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thanksgiving

Family Health and Gatherings Amidst a Pandemic

‘Tis the season to gather, make memories with family & friends, and share great food. The rising cases of COVID-19 will make gatherings look a little different this year. It is important to take precautions and be safe while gathering this year. The Centers for Disease Control and Prevention (CDC) has a great resource available to help you with tips to stay safe this year. When we think of Thanksgiving, we think of turkey, cranberry sauce, and pies! Did you know that Thanksgiving is also National Family History Day? It is a great opportunity to learn more about your family’s health history. Read on to learn more about staying safe this holiday season and learn more about your family health history.

Learning About Your Family’s History

Family gatherings are a great way to learn more about your heritage, learn about your family history, and any health issues previous family members have struggled with. Even if you are social distancing this year, find creative ways to collect this information.

When talking to your family, write down the names of parents, siblings, grandparents, aunts, uncles, nieces, and nephews. Discuss any conditions they have had and what the diagnosis was. Sharing chronic health conditions can be difficult, be sensitive to this information and make your goal clear, to prevent any health conditions from developing if you can avoid it.

Ask Questions

To find out more about the chronic conditions in your family, it’s important to ask a few questions. Make a list ahead of time before gathering virtually or in-person this Thanksgiving and start with some examples such as:

  1. Do you have any chronic diseases, such as heart disease or diabetes?
  2. Has your healthcare provider been concerned you have high blood pressure or high cholesterol?
  3. Have you had any other serious diseases, such as cancer or stroke? What type of cancer?
  4. Approximately how old were you when these health conditions were diagnosed?
  5. What is your family’s ancestry? What countries or regions did your ancestors immigrate from?
  6. What were the causes and ages of death for relatives who have died?

Start with these questions and go from there. This is a great start to learning more about your family’s health history. Make sure to record this information, share it with your extended family, and update as you gain more information.

thanksgiving

Thanksgiving is also National Family History Day

Follow-up and Act

After learning about your family’s health history, then follow up with your healthcare provider. Talk to your healthcare provider about the next steps to take, future lab work, and what early screenings to consider. Time could be of the essence; some conditions will require specific screenings such as health histories that include:

  • Colon Cancer
  • Breast or Ovarian Cancer
  • Heart Disease
  • Chronic Blood Pressure Issues
  • Diabetes
  • Parkinson’s
  • Dementia
  • Osteoporosis

Staying Safe at Gatherings

According to the World Health Organization (WHO), as of November 23, 2020, there are approximately 58,425, 681 confirmed cases of COVID-19. As cases continue to increase rapidly across the world, the safest way to celebrate Thanksgiving is to celebrate virtually. If you gather, do so with people that live in your immediate household. Remember, you can collect your family’s health history virtually, stay safe, and still enjoy a nice feast! If you decide to host a gathering or attend a gathering elsewhere, keep the following tips in mind:

  • Host an outdoor meal, weather permitting, or make sure there is good ventilation in your gathering space
  • Limit the number of guests in your home, or ask how large the group will be
  • Set expectations with your guest as to the precautions you will be taking
  • Clean and disinfect high touch surfaces in your home
  • Limit the number of people preparing food, or pitch in and support a local restaurant and have your meal catered

Encourage your guest to wear a mask when the mealtime is over, hand washes, or use sanitizer often. Remember, it is better to be safe than sorry. Wearing a mask and social distancing can ensure everyone has a safe and happy Thanksgiving.

Takeaway

This Thanksgiving, remember to be grateful for your health and family. Take advantage of a ZOOM gathering to connect with relatives in other cities, states, and countries! Start the conversation early and make it a yearly tradition to discuss any new health conditions before having your annual celebration.

Fact Check Sources:

Coronavirus disease (COVID-19)

Gathering During the Holidays

Family Health History Resource

Respiratory Therapist Spotlight: Ruthie Marker MSRC, RRT

Each year, Respiratory Therapists (RT) are celebrated during Respiratory Care Week, happening this year from October 25th to October 31st. RT’s play a vital role in the lives of various patient populations, and most notably this year, providing hands-on care for patients whose breathing has been compromised by the SARS-CoV-2 (COVID-19 Virus) pandemic.

