Health

Pulse oximeters and the fight for racial equity

A pulse oximeter in use (Credit: Adoscam)

By HEATHER M. BUTTS, JD, MPH, MA

Special to the AmNews

Pulse oximeters are a critical healthcare tool that in a time of need can mean the difference between life and death for someone who is sick. At the start of the pandemic, between March and June of 2020, the sale of pulse oximeters for home use increased by 500%. While pulse oximeters are an undeniably powerful medical tool, researchers and advocates have raised concerns about the limits of their effectiveness for some people of color.

A pulse oximeter is a device that measures your blood oxygen level. Blood oxygen information is crucial to life, and is often used by healthcare providers to provide better care for their patients. Home use is also sometimes warranted for certain individuals. According to Nihon Koheden, the company which first patented the device, “It can be fatal if there is not enough oxygen in the blood. Blood sampling does not always provide accurate, real-time information about the patient’s condition, which changes over time, but using a pulse oximeter does not hurt the patient and allows the surgeon to understand, in real time, how much oxygen the patient has in their bloodstream.” Like many medical devices, the pulse oximeter wasn’t created with Black people in mind and the effectiveness of pulse oximeters for people of color is not as high as it is for people with lighter skin.

Dr. Eric Gottlieb, a lecturer at MIT and a physician at Mount Auburn Hospital in Cambridge, Massachusetts who coauthored a study a recent study, when Hewlett Packard developed its pulse oximeter in the 1970s, said the company was aware of issues regarding accurate readings for non-white individuals and “put a lot of effort into trying to solve it, making these devices more equitable.”

However, over time, issues around equity and accuracy of pulse oximeters remained. According to Gottlieb, pulse oximeters “are very, very important and I wouldn’t say that they should be removed from practice, but the question of equity until the last couple of years sort of fell off the radar screen and then there was a renewed interest and then of course even more interest with COVID both in terms of their accuracy and how they should be used.”

This assessment is shared by author Amy Moran-Thomas, an associate professor of anthropology at MIT. Studies over the intervening decades continue to show issues with oximeters and skin tone, but the COVID pandemic brought the issue back into sharp focus.

Gottlieb said that when a patient’s pulse oximeter readings are higher, “we assume [patients are] oxygenating a little bit better so our treatment of oxygenation will probably be less intensive.” This, according to Gottlieb, can lead to “disparities in treatment.”

As for solutions and next steps, there is research currently being conducted to improve readings for people with darker skin tones. Rutendo Jakachira, a second-year Ph.D. student at Brown University in the Department of Physics, in partnership with Brown University Professor of Engineering Kimani C. Toussaint, is conducting research to create a non-invasive method of obtaining accurate blood oxygen readings from people with darker skin.

If you already have a pulse oximeter at home, it is vital that you take readings (and write them down) when you are healthy and not feeling sick. This will provide you with an important baseline to understand the readings you take when you are feeling ill.

Pulse oximeters can be helpful but, according to the FDA, the limits of the devices mean that you should take immediate action if you see: •Bluish coloring in the face, lips, or nails; •Shortness of breath, difficulty breathing, or a cough that gets worse; •Restlessness and discomfort; •Chest pain or tightness; and •Fast or racing pulse rate.

When using a pulse oximeter it is essential to write down the measurements, dates and times so you and your doctor can easily track your oxygen level. If you see your oxygen level going down over time, and much lower than previous readings you took when you were not feeling sick, and/or your symptoms increase or worsen, you should contact your doctor or visit an emergency room as soon as possible.

the administration will provide quality shelter to anyone experiencing homelessness and appropriate services to asylum seekers, regardless of an “overburdened” shelter system.

On July 21, in a presser, Adams said that the current shelter system is incredibly burdened as an explanation as to why the administration narrowly failed, about two weeks ago, to house four families under the time limit by state law. He said that the families weren’t placed in time, but they were found housing within 24 hours.

Adams bristled at “insinuations” of asylum seekers sleeping on the floor for days waiting for shelter, going hungry, or any inhumane treatment. He also said it was wrong for bordering states to turn people away that needed refuge in the first place.

Adams issued an emergency procurement declaration to “rapidly procure additional shelter and services to serve these individuals and families.”

In the declaration, the Department of Homeless Services said that the “expected census and shelter capacity” will not be able to help the asylum-seeking population that has arrived in the past few months because it was “not anticipated when determining capacity needs.” Additionally, asylum seekers need specialized services, like lawyers and advocates in their cases, that are not available or appropriate within the current shelter system.

Because of the asylum-seeking population, the city will be opening standalone facilities run by nonprofit providers during the continued housing crisis. “We are working across city agencies and with not-for-profit partners to ensure these individuals have access to a range of services, including legal support, health care, and education,” said Adams.

Comptroller Brad Lander added in a statement that his office would work closely with the Adams administration to appropriately expedite contracts for families urgently seeking asylum.

“We can no longer wait—and this declaration will allow the city to procure sorely needed additional resources as quickly as possible,” said Adams. “We are deeply committed to providing shelter and support to everyone who needs it, and we cannot do this work alone. We will continue to work with federal and state partners to procure additional financial resources immediately.”

On July 28, Speaker Adrienne Adams and Deputy Speaker Diana Ayala scheduled a hybrid hearing for Tuesday, Aug. 9, to discuss long-term issues in the city’s shelter system and the influx of asylum seekers.

“New York City is in the midst of a housing crisis that is exacerbating homelessness and must be confronted with expanded access to affordable housing. We also know that the shelter system has suffered from long standing issues that are unacceptable and must be addressed,” said Speaker Adams and Ayala in a joint statement.

The City has a responsibility to ensure adequate conditions in the shelter system for all residents, they said.

“The Council will hold a critical oversight hearing to examine how the mayor’s administration is handling these issues to uncover the real challenges and identify solutions. It is crucial for us to be clear about the steps needed to ensure access to safe temporary shelter and a pathway to permanent affordable housing for people in our city,” they said.

Ariama C. Long is a Report for America corps member and writes about culture and politics in New York City for The Amsterdam News. Your donation to match our RFA grant helps keep her writing stories like this one; please consider making a tax-deductible gift of any amount today by visiting: https://tinyurl.com/fcszwj8w