NOTE: I have contacted Garmin Support, and we troubleshot the watch and settings. And I'm to report back tomorrow if anything changes.
But In the meantime: this seems like a hardware issue, but it came about after a very specific use case ... so might be software related. Just wanted to see if anyone had experienced similar.
I went on a week-long canoe camping trip and wanted to use the watch for GPS as much as possible. I set it to battery-saver mode, and my Navigate, and Track Me activities used a power mode where GPS was enabled, but HR, Pulse OX, Bluetooth was off. All was good.
When I got home I took the battery saver off. HR and bluetooth are fine, but Pulse OX hasn't worked since. There were no events I'm aware of that could have damaged the watch. I was wearing it the whole time.