Ruthie Marker MSRC, RRT, Manager of Clinical Affairs at Belluscura, has worked as a respiratory therapist for over ten years in various clinical settings and locations and, most recently, as manager of clinical affairs at Belluscura. We interviewed Ruthie recently to get her thoughts and feedback regarding her clinical and non-clinical medical device careers.

respiratory therapist

Ruthie Marker MSRC, RRT, Manager of Clinical Affairs at Belluscura, plc

Q: What was your first job as a respiratory therapist?

A: In my last year of undergraduate coursework I applied to University Medical Center at Brackenridge (UMBC) in Austin, TX as a respiratory care assistant. In that role, I helped with things such as disinfecting equipment and maintaining supplies stocked throughout the hospital. That summer, I completed two internships at UMCB in the Level I Trauma Intensive Care Unit (ICU). I enjoyed my internships so much that after receiving my degree and passing the required board exams, I started my respiratory career at UMCB and called it home fore the next four years.

Q:  What did you like most at UMCB?

A: What I liked the most about UMCB was working closely with the group of pulmonologists. The group consisted of about six highly experienced pulmonologists. What I enjoyed the most was assisting with bedside tracheostomies.  A procedure that once required the patient to go to the operating room can now be performed in a patients’ room which conserves cost, time, and most importantly, reduces infection risks.

Q: What was the most important lesson you learned working there?

A: The most important lesson I learned at UMCB was that life is very short. Trauma happens when you least expect it and I saw a lot of it there. It taught me to be thankful for every moment I have on this earth. I attribute much of who I am today as a respiratory therapist to the lessons learned while working with such amazing clinicians and the hands on experience I gained.

Q:  After Brackenridge, what did you do next?

A: The next two years were very fluid due to relocations, and in 2013 I started working at the Parkland Health & Hospital System in Dallas, TX, specifically the Medical ICU. In 2016, I began working in Parklands Level III Neonatal ICU (NICU). I fell in love with the NICU and learned so much, I was part of a resuscitation team that attended all high risk and preterm deliveries.

Q:  What was the most challenging and rewarding part of working at Parkland?

A: The NICU has by far been the most challenging, yet most rewarding area I have had the pleasure of working in. The resilience of these tiny humans is unbelievable! I have cared for babies that weigh less than a pound, 370 grams to be exact! With the amazing multidisciplinary team at Parkland NICU and the progressive treatment approaches, these babies thrive!

Q: As an RT, have you worked with COVID-19 patients?

A: Working in the NICU was a relatively ‘safe’ place to work since many of our patient interactions were with babies. While we did risk exposing ourselves in various other areas of the hospital, it remained my haven.

When I left Parkland, I took a crisis RT position in Baltimore, MD. The hospital I worked at in Baltimore was extremely understaffed and not equipped to handle the surge of patients now making their way to hospitals for treatment. I wanted to challenge myself, seeing if my skills for treating adult patients were still there. The transition was a bit bumpy, but I got back in the swing of things fast.

Q: What did you find was the most difficult part of dealing with patients during this pandemic?

A: As a respiratory therapist, treating both adult and preterm infants, I was used to treating patients with various chronic and acute conditions. COVID-19 is something no one was prepared for and forced us to adapt quickly. In the beginning, there were many unknowns, for example how best to manage patients requiring respiratory support.  I’ll admit I cried the first week I was there, feeling an overwhelming amount of emotions and experiencing the physical toll it took on me.

It was difficult to feel as if I was making a difference in patients’ lives and still see patients dying. My time in Baltimore was short, I applaud all my fellow RT heroes that are showing up, day after day, overcoming physical, emotional, and mental stress!

Q: When and why did you decide to leave the clinical practice of respiratory therapy and join a medical device company?

A: After graduating with my masters in December 2019, I wanted to explore the potential of my profession outside of clinical practice. As RTs, we depend on the technology developed by respiratory care and medical device companies to care for our patients, both in the acute care setting as well as outpatient care. I wanted to immerse myself in the industry responsible for helping make patients’ quality of lives better, currently through the development of a portable oxygen concentrator, and continue my passion for being a patient advocate.

I think it is essential for RTs to be at the heart of any products or therapy that will improve the lives of patients. After all, we help patients breathe easier! I still have a close relationship with many practicing RTs, and I read more clinical trials and articles now than ever before. This helps me stay current with treatment practices and enables me to continue growing my knowledge of patient care.

Q: As a respiratory therapist yourself, why is Respiratory Care Week important to you?

