Written by Dr Karen Morton

Founder and Medical Director of Dr Morton’s – the medical helpline

We are monitoring our own health more intensively than ever before! In truth it started long before the COVID-19 pandemic with Apps to download to record everything from your menstrual cycle to trying to be three consecutive days alcohol-free, together with wearables recording your heart rate, number of steps, pulse rate, calorie consumption and even your ECG. A sensor can be attached to the back of your arm if you have diabetes and without drawing blood you can have a blood glucose level measurement by passing your phone over the device. Goodbye wrist watches; hello Fitbits!

Every day over the past month over 200,000 people daily have rung NHS 111 or used 111 online to report possible COVID symptoms to get advice about symptoms which could be COVID related. Hundreds of doctors have been appointed to ask and assimilate the answers to questions which will decide whether the caller is ill enough to warrant attending the local hospital for further assessment. Bear in mind that a huge priority has been to conserve hospital beds and particularly intensive care beds for those who really needed them.

Several of our GP advisors have been working for the NHS 111 call service and all have been instructed to ask the same 7 questions:

1. How is your breathing today?

2. Are you so breathless that you are unable to speak to me more than a few words?

3. Are you breathing harder and faster than usual when doing nothing at all?

4. Are you so ill that you’ve stopped doing your usual daily activities?

5. Is your breathing faster slower or the same as normal?

6. What could you do yesterday that you can’t do today?

7. What makes you breathless now that didn’t make you breathless yesterday?

Experienced doctors being asked to behave like an artificial intelligence algorithm rather than using their clinical judgment; but hey ho…..it introduces some uniformity to the system. After all, some of the doctors called back into practice have not listened to a chest or diagnosed pneumonia for many a long year.

Healthy people would saturate their blood with oxygen when breathing air (which contains 22% oxygen) to around 98%. If the saturation falls below 95% there is something wrong. No matter how the person may feel they are coping……. they are not! Every tissue in their body will now be getting less oxygen than it needs and some cells will be injured and die in the process, and the situation will escalate into something worse. It may be that all that is needed is to breathe extra oxygen.

‘Early recognition of deteriorating symptoms by the patient is crucial in speeding up the presentation to hospital emergency services, to ensure appropriate treatment and care is provided. We know that provision of simple measures to severely ill patinets such as oxygen and fluids can save lives in COVID-19 infection, for which, as yet, there are no known effective drug treatments.’

‘When caring for COVID-19 patients, continuous monitoring of blood oxygen saturation/pulse oximetry is vital to assess the ability of the lungs to absorb, and the ability of the blood o carry, oxygen. Sadly critically ill patients who die from COVID-19 usually die because they are unable to absorb enough oxygen from the lungs in order for vital organs to function. Multi-organ failure ensues. Home monitoring of blood oxygen saturations could play a valuable role in helping to detect deterioration in lung function earlier, allowing earlier presentation to emergency services for life’

So how much better would it be if instead of the seven questions, the doctor asked;

1. What is your temperature?

2. What is your pulse rate?

3. What is your blood pressure?

4. What is your oxygen saturation %?

Together these are called ‘the observations’, in medical speak. They speak volumes!

These are not expensive or complicated bits of kit. Our pregnant women monitor their own blood glucose and take their own blood pressure and dip their own urine. Results can even be blue-toothed in so that we (the obstetricians and midwives) can look at our women’s results on a moment by moment basis without the woman having to go to a clinic or hospital. This represents huge savings of time and money, and additional safety; quite apart from reducing the carbon footprint.

So people should have:

1. a good digital thermometer

2. a good blood pressure machine which will automatically give a pulse rate

3. a pulse oximeter which is literally a soft clip, placed over the tip of a finger and gives a readout as a percentage

This will be a turning point in so many ways and one will be enhanced knowledge about how our body works and an increased wish to be more in control of our health.

This blog was first published on 25/05/2020