fingers, and make sure you're less than 92 before rushing to the hospital.
These are the tips where you don't decide but you call your doctor. Your family doctor can decide for you, your Covid doctor can decide for you. Don't panic unnecessarily. It's a conglomeration of symptoms that leads the patient to the hospital.
Q: Someone is saying – my oximeter reading is between 85 and 90. I'm advised oxygen at home but there is no oxygen in the market. Do I stay at home or do I panic and go to the hospital? If I am at home, how do I get oxygen?
Even if you don't have any of the other symptoms and your oxygen suddenly drops below 92-91, and definitely under 90, we have a syndrome called happy hypoxia. The patient has no symptoms. He's happily sitting at home, but the oximeter gives the game away. This patient needs oxygen.
If you cannot give oxygen at home, go to a jumbo centre, go to a nursing home, go to a tent. And if there is no other choice, go to a hospital where they can provide you with oxygen. Oximeter plays a role only in giving a clue that the patient is otherwise normal but he has a sudden drop in the oxygen level. Yes, this patient at 85 or 90 should not be watching our show, he should be making his way to a hospital or to a nearby centre for oxygen.
Q: Should older people have to worry more if their reading is below 94?
Older people with age have lost their respiratory compliance. Because their lungs have lived for 70 years versus a young man whose lungs have lived for 30 years. If the oxygen level of elderly people drops below 90, then you have to quickly think of making arrangements.
Hospitalisation is not required. You can do home therapy, you can give oxygen supplementation at home. But the red flag goes faster in the case of elderly people. I agree.
Q: If my oxygen level has dropped, should I look for an oxygen concentrator?
- VINY KANTROO, SENIOR CONSULTANT, PULMONOLOGY AND RESPIRATORY MEDICINE, INDRAPRASTHA APOLLO HOSPITAL, NEW DELHI:
If the oximeter reading is consistently 85 or 90, it's not a one-off reading, the patient is short of breath and unable to talk, you might need oxygen inhalation. If they don't have a condition called COPD, where oxygen levels are chronically less than 90, that's a worrying factor.
Oxygen concentrators are machines that use atmospheric air and extract oxygen.
Q: How effective is it? And how often should I use it if I am a positive patient recovering at home?
When we wean patients off oxygen and send them home, we prescribe low-flow oxygen. Yes, this can be used at home. But one of the precautions is that you don't have to have a smoker nearby.
There is a very good chance of a fire hazard. You have to be very careful with these concentrators. You must not keep any kind of inflammatory material around it. But it's not a treatment for Covid-19.
Q: Do inhalers work when my oxygen level drops?
- BELA SHARMA, ADDITIONAL DIRECTOR, INTERNAL MEDICINE, FORTIS MEMORIAL RESEARCH INSTITUTE, GURUGRAM:
Studies in Europe have shown that steroid inhalers have worked very well for Covid patients. But this alone will not help. The person will require an oxygen concentrator or oxygen in the hospital. If inhalers are used judiciously, they definitely have a role.
Most patients can be managed in home isolation. The number of patients needing hospitalisation is quite less. But if the fever is not coming down, if oxygen saturation is dipping, if the CT scan is changing, we need hospitalisation.
Q: What's the right oxygen level that should give me a sense of security? And when should I start worrying?
- SAMRAT D SHAH, HONORARY INTERNIST TO GOVERNOR OF MAHARASHTRA, AND INTERNAL MEDICINE SPECIALIST:
When you get a fever, there tends to be a subtle decline in your oxygen saturation. But if there is a three percent drop in your oxygen saturation, that's a matter of concern.
If a person suffers from shortness of breath and it's going up from the fifth day to the eighth day and is now breathless, that's another symptom I follow very closely.
Q: Does an oxygen saturation reading of less than 94 mean I need hospitalisation?
Not really. You can really do well at 90-91 also. But it's an alarming signal. You need to bring it to the notice of your doctor.
Whether you need steroids or you need hospitalisation, your doctor will decide. But 94 and below, it's a matter of concern.