A: Have I mentioned one of the perks of Respiratory Care Week is all the delicious treats?! Ok, all kidding aside, the most important thing for me is for the world to know who we are. Breathing is a synonym for respiratory, and in my opinion, should be synonymous with a respiratory therapist. We are an integral part of patients’ lives, not only in the hospital setting but also in outpatient care, sleep medicine, asthma clinics, pulmonary rehabilitation centers, and soon will be involved in treating COVID-19‘long haulers.’

Takeaway

As healthcare continues to evolve rapidly, so will the various roles held by respiratory therapists. This Respiratory Care Week be sure to show your appreciation for the respiratory therapists in your community! They do so much behind the scenes with doctors and nurses and deserve recognition for what they do.

 

Ruthie has been a respiratory therapist for over ten years. She received her bachelor’s and master’s degrees from Texas State University in San Marcos, TX. She started her career working in a Level I Trauma center in Austin, TX, and most recently spent the last five years working at Parklands MICU and Level III NICU. Currently, she is the Manager of Clinical Affairs at Belluscura plc, a medical device company focused on developing innovative oxygen enrichment technologies designed to create improved health and economic outcomes for patients, healthcare providers, and insurance organizations.

Face Masks and Your Oxygen Levels

Face Masks

As we approach the fall and winter months, it is imperative we continue the use of face masks to slow the spread of COVID-19 and follow the recommendations set by the Centers for Disease Control and Prevention (CDC). Misinformation about their effectiveness to slow the spread of COVID-19 as well as the misconception that their use deprives a wearer’s oxygen level will only lead to adverse impacts on individuals who follow inaccurate information.

An infodemic, that has recently accompanied the COVID-19 pandemic, is an overabundance of information, some information is accurate, and some is not. This makes it difficult for people to find trustworthy sources and reliable guidance when they need it the most.

Face Mask

Misinformation regarding the use of masks could impact the spread of COVID-19.

Oxygen Levels

For most adults, wearing a face mask will not lead to the wearer developing hypoxemia. There are a few exceptions, including the use among very young children and people with certain pre-existing pulmonary or cardiac issues. Hypoxemia is a condition in which the supply of oxygen is inadequate for normal organ function and levels of oxygen are extremely low at the tissue level. Hypoxemia is determined by measuring the oxygen level in a blood sample, the artery, or it can be estimated by measuring the oxygen saturation of your blood by using a pulse oximeter.

Normal arterial oxygen is approximately 75 to 100 millimeters of mercury (mm Hg). For healthy individuals, a pulse oximeter reading of 95 to 100 percent is normal however for those with chronic respiratory conditions such as chronic obstructive pulmonary disease (COPD), an acceptable pulse oximeter reading is 88 to 92 percent. Pulse oximetry levels among COVID-19 patients vary as the condition evolves.

In a press release from earlier this year, CDC Director Dr. Robert R. Redfield shared, “Cloth face coverings are one of the most powerful weapons we have to slow and stop the spread of the virus, particularly when used universally within a community setting. All Americans have a responsibility to protect themselves, their families, and their communities.”

Stay safe and stay informed with good sources of information. Research shows masks are effective in spreading COVID-19 and they will not cause oxygen deprivation.

Read more about this topic at https://www.reuters.com/article/uk-factcheck-oxygen/fact-check-face-masks-do-not-cause-terrible-damage-to-the-brain-by-depriving-it-of-oxygen-idUSKBN2761ZW

Our fact-check sources:

The CDCs Recommendations

Questions and Answers regarding Face Coverings

True Hypoxia and Hypoxemia Facts

Frontline Workers & The Truth About Masks

Pulse Oximetry and its Importance in COVID-19

Patients with conditions such as chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, and various cardiac conditions have utilized pulse oximeters as tools in monitoring their supplemental oxygen use. Pulse oximeters have become essential diagnostic tools because of ease of use, portability, and applicability in a wide range of clinical settings. In the face of the current pandemic, pulse oximeters have gained popularity with patients and physicians alike. Could early pulse oximetry monitoring be utilized in COVID-19?

Globally as of today,  09/23/2020, there are now approximately 31,375,325 confirmed cases of COVID-19 according to the World Health Organization (WHO). Since the outbreak, there have been roughly 749,069 cases in Texas with a significant spike in cases just days ago on 09/21 of 9,853. That is the most significant jump in new daily cases since mid-July when cases climbed to 14,916 on 07/17/2020.  While the number of daily new cases is trending down, we should remain cautious and continue to wear masks, social distance, and avoid large gatherings when possible.

