Journal of Correctional Health Care - April 2023 - 145

PULSE OXIMETRY IMPROVES COVID SCREEN SENSITIVITY
145
deviations (SD) from the mean (M) as defined by data
published from population studies that reported a M
SpO2 for males of 97.2% (SD 1.6; Vold et al., 2012)
and M temperature of 97.88F, 95% CI [96.26-99.14]
(Obermeyer et al., 2017).
Several algorithms with various combinations of
symptoms, temperature, and SpO2 were retrospectively
applied to all three of the study groups. A cut-off of 7
days post-initial lab test was used since a positive screen
past this date would have limited impact on controlling
potential spread of the virus given current research on
the periods of infectiousness (He et al., 2020).
Results
A group of 57 individuals with laboratory confirmed
COVID-19 infections and a group of 81 laboratoryconfirmed
controls were identified. Of the 57 individuals
with infections, 22 (39%) were classified as symptomatic
and 35 (61%) were asymptomatic. The majority of infections,
55 (97%), were from an outbreak of COVID-19 on
two different housing units in late May. Two additional
infected individuals were found from June to August
2020.
Two infected individuals from the outbreak in May initially
had a negative Abbott Rapid ID Now test. However,
they became symptomatic and febrile on the same day as
their cohort on their housing unit, and were identified later
with a positive follow-up laboratory test; thus, they were
treated as laboratory-confirmed infections with the date of
onset of their illness treated as the date they became
symptomatic. Unfortunately, two (4%) of the individuals
did not survive and one (2%) had a severe illness that required
intubation and mechanical ventilation; however,
they were included as each case had vitals from the first
several days of their illness.
Of the controls, 259 were excluded, the majority of
which were due to not having pulse oximetry data or having
only received temporal thermometry. There were 11
''presumed positive'' infections: 6 (55%) from the initial
outbreak cohort that were not on either of the 2 housing
units where the outbreak occurred, 4 (36%) from different
housing units after the initial outbreak, and 1 (9%)
from one of the initial outbreak housing units.
Data for age, BMI, PMH, T-max, and SpO2-min are
summarized in Table 1. There were no differences between
groups for age (p= .74) and BMI (p= .52). Data
for SpO2-min and T-max are presented in Figures 1
and 2, respectively.
The M, prevalence, date of onset into the illness, and
duration of hypoxia are summarized in Table 1. Controls
had a higher SpO2-min than both the AC group (p< .001)
and the SC group (p< .001), but there was no difference
between AC and SC (p= .3). Supporting the finding of
asymptomatic hypoxemia in COVID-19, when comparing
the SpO2-min of the eight (14%) individuals with a
complaint of dyspnea versus the 49 (86%) without,
there was still no difference (p= .2). Of the four controls
with a SpO2-min £95%, three (75%) had a BMI between
33.9 and 38.9, and one (25%) had sickle cell disease.
The M and SD for T-max is summarized in Table 1.
There was a significant difference (p< .001) between
all groups for T-max. A T-max ‡99.6F was rarely seen
in AC, yet a T-max ‡99.1F was seen in the majority
of AC while being very rare in controls.
The results of the screening algorithms are shown in
Table 2. Traditional screening algorithms that rely
Table 1. Characteristics of Controls and Asymptomatic and Symptomatic COVID-19 Infections
Characteristics
Age, M (SD), years
Body mass index, M (SD), kg/m2
Cardiac disease history, n (%)
Pulmonary disease history, n (%)
Mental health disease history, n (%)
Over-the-counter antipyretic medication use, n (%)
T-maxc M (SD),F
SpO2-mind, M (SD), %
No. (%) with SpO2£95%
M (SD) onset of SpO2 £ 95%, days
M (SD) duration of SpO2£ 95%, days
No. (%) with SpO2£94%
M (SD) onset of SpO2 £ 94%, days
M (SD) duration of SpO2£ 94%, days
All groups received COVID-19 laboratory testing for diagnosis.
aAsymptomatic infection are defined as having no reported symptoms 7 days prior to and 14 days after testing.
bSymptomatic infections are defined as having a COVID-19 symptom either 7 days before or 14 days after testing.
cT-max, Maximum recorded temperature in the 7 days prior to or 14 days after testing.
dSpO2-min, Minimum recorded SpO2 in the 7 days prior to or 14 days after testing.
M, mean; SD, standard deviation; SpO2, blood oxygen saturation; Temp, temperature.
47.4 (12.6)
29.6 (6.7)
9 (11)
8 (10)
2 (3)
0 (0)
98.53 (0.3)
97.2 (1.3)
4 (5)
3.5 (4)
1.8 (1.5)
2 (2)
5
1 (0)
45.6 (10.7)
28.4 (5.8)
0 (0)
3 (9)
8 (23)
2 (6)
99.19 (0.36)
94.4 (1.4)
29 (83)
3.9 (3)
3.9 (3.1)
17 (49)
5.4 (3.5)
2.1 (1.3)
Controls (n= 81) Asymptomatic infectionsa (n= 35) Symptomatic infectionsb (n= 22)
46.0 (14.4)
28.9 (5.0)
3 (14)
2 (9)
9 (41)
7 (32)
100.97 (1.41)
93.0 (3.1)
21 (95)
2 (2.2)
4.7 (4.5)
14 (64)
3.3 (3.3)
3.7 (3)
Journal of Correctional Health Care - April 2023

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