What is Happy Hypoxia Syndrome in Covid-19?

Emerging presentation of Coronavirus: Happy Hypoxia Syndrome

What is Coronavirus

In the present time, the whole world is going through a medical disaster known as coronavirus disease 2019. Coronavirus disease also named COVID-19 is an infectious disease caused by a newly discovered coronavirus.
It is mainly a respiratory illness. But different people can be affected in different ways. Symptoms and severity of the disease vary from person to person and underlying medical conditions such as Diabetes, Hypertension, etc are at higher risk.

Coronavirus Symptoms

Most people have mild to moderate symptoms and mostly recovers without hospitalization.

The most common symptoms are:
fever, dry cough, tiredness

Less common symptoms are:
Body ache, headache
Soreness of throat
Loss or change in taste or smell,
Rashes on the skin, or discoloration of fingers or toes

Serious symptoms:
Shortness of breath or difficulty in breathing,
Pain or pressure in the chest,
Speech or movement loss
(Source: World Health Organization)

Emerging presentation of Coronavirus

Since the disease is new to the world, we have less information about it. Scientists and researchers continuously monitoring and evaluating the disease pattern and information.
Today, we will discuss a new presentation of coronavirus that is Happy Hypoxia Syndrome. Though Happy Hypoxia is not new to the medical field but when it is observed in coronavirus cases, we should think about it for public health. Let’s discuss Happy Hypoxia by a Case.

Our case

  •  60-year male patient
  • Comorbidities: Diabetes, Hypertension for a long time
  • Complaining of mild lethargy for 3 days
  • His vitals were stable
  • On examination, his SPo2 that is oxygen saturation was around 80% with Respiratory Rate was 18/min
  • He denied a history of fever or cough or breathlessness
  • Chest X-ray: bilateral lung infiltrates
  • HRCT lungs: bilateral diffuse GGO suggestive of viral pneumonia
  • COVID-19 throat swab RT PCR: positive
  • Diagnosis: Happy hypoxia variant COVID-19

What is happy hypoxia syndrome?

There is hypoxia without dyspnea is called Happy Hypoxia (on SPO2 and ABG). And the patient looks happy means there are No respiratory symptoms, no tachycardia, no tachypnea.

Why hypoxia is compensated?
The reason is unknown

How is the overall prognosis?
Usually, such patients require oxygen for a few days, and then slowly oxygen requirement goes down and recovers very fast. So the overall prognosis is good.

Any specific treatment?
Awake proning (ask the patient to sleep in the prone position for at least 4 to 6 hour)
LMWH (prophylactic dose) if D-dimer and ferritin is high

Back to our case:

  • Initially, the O2 requirement was very high which slowly improved
  • LMWH was given as D-Dimer was very high
  • No specific antiviral was given
  • Ceftriaxone with azithromycin with HCQ with regular QTc monitoring was done
  • Discharged on day 12 without any problem

Learning point

Measure SPO2 in all patients even asymptomatic.

I learned about the Happy Hypoxia concept from one of the podcasts by Dr.Weingart who is an emergency medicine physician in the USA and has treated many COVID-19 patients. Very interesting podcast on clinical phenotypes of Covid-19 being seen by ICUs in the USA.
Link: https://podcasts.apple.com/in/podcast/emcrit-podcast-critical-care-and-resuscitation/id314020330?i=1000470508007

This article is reviewed by:

Dr. Pratik Savaj
Infectious Disease Physician at
SCID-AI (Surat Clinic of Infectious Disease and Adult Immunisation) Hospital
Address: 401, SNS Axis building, near Mahavir Hospital, Nanpura, Surat, Gujarat, India.

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