Several issues related to COVID-19 are being pointed out by both electronic and print media these days. One such important issue is about fingertip pulse oximeters. We have to examine this issue very carefully as incorrect measurements can misguide healthy people as well. There is a possibility of a person getting a sudden heart attack or a panic attack due to false readings given by a low quality, toy-type pulse oximeter. Then who will be responsible for those lives? Who could be the culprits? What can we do to save our precious lives?
A pulse oximeter is a medical device that indirectly monitors the oxygen saturation of a patient’s blood (as opposed to measuring oxygen saturation directly through a blood sample) and changes in blood volume in the skin, producing a photoplethysmogram that may be further processed into other measurements. The pulse oximeter may be incorporated into a multiparameter patient monitor. Most monitors also display the pulse rate. Portable, battery-operated pulse oximeters are also available for transport or home blood-oxygen monitoring.
Pulse oximetry is a noninvasive method for monitoring a person’s oxygen saturation. Peripheral oxygen saturation (SpO2) readings are typically within two percent accuracy (within four percent accuracy in the worst five percent of cases) of the more desirable (and invasive) reading of arterial oxygen saturation (SaO2) from arterial blood gas analysis. But these two are correlated well enough that the safe, convenient, noninvasive, inexpensive pulse oximetry method is valuable for measuring oxygen saturation in clinical use.
The most common approach is transmissive pulse oximetry. In this approach, a sensor device is placed on a thin part of the patient’s body, usually a fingertip or earlobe, or an infant’s foot. Fingertips and earlobes have higher blood flow rates than other tissues, which facilitate heat transfer. The device passes two wavelengths of light through the body part to a photodetector. It measures the changing absorbance at each of the wavelengths, allowing it to determine the absorbencies due to the pulsing arterial blood alone, excluding venous blood, skin, bone, muscle, fat, and (in most cases) nail polish.
By now there is a severe shortage of high quality National Medicines Regulatory Authority (NMRA)-approved pulse oximeters in the market. Because of this shortage, a lot of people have put various types of very low quality or toy-type pulse oximeters on the market for extremely high prices, sometimes even at Rs. 5,000. But before the COVID-19 outbreak, the price of a pulse oximeter was a maximum Rs. 2,000. Some of those pulse oximeters are just pre-programmed toys. That means those instruments only show a value that was entered during the manufacturing process, but not the actual oxygen saturation level of the person who uses it. Some of those toy-type pulse oximeters which are being sold in some private pharmacies work even when a pen, stick or something like that is placed instead of a finger.
If you want to purchase a high quality pulse oximeter, it is better to go to an Osu Sala outlet or a reputed private pharmacy than buying from any other private pharmacy. The instrument should have the approval of the NMRA, a warranty period and the name and other details of the agent. It should contain the details of the after-sales service as well. It is just as same as any other medical device and therefore all details mentioned on the box and the receipt of those other medical devices should be available for pulse oximeters and nothing can be omitted. It is exactly the same details that you receive when you buy a glucometer, pressure meter etc.
When a healthy individual gets wrong readings from a low quality/toy oximeter, he/she would run to a hospital which is full of COVID-19 patients and that would result in that person getting infected within seconds when outside. He/she may come back home happily from the hospital or any other place after getting his/her real and accurate oxygen saturation level tested by a high standard pulse oximeter. But by then, he/she would be actually harbouring the COVID-19 virus inside his/her body, carried from that hospital/any other place. That person has now become a carrier. It can be the three wheeler driver or any other driver of an air-conditioned cab which transported him/her to the hospital who transmitted the virus. The fake/toy pulse oximeter is responsible if that person dies from COVID-19.
According to the few importers (around three) of high quality pulse oximeters with the NMRA approval, it is the responsibility of the NMRA to assist the police to raid fake/toy pulse oximeters available all over the country at extremely high prices. The police do not need to request the NMRA for assistance and it is the NMRA which should obtain the assistance for raids. Some media reported recently the NMRA conducted a few raids and around 3,500 fake low quality pulse oximeters were taken into custody. The media also reported the possibility of introducing a price control for pulse oximeters.
According to them, what available in the market are some fake/toy pulse oximeters brought into the country, hiding inside travelling bags or through boats from foreign toy factories and low quality companies. They are pre-programmed toy pulse oximeters which show whatever the readings entered before and not the readings of the person who uses them.
When considering the current situation, it is better to stay at home safely if you feel you are healthy. It is up to us to decide whether to trust the readings of a pre-programmed toy oximeter bought from a private pharmacy after spending nearly Rs. 8,000 or to stay at home comfortably while carefully monitoring ourselves. We can check whether anything unusual is happening inside our bodies. For instance, an uncomfortable feeling or difficulty in breathing can be carefully examined when we engage in our usual routines such as walking up to the gate and coming back, walking to the toilet located outside home etc.
It is much better to make sure that the COVID-19 virus does not enter into our bodies than to check our oxygen saturation levels all the time using a fake/toy pulse oximeter. We have to do only a few simple things. They are wearing a standard mask properly covering both nose and mouth all the time when we go out of our houses, making sure to avoid touching the mask or taking it off in the middle of a crowd or an-air conditioned or tightly-closed hall/room with several people inside it, keeping at least two-metre distance from any person all the time, washing hands with soap and water for 30 seconds or using a standard hand sanitiser often or especially before touching the parts above our shoulders.
No matter whether it is Delta, Epsilon or any other new COVID variant that spreads in Sri Lanka, we can protect ourselves and lead a new normal and comfortable life if we do these. Another most important factor is ‘Speaking Up!’. We should speak up whenever we see a person without a mask or with an improperly-worn mask in front of us because that specific person can infect us with the deadly COVID-19 no matter how careful we are. Being vigilant all the time whenever we step out of our homes is essential.
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