Prior restrictions on home oxygen therapy qualifications and funding are being waived during the pandemic Providers have indicated that they can rapidly initiate in the home, including weekends. Providers include VitalAire Order Form ProResp Order Form Aim is to keep O2 saturation between 92% but not above 96% for best outcomes for COVID-19.  This can help agitation and confusion. For other symptom management and management of dyspnoea please see the palliative symptom management resources pathway. You can obtain a pulse oximeter for patients who do not have one here. Steroids Consider also initiating steroids in patients in whom oxygen is required. Usual dose is dexamethasone 6mg OD for 7 days. Appropriateness will be determined by patient context and safety. NOTE: Patients with COVID-19 undergoing treatment with dexamethasone and/or tocilizumab who have Strongyloides may be at increased risk of disseminated Strongyloidiasis, which can carry a mortality rate of greater than 85%. Infection is usually asymptomatic so all patients should be screened for epidemiological risk of Strongyloides prior to starting steroids or tocilizumab and treated with Ivermectin.  Epidemiological risk includes patients born in or residing consecutively for more than 6 months in any of the following regions: Southeast Asia, Sub-Saharan Africa, South America, Caribbean, Mediterranean, Middle East, North Africa, Indian Sub-continent, Asia, Oceania (exclude non-aboriginal Australians and New Zealand). These patients should all receive Ivermectin prior to steroids or toculizimab or other immunosuppressant treatment for COVID. Detailed information and dosing here. Evidence for Oxygenation targets Current NIH guidelines for oxygenation targets in COVID-19 are congruent with local GIM advisers recommendations and state: “The optimal oxygen saturation (SpO2) in adults with COVID-19 is uncertain. However, a target SpO2 of 92% to 96% seems logical considering that indirect evidence from experience in patients without COVID-19 suggests that an SpO2 <92% or >96% may be harmful.” In one trial of ventilated patients with COVID-19 and ARDS, those randomised to a lower target range (88-92%) had poorer outcomes and a higher mortality rate. However this trial has been assessed by the McMaster Evidence Review group as high risk of bias so the evidence remains uncertain. Regarding the potential harm of maintaining an SpO2 >96%, the NIH guidance refers to a meta-analysis of 25 randomized trials involving patients without COVID-19 found that a higher SpO2 was associated with an increased risk of in-hospital mortality compared to a lower SpO2 comparator (relative risk 1.21; 95% CI, 1.03–1.43).