When oxygen levels are low, the organs in our body receive less oxygen which can negatively impact their bodily function. Knowing baseline oxygen saturation levels at rest and with activity can help trend changes among various health conditions. In the presence of COVID-19, monitoring pulse oximetry levels can help monitor oxygenation and warn of impending or silent hypoxemia. While only a few independent studies have assessed the performance of pocket oximeters and smartphone-based systems, future studies could be performed to determine their accuracy.

Pulse Oximeter

Pulse Oximeter monitoring SpO2 and heart rate.

Common Questions regarding Pulse Oximeters:

What is a Pulse Oximeter?

A pulse oximeter is a small, battery-powered device that is used to measure how much oxygen your blood is carrying. The blood oxygen level measured with an oximeter is called your oxygen saturation level (SpO2) and is displayed as a percentage. The device works by sending two wavelengths of light into the finger through the nail bed and measures what is absorbed by the blood. It can also calculate your pulse and that is displayed as beats per minute (bpm).

How are Pulse Oximeters used?

A pulse oximeter comes as a small unit with a built-in finger/toe clip. All you must do is place your finger inside the pulse oximeter. The pulse oximeter delivers a calculated value and will display it once the reading stabilizes. It is normal for the value to fluctuate so do not worry if you see it changing constantly. Remember to keep working batteries in your oximeter to limit interruptions in your monitoring.

What is a Normal Oxygen Saturation Level?

The American Thoracic Society (ATS) recommends you ask your health care provider what oxygen saturation level they want you to maintain. ATS suggests most people need an oxygen saturation level of at least 89% to keep their cells healthy. COPD patients are advised to maintain a pulse oximetry level between 88-92%. Normal oxygen saturation levels run between 95% and 100%. Medical professionals should be consulted if a patient with suspected or confirmed COVID-19 has SpO2 ≤90%. Having a pulse oximeter will allow you to monitor your blood oxygen level, know if you are within your recommended range, and whether you need to increase your supplemental oxygen level.

How Accurate is a Pulse Oximeter?

The oxygen level from a pulse oximeter is reasonably accurate. Most oximeters give a reading 2% over or 2% under what your saturation would be if obtained by arterial blood. A pulse oximeter may also be less accurate with very low oxygen saturation levels (below 80%).

Factors affecting accuracy to read include:

  • Dark-colored nail polish
  • Cold fingers or poor circulation
  • Tremor or movement
  • Too much pressure on the probe
  • Low blood pressure

Closing Thoughts

For patients and health professionals alike, it will be imperative to be vigilant in the use of new technology advances, such as the way consumer tech companies are marketing health capabilities and promoting pulse oximetry monitoring among their devices. What they can do and what they can reliably do may in fact be two separate things. The use of these devices could potentially threaten and jeopardize a person’s health if the user relies on its accuracy to dictate when they seek medical care. Recently, Brian Clark, a pulmonologist and professor at the Yale University School of Medicine was featured in an article in the Washington Post speaking on the topic of emerging tech companies diving into the medical space. He commented, “I agree with you that it is a dangerous trend for technology companies to release medical devices that don’t meet FDA standards and claim that they are not medical devices”. Dr. Clark also adds, “But the more concerning and potentially dangerous scenario is when the devices provide false reassurance and people don’t seek health care when they really need it”.

Patients suffering from respiratory health conditions will continue to use pulse oximetry monitoring devices for the unforeseeable future. Hand-held pulse oximeters have become a common assessment tool and according to various studies, have been useful as diagnostic tools for the assessment of COPD. They can be used during both stable phase and exacerbations, as well as confirming the need for oxygen therapy.

Worldwide, people are looking to health monitors for any clue that they may have COVID-19, the illness caused by the novel coronavirus. For regular supplemental oxygen users that notice oxygen levels trending low, it will be important to speak with your healthcare provider or respiratory therapist as to when to increase or decrease your oxygen level based on pulse oximetry readings. Regardless of preexisting conditions, monitoring yourself for COVID-19, or recovering from recent hospital admission, its important to seek immediate medical attention if you notice significant changes in your oxygen levels. If you are caring for a patient with COVID-19 and their SpO2 ≤90%, refer to their primary care provider for further evaluation and possible treatment.

