Remote management of covid-19 using home pulse oximetry and virtual ward support

Negative antigen RDT and RT-PCR results do not rule out COVID-19 if clinical suspicion is strong – Authors' reply

“…Pulse oximetry is a proxy measure of arterial oxygenation, a prognostic indicator, and recommended for inpatient and remote monitoring of patients with confirmed or possible COVID-19 to identify silent hypoxaemia and limit risk of significant deterioration. 3 We believe pulse oximetry is a more practical risk-stratification tool for confirmed or possible COVID-19 patients, especially in low-resource settings. Those with pulse oximetry levels lower than 92% should be managed as severe COVID-19 disease, per WHO guidelines.…”

Pulse oximetry gives artificially high readings in presence of carboxyhaemoglobin

“…Greenhalgh and colleagues omit a serious limitation of two wavelength pulse oximetry 1. They mention “falsely low readings with certain haemoglobinopathies,” but a much more important danger is that standard two wavelength pulse oximeters give artificially high readings in the presence of circulating carboxyhaemoglobin to the extent that the pulse measurement of oxygen saturation approximately equals arterial blood oxygen saturation (SaO 2 %) plus carboxyhaemoglobin (COHb%).…”

You can’t stop the bleep

“…Another is safety, but Trisha Greenhalgh and colleagues explain how clinical support is also required in the form of phone calls—for example, as part of a virtual ward setting. Importantly, services must be adapted to local settings 6…”