There might be many reasons why a Covid case could wind up in the ER, then be admitted to the hospital.
Low blood oxygen is the main reason for which I have seen people check themselves in to a hospital.
I believe that with the right interventions and early treatment, a dropping oxygen level can and should be handled to avoid hospital outcomes.
The main reasons for dropping oxygen levels that I will cover below are clotting and inflammation.
From What Is Inflammation of the Lungs? (verywellhealth.com):
Symptoms of lung inflammation can include:
- Feeling tired after physical activity
- A general sense of fatigue
- Dry or productive (i.e., mucus-producing) cough
- Trouble breathing
- Chest discomfort or tightness
- A sense of lung pain
- Gasping for air
What can be done about inflammation?
The FLCCC protocol calls for using steroids after Day 7, if oxygen saturation is 88-94 %. (see red arrow in picture below). Their steroid of choice is prednisone.
Dr DeMello uses the steroid dexamethasone, also after the initial viral phase, when needed. Another anti-inflammatory used by Dr DeMello is colchicine, administered at the start of infection without delay. (What is colchicine?). In addition to dexamethasone and colchicine, Dr DeMello also uses histamine blockers of two types: H1 blocker cetrizine (Zyrtec) and H2 blocker famotidine (Pepcid) – both are available over the counter – at the start of symptoms. (There are many technical articles on the role of H1 and H2 blockers in Covid that you can look up).
If you are consulting with a doctor in the US, make sure to discuss steroids and histamine blockers to manage inflammation. (Note: Steroids are not to be used in the first week as they inhibit necessary immune response in the first week of infection).
This article from Boston University from October 2020 describes what is called “silent hypoxia” – low oxygen levels without shortness of breath or difficulty breathing:
BU biomedical engineers used computer modeling to investigate why blood oxygen drops so low in many COVID-19 patients
Here are some excerpts that I found particularly interesting.
“One of the biggest and most life-threatening mysteries is how the virus causes “silent hypoxia,” a condition when oxygen levels in the body are abnormally low,”
“Despite experiencing dangerously low levels of oxygen, many people infected with severe cases of COVID-19 sometimes show no symptoms of shortness of breath or difficulty breathing.”
“Healthy lungs keep the blood oxygenated at a level between 95 and 100 percent—if it dips below 92 percent, it’s a cause for concern and a doctor might decide to intervene with supplemental oxygen.”
“Next, they looked at how blood clotting may impact blood flow in different regions of the lung. When the lining of blood vessels get inflamed from COVID-19 infection, tiny blood clots too small to be seen on medical scans can form inside the lungs.” [emphasis mine]
What do you mean, “tiny blood clots too small to be seen“?
This is also called “micro-clotting” and is of utmost importance in the treatment of Covid infections (see article below).
“Clotting in really sick COVID-19 patients is not something trivial and unimportant — it may well be fundamental to what is going on.“
The quote above is from this article on micro-clotting:
What can be done about clotting?
First, some definitions:
Thrombosis occurs when blood clots block your blood vessels. There are 2 main types of thrombosis: Venous thrombosis is when the blood clot blocks a vein. Veins carry blood from the body back into the heart. Arterial thrombosis is when the blood clot blocks an artery.
Fibrinogen: a soluble protein present in blood plasma, from which fibrin is produced by the action of the enzyme thrombin.
Fibrin: an insoluble protein formed from fibrinogen during the clotting of blood. It forms a fibrous mesh that impedes the flow of blood.
Platelet: An irregular, disc-shaped element in the blood that assists in blood clotting. During normal blood clotting, the platelets clump together (aggregate). Although platelets are often classed as blood cells, they are actually fragments of large bone marrow cells called megakaryocytes. If your blood has too many platelets, you may have a higher risk of blood clots.
There are two classes of antithrombotic [preventing “thrombosis” or clots] drugs: anticoagulants and antiplatelet drugs. Anticoagulants slow down clotting, thereby reducing fibrin formation and preventing clots from forming and growing. Antiplatelet agents prevent platelets from clumping and also prevent clots from forming and growing.
