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Study Shows Inaccurate Pulse Oximetry Readings May Have Delayed COVID-19 Treatment for Black and Hispanic Patients
A recent study published in JAMA Internal Medicine investigated whether pulse oximetry readings were accurate or whether there may be racial and ethnic biases in pulse oximetry which may have led to delayed care. The study looked back at patients with COVID-19 as well as pulse oximetry readings and arterial blood gas levels. 7,126 patients with COVID-19 were identified, and out of those, 1,216 individuals had both pulse oximetry readings as well as arterial blood gas levels. In these individuals, it was found that for Asian, Black, and Hispanic patients, pulse oximetry overestimated oxygen levels in these individuals compared to white patients. In addition, among the remaining patients who did not have arterial blood gas levels but other data available along with pulse oximetry readings, it was found that 1,903 Black and Hispanic patients systematically failed to received COVID-18 therapy even though they qualified, in part due to pulse oximetry readings overestimating blood oxygen levels for these individuals.
Pulse oximetry is an incredibly common tool in medicine to quickly measure an individual’s blood oxygen levels. Since the COVID-19 pandemic began, it has been used widely, however data has suggested that pulse oximetry has not been the most accurate tool, particularly for racial and ethnic minorities. This study highlights the potential effects of such a tool being used as well as highlights a huge inequitable part of medicine. Without the same, quick, and accessible tools to determine severity of an individual’s condition, racial and ethnic minorities, particularly Black and Hispanic folks in this study, suffer from delayed therapy and thus, worse health outcomes. This is, unfortunately, not the only example of systemic racism in healthcare, but it is a timely and crucial example during this COVID-19 pandemic knowing that Black and Brown communities have been disproportionately affected.
COVID-19 Cases Could Be 30 Times Higher Than Reported
For months, we've known that COVID-19 case counts are dramatically incorrect, massively undercounting the actual numbers, and we now have some preliminary data that shows how large the disparity is. A new survey from New York City found that case counts of COVID-19 this spring were likely undercounted by a factor of 30. If this discrepancy is consistent in Michigan, it would mean that when Michigan reported 2,223 confirmed cases on Tuesday, the real number would be around 67,000 cases that day. That value would be nearly three times the highest number ever recorded by the state, back in early January. Nationwide, the CDC is currently reporting an average of around 100,000 new cases per day, which would be 3 million per day, if the 30:1 undercount rate holds true. Even if the true factor was only one third of what the study's authors claim, that would still represent a million new cases per day in the U.S.
Testing used to be conducted at centralized, professional facilities, with all results entered into county and state health department databases, and finally reported to the CDC. Now, most testing is being conducted using at-home tests and results are not being reported to health departments. As a result, the number of positive cases detected is only a small fraction of what's actually occurring, incorrectly making it look like there are very few cases in comparison to times earlier in the pandemic when we had more accurate data.
"‘We’re playing with fire’: US Covid cases may be 30 times higher than reported"
"Trends in Number of COVID-19 Cases and Deaths in the US Reported to CDC, by State/Territory"
Recent Clinical Trial Shows Two Drugs Reduced Chance of Death for COVID-19 Patients
In a recent U.S. National Institutes of Health (NIH) news release, it was announced that two drugs were shown to improve clinical status and reduce deaths in patients hospitalized with COVID-19. The drugs infliximab, brand name Remicade and made by Johnson and Johnson, as well abatacept, brand name Orencia and made by the company Bristol Myers Squibb, are both considered immune-modulator drugs, drugs that work on our immune system, and are used for other conditions, particularly autoimmune diseases. These drugs were studied to see if they could potentially shorten recovery time from those with COVID-19, and while the clinical trial did not show this, it did show these two drugs improving clinical status and reducing deaths. This is an example of the ongoing Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) public-private initiative by the NIH to find more ways to treat and help those with COVID-19, including investigating already existing drugs. Research is still ongoing, and while some existing drugs have been shown to not be effective in treating COVID-19, these two drugs may be examples of existing drugs that might help reduce deaths due to COVID-19.
Study Shows the Black Hospital Patients Are More Likely To Be Subjected to Security Responses and Restraints
A study published last month found that Black patients in hospitals are more likely to be subjected to security emergency responses and physical restraints than white patients. These security responses are intended to protect the safety of staff and patients, but can have health impacts on patients and can even cause death. Additionally, the higher incidence of these types of responses is likely to result in many Black people avoiding or being less likely to seek care at hospitals and healthcare facilities, knowing that even when trying to seek medical care, they will be treated as a threat and will be subject to physical attacks.
This is only one of many forms that medical racism takes, all of which work together to reduce healthcare access and reduce healthcare effectiveness for BIPOC in the United States.
"Black patients more likely to face hospital security response, study shows"
"Race and Ethnicity and the Utilization of Security Responses in a Hospital Setting"
Recent Study Out of Paris Shows Trained Dogs Can Detect COVID-19
A recent study published in the journal PLOS One found that dogs trained to detect COVID-19 in symptomatic and asymptomatic individuals did so with high accuracy. Dogs using smell, primarily of sweat, were compared against rapid nasopharyngeal antigen testing as well as against saliva and nasopharyngeal RT-PCR testing. The dogs were shown to be 97% accurate in symptomatic individuals, and 100% accurate in those who were asymptomatic when compared with RT-PCR. Overall, the dogs were shown to be more sensitive than rapid antigen tests, although specificity was a bit lower. In addition, this study was done in early 2021, before many variants appeared. While that research is ongoing, it might be interesting to see whether specially trained dogs might be a way to very quickly identify COVID-19!
California Task Force Releases 500-page Report on Harms Done to Black People
On Wednesday, the California Task Force to Study and Develop Reparation Proposals for African Americans released their Interim Report. The 492-page document details the harms done to Black people through Enslavement, Racial Terror, Political Disenfranchisement, Housing Segregation, Racism in Environment and Infrastructure, Pathologizing Black Families, Control Over Creative Cultural and Intellectual Life, Stolen Labor and Hindered Opportunity, An Unjust Legal System, Mental & Physical Harm and Neglect, and The Wealth Gap. The report calls for the creation of a California African American Freedmen Affairs Agency to be tasked with implementing recommendations.
Some highlights, according to Politico:
"Estimating the value of Black-owned businesses and property in California that was stolen or destroyed through acts of racial terror, distributing that money to Black Californians, and making housing grants and zero-interest business and housing loans available."
"Compensating residents who were forcibly removed from their homes by the state through eminent domain construction projects — and families who were denied inheritances because of laws criminalizing interracial marriage."
"Repealing Article 34 of the California Constitution, which requires cities to get voter approval before building public housing."
"Creating a state-subsidized mortgage program to provide low interest rates for qualified applicants."
"Providing more students free tuition at California colleges and universities."
"Raising the minimum wage and requiring health benefits and paid time off for workers in food and hospitality services, agricultural, food processing and domestic-worker industries."
"Requiring that incarcerated people be paid market rate for their labor in prison and be allowed to vote."
"California Task Force to Study and Develop Reparation Proposals for African Americans: Interim Report"
"Reparations task force releases historic report"
"Historic California report on systemic racism in law and policy hailed by slave reparations advocates"
This Week's QM Round-Up Contributors (in alphabetical order):
Wilfredo Flores (he/him/his), PhD in Writing and Rhetoric, M.A. Technical Communication
Grey L. Pierce (they/them); M.A., Cognitive Psychology; Chair, Power of We Consortium
Francis Yang (he/him/his), M.S.-Global Medicine, Third-year medical student