Signs of severe COVID-19 infection vary but can include shortness of breath, an indicator that oxygen levels are low. To measure this, clinicians often use pulse oximeters – portable devices that clip on fingers, ears, or toes – to detect oxygen levels. However, through an analysis published in JAMA Internal Medicine, researchers found that pulse oximeters are more likely to overestimate oxygen levels among adults who identify as Asian, Black, and Hispanic compared to white adults. As a result, these patients may be more likely to miss out on or experience delays in COVID-19-related treatment and care. Examples range from patients receiving remdesivir, an antiviral, to supplement oxygen and other guideline-directed therapies.
To conduct this review, researchers, including those supported by NHLBI, retrospectively analyzed data from patients who had COVID-19 and received hospital care. They compared oxygen levels from pulse oximeters to those taken from blood samples, which are less commonly used but more accurate. The researchers found that one in three patients from diverse racial or ethnic minority groups had lower blood oxygen levels that went undetected through pulse oximetry compared to less than one in five white patients. Black and Hispanic patients were also more likely to miss COVID-19-related treatment compared to white patients. Additionally, Black patients were more likely to experience treatment delays compared to white patients.
The authors conclude that pulse oximeters may be inadequate tools for guiding COVID-19-related treatment decisions. These findings may have implications for guiding treatment for other types of respiratory conditions, including pneumonia.