The FLCCC recommends daily aspirin under their Anticoagulant section (see red box in above picture).
Dr DeMello uses the follopwing drugs to prevent and combat micro-clotting:
Clopidogrel (brand name Plavix). It is an antiplatelet medicine. This means it reduces the risk of blood clots forming.
Colchicine – Dr DeMello has used it with great success on over 10,000 patients. From a study (among many others) in Science Direct: “Our data indicate that colchicine exerts anti-platelet effects … suggesting that its beneficial cardiovascular properties may be due, at least in part, to an inhibitory effect of platelet activity”
Enoxaparin (brand name Lovenox – a medication that is self-injected), used in more serious cases as an anticoagulant that helps prevent the formation of blood clots.
Note: You might find doctors in the US practicing telemedicine or in office practice who are willing to prescribe Plavix and Lovenox. Most will be willing to prescribe steroids, even if you have to remind them about it.
Here is an excerpt from my post Directory of Docs:
I very recently heard that Dr Peter Hibberd was a good choice, spent a half hour on the phone in consultation, prescribed differently for different members of the family based on their symptoms, and included anti-clotting medicine (Plavix) where needed (He gets a star from me for this!*)
(561) 655-4477; (561) 725-2356 (text)
(States: FL, TX, CA, IL, CT, IN, KY)
What can you do in addition to medications?
Everyone should have an oximeter to monitor their oxygen saturation level.
Oximeters temporarily clip around your finger and use light to penetrate through your fingernail and get an oxygen reading. Best to not wear nail polish to get an accurate reading.
Oximeters can be purchased at your local drugstore, or ordered from Amazon. (I have no particular brand recommendation.)
Here is an example:
According to the Boston University article above, “Normally, the lungs perform the life-sustaining duty of gas exchange, providing oxygen to every cell in the body as we breathe in and ridding us of carbon dioxide each time we exhale. Healthy lungs keep the blood oxygenated at a level between 95 and 100 percent—if it dips below 92 percent, it’s a cause for concern and a doctor might decide to intervene with supplemental oxygen.” [emphasis mine – see section below]
Dr DeMello’s recommendations for using the oximeter:
Please take, record and track temperature (Why temperature? A new or continuing fever in the secondary clotting phase of the disease, day 7 onward, indicates clotting) and pulse oximeter reading at 8AM, 2PM and 10PM every day for the next 14 days. Anything 95 and above is normal, no damage to the lungs.
What do the numbers mean?
Here is Dr Demello’s scale:
95-100 is ideal
90-94 is concerning
85-89 is very concerning
84 and below requires oxygen, best done by admission to a hospital.
If you are in very concerning range, Dr DeMello can still provide suggestions on treatment for you in order to stay out of the hospital, but would require close cooperation on a daily or hourly basis.
Dr. DeMello is available for consultations for prevention and for suggestions regarding the treatment of Acute Covid infection.
He can be most easily reached on WhatsApp: +91-7718079507 (his preferred method of communication).
He can also be reached by email email@example.com
He also has a website https://www.darrelldemello.in/
What is supplemental oxygen?
It seems to me that in the US doctors are quick to send you to the hospital for supplemental oxygen. In my opinion, (depending on how low you find your oxygen level), they mostly skip the step of providing you with at-home supplemental oxygen.
Having an oxygen concentrator at home can make the difference, and can keep you out of the hospital.
How Does an Oxygen Concentrator Work?
Oxygen concentrators are medical devices that assist people who have a low level of oxygen in their blood. They are powered by plugging the device into an electrical outlet or by using a battery. If a battery is used, then it will need to be charged by plugging it into an electrical outlet. Most concentrators also come with an adapter so you can use the device while you drive.
An oxygen concentrator receives air, purifies it, and then distributes the newly formed air. Before it goes into the concentrator, air is made up of 80 percent nitrogen and 20 percent oxygen. An oxygen concentrator uses that air then it comes out as 90 to 95 percent pure oxygen and 5 to 10 percent nitrogen. The nitrogen is separated to give the patient the highest dose of oxygen possible, as it is difficult to get that percentage of oxygen without the help of a medical device.
