Oxygen and Mortality in COVID-19 Pneumonia: A Comparative Analysis of Supplemental Oxygen Policies and Health Outcomes Across 26 Countries

Abstract

Introduction: Hypoxia is the main cause of morbidity and mortality in COVID-19. During the COVID-19 pandemic, some countries have reduced access to supplemental oxygen, whereas other nations have maintained and even improved access to supplemental oxygen. We examined whether variation in the nationally determined oxygen guidelines had any association with national mortality rates in COVID-19.Methods: Three independent investigators searched for, identified, and extracted the nationally recommended target oxygen levels for the commencement of oxygen in COVID-19 pneumonia from the 29 worst affected countries. Mortality estimates were calculated from three independent sources. We then applied both parametric (Pearson's R) and non-parametric (Kendall's Tau B) tests of bivariate association to determine the relationship between case fatality rate (CFR) and target SpO2, and also between potential confounders and CFR.Results: Of the 26 nations included, 15 had employed conservative oxygen strategies to manage COVID-19 pneumonia. Of them, Belgium, France, USA, Canada, China, Germany, Mexico, Spain, Sweden, and the UK guidelines advised commencing oxygen when oxygen saturations (SpO2) fell to 91% or less. A statistically significant correlation was found between SpO2 and CFR both parametrically (R = −0.53, P < 0.01) and non-parametrically (−0.474, P < 0.01).Conclusion: Our study highlights the disparity in oxygen provision for COVID-19 patients between the nations analysed. In those nations that pursued a conservative oxygen strategy, there was an association with higher national mortality rates. We discuss the potential reasons for such an association.

Patients' experiences of, and engagement with, remote home monitoring services for COVID‐19 patients: A rapid mixed‐methods study

“… 29 , 30 If patients do not engage with these services, they may be at risk of negative outcomes that the service aimed to prevent, for example, silent hypoxia (very low oxygen saturations, often without breathlessness) 36 and/or delayed admission to hospital. 37 , 38 Additionally, if engagement is limited, then it is not possible to evaluate whether or not the service influences key outcome measures such as any changes in mortality or hospital use. This study addresses this gap by evaluating patient experience of and engagement with COVID‐19 remote home monitoring services.…”

Standard of care for COVID-19 in randomized clinical trials registered in trial registries and published in preprint servers and scholarly journals: a cross-sectional study

“…Combined, the target SpO2 for the commencement of oxygen and target oxygen saturation for ongoing treatment varied from 90 to 98%. In nations that used a conservative oxygen strategy, they found an association with higher national mortality rates [17]. Some components of SoC were likely motivated by reports about clinical abnormalities observed in the COVID-19 patients.…”

The Misattributed and Silent Causes of Poor COVID-19 Outcomes Among Pregnant Women

“…Importantly, a disparity in oxygen provision for COVID-19 patients between different countries was recently demonstrated, and a strong inverse correlation has been demonstrated between the national thresholds for the commencement of oxygen support and national case fatality rates ( 114 ). Therefore, an examination and re-assessment of national thresholds for the commencement of oxygen support, adjusted to the COVID-19 pandemic, are justified.…”