‘Persistent hypoxia’ triggered deaths of patients

Taking steps to pick up warning signs early: experts

Persistent hypoxia (reduced oxygen in the cells) was the main trigger for the deaths of persons who had tested positive for COVID-19 in the State, according to senior doctors.

Tamil Nadu, which reported the first death of a COVID-19 patient on March 25, has recorded a total of 11 deaths of persons aged between 45 and 75 years so far. At least five of them are women. Some of them had comorbidities, including diabetes and hypertension.

Officials of the Health Department said each of these deaths was being audited, and treatment and monitoring protocols were being tweaked for better management of patients, and to prevent further deaths.

“All these patients had persistent hypoxia. This was the trigger. In some patients, it happened all of a sudden. In some, their condition did not improve even with us providing oxygen supply. So, we are taking measures to detect hypoxia early. It is important to pick up the signs early. We have modified the protocols, making it practical for better management of patients,” a senior doctor said.

Constant monitoring

Pulmonologists explained that hypoxia basically means reduced oxygen in the cells, and in COVID-19 cases, typical for critical cases. When the lungs are damaged, adequate oxygen does not reach the cells. This leads to resistance to treatment.

Doctors said that they were monitoring the oxygen saturation levels in patients using pulse oximeters. “Some patients, who have tested positive for COVID-19, have no symptoms. They were identified during contact tracing and isolated. We see that they are doing fine during rounds. On the second or third day, they develop breathlessness when they walk. So, for patients who are ambulant, we are using finger pulse oximeters once in two to three hours. This way, we are able to find the oxygen saturation in the blood. We can pick up early signs before their condition deteriorates,” a doctor involved in the treatment of COVID-19 patients said.

He explained that in patients with COVID-19, the fluid in the lungs interferes with the oxygen transfer to the blood. As a result, there is a decrease of oxygen levels.

He added that patients undergo chest X-ray on admission. “We see if there are findings suggestive of involvement of the lungs. Even if it is mild, we bring these patients under our radar and they are monitored frequently. Supplementary oxygen is also provided, and there are instances where patients have recovered well,” he said.

If the patients have a saturation level of above 96% or 97% in the room air environment, they are taken off the radar, while others with 93% or 94% are monitored, he said.