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Pulse oximeters and COVID-19: what you need to know

This everyday medical device is suddenly in high demand for its potential in monitoring COVID-19 symptoms, but don't rush out to buy one just yet

Pulse oximeters and COVID-19: what you need to know

A pulse oximeter is a small device that clips onto your finger and monitors oxygen levels in the blood. They have been getting attention lately for their potential to help monitor symptoms of COVID-19 at home, but the medical experts we spoke to don’t think this means you need to worry about buying one.

One of the many strange things about this new coronavirus is that some patients with very low blood oxygen levels (which require medical treatment) aren’t always aware of it. They may not feel particularly unwell or have other symptoms of low oxygen levels.

This has led some doctors – especially in the US – to suggest that pulse oximeters might help people track symptoms at home.

As official advice tells us to monitor COVID-19 symptoms at home where possible, a health device that tells you about your blood oxygen levels sounds like something handy to have.

But even though they are used commonly in clinical settings, their value for otherwise healthy people at home is limited. Used incorrectly, they may give inaccurate or poor readings, and it’s unwise to rely on them without wider diagnostic support from a medical professional.

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What does a pulse oximeter do?

A pulse oximeter is a small device that clips onto your finger, and measures your pulse and the percentage of oxygen in your blood, by shining a light into your finger.

According to the British Lung Foundation, the normal blood oxygen saturation level for someone who’s healthy will be around 95–100%. If the oxygen level is below this, it can be an indicator that there is a lung problem.

A level below 92% (or 88% for people with chronic obstructive pulmonary disease – COPD) would suggest someone is seriously ill and may need supplementary oxygen or to be monitored in hospital.

Pulse oximeters are common medical devices that have been used in some form since the 1970s. They are used most often by people with respiratory problems, and also sometimes by athletes and pilots who have to monitor blood oxygen levels.

They are mostly used for tests and monitoring in clinical settings, such as at the GP surgery or in hospital, but for specific groups of people (like those mentioned above), they might be useful for home monitoring too.

Can a pulse oximeter diagnose COVID-19?

There has been some confusion over this, but the answer is no.

A pulse oximeter may signal issues with blood oxygen levels, which could be related to coronavirus, but it’s only one part of a wider diagnostic picture.

Londonwide LMCs, a representative committee of NHS GPs in London, advises that: ‘pulse oximetry can be a useful aid to clinical decision-making but it is not a substitute for a clinical assessment, nor sufficient for diagnosis by itself.’

Some doctors have suggested discharging people with a pulse oximeter if they’ve been diagnosed with COVID-19 or have suspected symptoms but aren’t ill enough to stay in hospital.

But there isn’t a consensus on how and when this would be most useful or feasible, so it’s a conversation to be had between the individual patient and their doctor.

Should you buy a pulse oximeter?

If you don’t have any underlying respiratory issues and have never used one before, you shouldn’t really need to buy a pulse oximeter. It’s best to only use one if advised by your doctor.

Professor Chris Hui, clinical assistant professor at Hong Kong University and honorary consultant in respiratory and critical care medicine at the Royal Free Hospital London, says pulse oximeters can be useful monitoring and early-alert devices for self-monitoring at home. This is dependent on them being given to the right groups of patients, such as those who are vulnerable, prone to respiratory failure, suffer from a chronic respiratory condition, or require oxygen therapy at home.

Some people have suggested buying one and testing yourself to understand your ‘normal’ oxygen levels as a precaution, but if you haven’t been diagnosed and you’re not experiencing symptoms, this isn’t necessary.

The reading won’t be that useful without input from a medical professional, and if you haven’t used one before you may do it incorrectly or misinterpret the results.

Dr Andy Whittamore, clinical lead for Asthma UK and the British Lung Foundation, advised that ‘at this stage, while the use of pulse oximeters in response to COVID-19 is still being examined, it remains really important that before testing at home, people talk to their healthcare professional.’

He adds that ‘any monitoring done at home needs to be part of a clear management plan and is not a substitute for clinical advice. Anyone worried about their symptoms should speak to a doctor.’

As with many coronavirus-related products, demand for pulse oximeters has risen due to the publicity they have received, so be wary of unscrupulous sellers selling these devices online for inflated prices, or without proper safety certificates (approved medical devices in the UK must display a CE mark).

Watch out for counterfeit coronavirus medicines being sold online, and if you’ve seen examples of inflated prices online, report price-gouging to Which? to let us know.

Using a pulse oximeter correctly

Professor Hui says that, although these devices are usually accurate, they need to be used correctly to yield the best information.

  • They need to be held steady in place for 30 seconds – if there is a lot of movement, poor placement or insufficient time for the computer to calibrate, the readings may be difficult to interpret or inaccurate.
  • Avoid nail varnish and false nails – these can block the light from the device getting to your blood and can affect the reading.
  • Medical conditions – some, such as anaemia and Raynaud’s syndrome (where fingers are unusually cold) can affect the accuracy of readings.

Professor Hui adds that the quality of the tech inside oximeters – the quality of the LED diodes, photo detectors and quality of electronics – can also affect accuracy of readings.

Accuracy of the oximeter aside, the key is that it doesn’t tell you everything, so relying on it in place of medical advice could give you false reassurance.

Can your fitness tracker or smartwatch double up as a pulse oximeter?

Some fitness trackers and smartwatches have a pulse oximetry function (often referred to as the SpO2 sensor), but you shouldn’t rely on this reading, as it’s intended for recreational rather than medical purposes.

Popular smartwatch brand Garmin says that knowing your oxygen saturation can help you determine how your body is acclimatising to high altitudes (for alpine sports and expeditions), and can also be useful for flagging signs of sleep apnoea, or if you’re overexerting yourself during exercise.

But it does state clearly that the data is not intended to be used for medical purposes, or to diagnose, treat, cure or prevent any disease or condition.

Accuracy may be compromised by the location of the device: fitness trackers take blood oxygen measurements from the wrist rather than the fingertip.  Here they are more likely to move around, and there is a lower concentration of blood at the surface level.

We recently tested this feature on a couple of popular wearables – the Huawei GT2, Huawei GT2e, Garmin Venu, Garmin Vivoactive 4 and Honor Band 5.

We compared the results to those taken by a reference medical device on 10 healthy people, all within the normal range of SpO2 sensors. Some were easy to use and accurate, giving readings that were close to those of the reference device, while others were more capricious and required us to take a couple of readings.

Notably, some struggled on darker skin, due to the technology involved in taking a reading. One model we looked at is pretty useless unless you have pale white skin.

Even for those devices that worked well on everyone, we’d recommend taking two readings to confirm the values.

And, it’s worth reiterating that fitness trackers and smart watches aren’t medical devices, so you shouldn’t rely on them to detect a problem. However, if you do notice something unusual, then it’s worth following up with your doctor.

Coronavirus: how to protect yourself and others – we round up what you need to know about protecting yourself from infection, and what to do if you think you have coronavirus.

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