How to manage COVID-19 with breathlessness and low oxygen?

Question

Hello doctor,

A 23-year-old female, weighing 253.5 pounds and 160 centimeters tall, with no history of breathing problems and a non-smoker, reports having COVID-19 for the past week. She experiences significant breathlessness, with her SpO₂ dropping to 93 or 91 but returning to 98 within a minute. When she holds her breath, it drops to 80. She feels confused about these readings. While walking, her SpO₂ is 94 and her pulse rate is 140 bpm. Most of the time, her SpO₂ remains at 99. This fluctuation is confusing.

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Based on the symptoms described, it is strongly advised to visit a hospital or consult a physician immediately. The key concerns include breathlessness accompanied by a drop in peripheral oxygen saturation (SpO₂) to 91 to 93 percent. Although it returns to 98 percent, this temporary drop suggests the lungs may be struggling to meet oxygen demands during physical stress such as walking or breath-holding. Additionally, the SpO₂ falling to 80 percent during breath-holding indicates limited oxygen reserve, which is not typical for a young, otherwise healthy adult.

The heart rate reaching 140 beats per minute (bpm) during walking is notably high and may signal that the heart is compensating for low oxygen levels or systemic stress. The fact that the patient has been COVID-19 (Coronavirus disease) positive for a week is significant, as this period is critical for the development of COVID-related pneumonia or post-viral complications. With a body mass index (BMI) of approximately 45, the risk for lung-related issues is considerably increased, even in the absence of prior respiratory conditions.

These symptoms raise concerns for possible silent hypoxia or early COVID-19 pneumonia, where the lungs may appear normal initially but fail to deliver adequate oxygen under stress. There is also a possibility of microvascular clots or inflammation within the lungs, impairing oxygen exchange.

Immediate actions should include visiting a hospital or emergency department, particularly if breathlessness worsens or oxygen levels drop again. Upon arrival, the patient should request a chest X-ray or high-resolution computed tomography (HRCT) scan to assess for pneumonia. Blood tests such as C-reactive protein (CRP), D-dimer, interleukin-6 (IL-6), ferritin, and lactate dehydrogenase (LDH) can help evaluate the extent of inflammation and clotting risk. An arterial blood gas (ABG) test is also recommended to assess oxygen and carbon dioxide levels more accurately.

If SpO₂ consistently falls below 94 percent, hospital admission is advised. Until hospital care is reached, the patient should rest completely, avoid unnecessary movement, and monitor oxygen levels every 30 to 60 minutes at rest and after minimal exertion, such as walking a few steps. Prone positioning, lying face down, for 30 minutes three to four times a day, may improve oxygenation. Hydration should be maintained, and prescribed medications should be continued unless instructed otherwise. Generic names of common medications used in such cases include Paracetamol (Acetaminophen) for fever, and antipyretics or corticosteroids such as Dexamethasone, if prescribed by a physician.

Emergency medical attention should be sought immediately if SpO₂ remains below 94 percent, if there is difficulty speaking full sentences, if confusion or chest pain occurs, or if the resting heart rate exceeds 120 to 130 bpm.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.