(Source: Oxygen Concentrator Store)
I have some personal experience with oxygen concentrators. I have spent many years traveling between Florida and the mountains of Colorado, where I discovered I suffered from intense altitude sickness, which was fully resolved by using an oxygen concentrator off and on during the first day of my trips.
When I started to research “how to stay alive” in these Covid times, I quickly decided that I wanted to own an oxygen concentrator. (They are expensive to buy, but they can also be rented – both require a doctor’s prescription in the US.) I obtained a prescription from a doctor by saying (ahem) that I needed it for future trips to the mountains.
I have lent out this machine to friends in need, and I know that using it has kept at least one person out of the hospital and gotten them through the disease.
Note: You can buy oxygen concentrators on Amazon without a prescription. They are all made in China. Suspiciously, they have very, very few reviews. I have no idea if they work as advertised. And I have no idea how to verify whether or not they work. I suppose you could use one for an hour and see if your oxygen level goes up. Better make sure it’s returnable if you get one. I’m just glad I have my own, made in the USA.
By the way, this is also sold on Amazon, and it is NOT an oxygen concentrator. A concentrator gives you a continuous flow of oxygen all day and all night. I’ve seen these bottles of oxygen up in the mountains, where people use them briefly for altitude headaches. I have never tried one.
Why don’t we hear about oxygen concentrators?
I was simply shocked to discover, upon a quick internet search, that oxygen concentrators are used liberally in India, but somehow we don’t hear anything about them in the US.
Take a look at this article:
I advise everyone to have contact with a doctor during their illness. Here is a list of doctors who are open to early treatment. These doctors will send a prescription electronically to a pharmacy of your choice for any medications you might need. I suggest that before you make contact with one of these doctors, you choose a pharmacy, but also choose a medical supply store that has oxygen concentrators available to rent, and before you hang up with your doctor, tell them to send a prescription for an oxygen concentrator to the medical supply store of your choice. You can decide to wait before you pick up your concentrator and find you do not need it, which is fine. The store will have your prescription on file.
(I get my advice from Dr DeMello in India, but unfortunately, he would not be able to prescribe an oxygen concentrator in the US.)
You should monitor your oxygen with your oximeter every day, several times a day during illness. (I advise you to keep a journal so you can track patterns – it can be normal for oxygen to be lower at certain times of day.)
At the first dip below comfort level (anything below 95), I would start to do the following:
Blowing up balloons and/or using a spirometer (device which you blow into in order to measure lung capacity – you can aim for higher numbers each time). Both are explained in my post Breathing Exercises for Better Outcomes. My husband used the balloon trick and was able to raise his oxygen from 91 to a steady 97.
Using a nebulizer with a low concentration solution of hydrogen peroxide, or with an anti inflammatory like Budesonide could give you results by relieving your lungs of inflammation. See my post Nebulized Hydrogen Peroxide.
During the course of the disease, Dr DeMello recommends getting up and walking (even if around the house) for about 6 minutes each time, and doing proning exercises – both 3-6 times a day (see two examples below).
During the critical clotting period, evening of Day 7 into Days 8, 9, 10 of symptoms (please count your days from the very first symptom, not from your positive test), if oxygen is bouncing between 90% and 95%, if oxygen is mostly below 90%, or if fever is present from Day 7 onward, Dr DeMello recommends staying up at night, starting with the evening of Day 7, with walking and proning exercises off and on through the night, and sleeping during the day. This method and more information about Covid clotting are fully covered in my post Reverse Sleeping Schedule – I recommend you take a look.)
For a quick look, here are two videos demonstrating the proning exercises mentioned. This is NOT passively lying prone (on your stomach) as we have seen in the news.
Proning Exercise Demonstration: https://www.youtube.com/watch?v=z2VaS-exhlg
“Happy Puppy” Proning Exercise Demonstration: https://youtu.be/FmDunxWaMjc
Be well, do well, stay well!