Sources:
  1. Adler JN, Hughes LA, Vivilecchia R, Camargo CA Jr.Effect of skin pigmentation on pulse oximetry accuracy in the emergency department. Acad Emerg Med1998596570
  2. Fowler, G. (2020). Washington Post [Editorial]. Https://www.washingtonpost.com/technology/2020/09/23/apple-watch-oximeter/. Retrieved September 23, 2020, from https://www.washingtonpost.com/technology/2020/09/23/apple-watch-oximeter/
  3. Luks AM, Swenson ER. Pulse Oximetry for Monitoring Patients with COVID-19 at Home. Potential Pitfalls and Practical Guidance. Ann Am Thorac Soc. 2020 Sep;17(9):1040-1046. DOI: 10.1513/AnnalsATS.202005-418FR. PMID: 32521167; PMCID: PMC7462317.
  4. Lipnick, Michael S. MD*; Feiner, John R. MD*; Au, Paul BS*; Bernstein, Michael BS†; Bickler, Philip E. MD, Ph.D.* The Accuracy of 6 Inexpensive Pulse Oximeters Not Cleared by the Food and Drug Administration: The Possible Global Public Health Implications, Anesthesia & Analgesia: August 2016 – Volume 123 – Issue 2 – p 338-345 DOI: 10.1213/ANE.0000000000001300
  5. WHO Coronavirus Disease (COVID-19) Dashboard. (n.d.). Retrieved September 23, 2020, from https://covid19.who.int/

Alta demanda; Suministro corto. Satisfacer las necesidades de oxígeno de los pacientes COVID-19 en el área de Río Grande y más allá

Si bien nos centramos en el tratamiento de los pacientes COVID-19 más enfermos en el hospital, ¿cómo vamos a dar la misma importancia a la gestión del alta hospitalaria de la enfermedad. Las hospitalizaciones de pacientes con COVID-19 han sido una métrica clave tanto del peaje del coronavirus como de la capacidad del sistema de atención médica para lidiar con él.

Read more

High Demand; Short Supply. Meeting the Oxygen needs of COVID-19 Patients in the Rio Grande Area & Beyond

While our focus remains on treating the sickest COVID-19 patients in the hospital setting, how will we place equal importance on managing the disease post-hospital discharge. Hospitalizations for COVID-19 have been a key metric of both the coronavirus’s toll and the health care system’s ability to deal with it.

Globally as of 08/25/2020 , there were 23,518,343 confirmed cases of COVID-19, including 810,492 deaths, reported by the World Health Organization (WHO). Coronavirus cases continue to grow in Texas. From cities to rural towns, COVID-19 is spreading and affecting families, commerce, and travel. Texas is the second largest U.S. state by both area and population and has reported 588,761 cases and 11,391 deaths.

The number of hospitalized patients remains high despite recent decline over the past few weeks. What is important to keep in the forefront of our minds is, what happens now to patients who were once mechanically ventilated or required high levels of oxygen therapy during their treatment? For some patients with pre-existing medical conditions, their new reality will be to be sent home with oxygen and perhaps need it for the short term.

Patients that have been discharged from the hospital or those who treated their symptoms in the hospital are now being called “long-haulers”. While it is unclear how many survivors become long-haulers, a recent study from the United Kingdom found 1 in 10 people are sick for a least three weeks. People are starting to experience the effects post recovery. Andre Sofair, MD, MHS, a Yale Medicine internal medicine physician was interviewed and states that an estimated 20 to 50% of patients continue to face health challenges after being discharged from the hospital. Yale Medicine is in the process of opening a post-COVID clinic. The concept is much like existing outpatient clinics that treat specific diseases and the focus will be to help relieve residual symptoms, which are mostly but not exclusively pulmonary.

Families In Line for Oxygen

Photo Credit Ruptly: Relatives of patients stand in line to fill oxygen tanks to care for COVID-19 patients.

The Monitor, a local news outlet in McAllen, TX covering Starr and Hidalgo counties, reported that hospitals in the area are experiencing challenges related to COVID-19 and discharging patients on oxygen. “One of the things that we have experienced is oxygen concentrators that are in high demand and short supply,” said Maritza Padilla, Assistant Chief Nursing Officer at DHR Health. While oxygen cylinders are the gold standard for most patients and often is what is readily available at discharge, they may be the only option for home use if the demand continues to grow. When discussing the topic further Dr. Robert Martinez, Chief Medical Officer for DHR Health, stated “I think that has been a big misconception, the inside of the hospital is not short of oxygen. The home — that’s where our challenge has been.”

