Pulse oximetry is a ubiquitous measurement in health care used to assess oxygen perfusion status and guide oxygen therapy. There is ongoing discussion as to whether pulse oximetry measurements are accurate in patients with darker skin colors. A recent study showed higher rates of occult hypoxemia in Black patients compared to White patients, based on selfreported race. This report triggered an FDA Safety Communication emphasizing the interpretation and limitations of pulse oximetry particularly in monitoring of patients with COVID-19 infections. Race is not binary. There is a wide range of graded skin colors. We investigated this issue by evaluating correlations between skin color and occult hypoxemia using a retrospective review and a more discriminating assessment of skin color.