In a recent July trip to Weslaco, TX, Gov. Greg Abbott told Hidalgo County Judge Richard F. Cortez that the county would be sent oxygen concentrators, additional beds and IV pumps. It remains unclear, though, how many were sent or whether the additional supply was enough to cover the need. A local DME owner told The Monitor that he has never seen a situation where so many patients needing oxygen are being discharged home at the same time. He has been inundated with calls to meet the needs of oxygen patients from San Antonio, TX, and bordering towns in Mexico. He is seeing the effects in his business, experiencing some back order from oxygen concentrator companies.

Case managers and social workers are working tirelessly to ensure that a patient has a safe discharge however it becomes challenging when patients do not have adequate coverage or the means to get oxygen. With COVID-19, the lungs are greatly affected as are other organ systems that rely on the supplemental oxygen that can delivered with an oxygen concentrator. Veronica Silva, Nursing Director of DHR Special Infectious Disease Unit-2 in Edinburg, TX shared that DHR has developed a charity through which they donate needed oxygen to patients and will continue to do so until resources are exhausted.

Other areas of Texas are also experiencing challenges related to COVID-19 and discharge delays due to shortages in oxygen availability. Last month, the Texas Department of State Health Services responded to the call for help that more than 70 hospitals around the state were pleading for.

The Rio Grande Valley area has been overwhelmed with COVID-19 patients and Doctors from Starr County Memorial spoke out. Hospital President, Dr. Jose Vazquez shared in an interview how greatly affected the population has been in the area, most of which are Mexican Americans with high rates of diabetes and obesity. Dr. Vazquez shared his hospital was lacking even the basic medical necessities, oxygen. He said five patients had a delayed discharged and remained admitted to the hospital because they could not get the oxygen they need for their homes.

“You know, when you live in America an oxygen tank or an oxygen concentrator should not be the reason why a patient is not discharged, when you are needing those beds for somebody sicker than you,” Vazquez said. State officials were working on getting oxygen concentrators to the region to free up more beds, however the status of that remains unknown yet.

While the United States of America may not be experiencing an extreme shortage of oxygen in the hospital settings due to more advanced infrastructure, lower-income countries such as Mexico, Peru, Brazil, and India are experiencing such challenges. Shortfalls include extreme measures such as patients and their family members buying overpriced oxygen on the black market for their sick loved ones in Peru. Or as seen in Reynosa, Mexico there is a shortage of oxygen for coronavirus-infected patients who must be treated at home due to the lack of hospital bed availability. Families in Mexico often wait in long lines to have their oxygen tanks filled, waiting for several hours at times, and are paying inflated cost due to demand. A Rental of a tank costing them $400 a month and additionally $200-300 per refill which is needed about every 3 days depending on the level of oxygen needed.

According to information published by the WHO, they are partnering with the United Nations and are working with manufacturers to buy oxygen concentrators for countries that need them most. This has allowed the WHO to buy 14,000 oxygen concentrators, which will be sent to 120 countries. Additionally, it identified 170,000 more that will be available over the next 6 months at a cost of $100 million.

We now know the vital role that oxygen plays in the treatment of COVID-19. Now more than ever it will be imperative to ensure patients that are discharged home post COVID-19 have the appropriate resources, oxygen therapy, available to them and work to meet the growing demand worldwide.

References:
https://usafacts.org/visualizations/coronavirus-covid-19-spread-map/state/texas
https://www.themonitor.com/2020/07/29/lack-oxygen-concentrators-delays-discharge-virus-patients/
https://www.keranews.org/post/inside-rio-grande-hospital-no-icu-during-covid-19-outbreak
https://www.cidrap.umn.edu/news-perspective/2020/06/covid-19-demands-intensify-efforts-ease-oxygen-shortages
https://covidtracking.com/data/us-daily
https://www.yalemedicine.org/stories/covid-19-recovery/
https://www.univision.com/univision-news/covid-19-patients-in-reynosa-mexico-facing-oxygen-shortage-video
https://www.cidrap.umn.edu/news-perspective/2020/06/covid-19-demands-intensify-efforts-ease-oxygen-shortages
https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/special-populations/index.html