Wearable Technology and COVID-19 – The Lancet Respiratory Medicine

A basic smartwatch or fitness tracker can be had for under £40. It will tell you how many steps you have taken, the calories you have burned, and the quality of your sleep. It will track your heart rate and nag you if you spend too much time sitting. Depending on the model, there may even be blood oxygen and blood pressure monitors. The most advanced devices are able to detect respiratory disorders. Other functions may include electrocardiograms, fall detectors and skin temperature gauges. It’s a thriving market. One in four Americans are thought to own some sort of wearable technology.

The implications for health care are enormous. “Wearable devices provide an almost continuous stream of data; they monitor vital signs and help identify changes occurring in the body in real time,” said Robert Hirten, associate professor of medicine and artificial intelligence at the Icahn School of Medicine at Mount Sinai (New York, NY). , United States). A 2020 study involving more than 47,000 Fitbit users in the United States concluded that data on resting heart rate and sleep duration could significantly improve models predicting trends in influenza-like illnesses. In a study published last year, a machine learning model used data from wrist-worn devices to diagnose rhinovirus and influenza with high accuracy. It was also shown to be able to distinguish between different severities of the disease, 24 h before the onset of symptoms.
“The COVID-19 pandemic has really moved things forward,” Hirten said. Respiratory Medicine The Lancet. Several studies have used wearable devices to predict the onset of COVID-19. Hirten co-authored a paper that found that changes in heart rate variability, captured by a smartwatch, signaled the presence of SARS-CoV-2 infection days before diagnosis. Other studies have explored the effects of vaccination on the body, which could potentially lead to individualized dosing, and how long it takes for heart rate to return to baseline after an individual has contracted the SARS-CoV-2, which could help map the course of the disease as well as identify long COVID cases.
Researchers using wearable devices to detect whether the body is in the early stages of fighting infection currently tend to focus on heart rate-related metrics, which are relatively simple to capture. But as wearable devices become increasingly capable of collecting precise data on functions such as respiratory rate and skin temperature, and algorithms are refined to take into account the effect of infection on the activity markers, the models can be optimized. A study of 32 people who contracted COVID-19 in 2020 found that 26 had changes in heart rate, daily step count or sleep duration. In several cases, these changes occurred more than a week before the onset of symptoms.

All of this sets the stage for a future in which users of smartwatches and fitness trackers receive alerts letting them know that their recent biometric data indicates an infection and that they may need to consider self-isolation. The use of Global Positioning System (GPS) for contact tracing is already well established. Wearable devices offer the ability to warn individuals that they may have been exposed to a virus and subsequently inform them when the exposure appears to have resulted in an infection.

Hirten noted that as machine learning approaches are applied to the large amounts of information extracted from wearable devices, they will begin to unravel the subtle physiological cues that suggest the presence of an infection or other disease state. . “We have proof of concept that we are able to predict inflammatory events, such as respiratory viruses like SARS-CoV-2 and influenza, but the approaches are not infection or etiology specific,” said explained Hirten. Combining data from wearable devices with self-reported symptoms could prove productive, although users may not have the time or inclination to continuously provide up-to-date information.

“Having your own personalized baseline can help you better understand your health and alert you when things go off baseline,” added Julia Moore Vogel, Participant Center Program Director, All of Us Research Program at Scripps Research (La Jolla, CA, USA). She has had long COVID for over 2 years. “I had brain fog for about 6 months after the initial infection, and it always happens when I overdo it. Everyday I have fatigue, headaches and pain in my stomach. chest,” Vogel said. People with long-term COVID, including Vogel, typically find that up to 72 hours after overexerting themselves, they experience a flare-up of their symptoms. Choosing carefully when to be active and when to rest , a process known as stimulation, can help manage the condition.

“Boosting helps you avoid some of the lows associated with long COVID, but the problem is you can’t always tell when you’re overdoing it, and there’s a lag before you feel the consequences,” said Vogel. Physical exertion is only one side of the story. The brain uses about 20% of the body’s energy reserves. “It took me a while to realize that cognitive rests are just as important as physical rests, but it’s much easier to monitor how much exercise you’ve been doing than to monitor how hard you’ve worked. your brain,” Vogel said.

The Body Battery feature in Garmin smartwatches uses physical activity, sleep, and stress levels to provide a composite score from 0 to 100 that equates to how much energy you have left. “I use body battery to manage my symptoms. I work up to a certain threshold, and that means my symptoms are reasonably stable,” Vogel said. She is leading a planned study into whether wearable devices can help people with long COVID implement stimulation.” We still need treatments to resolve long COVID,” Vogel pointed out. “But for many people, managing their symptoms through stimulation can help. improve their quality of life; wearables can give you quantifiable data on how to do this.

Marielle Gross is Assistant Professor at the Center for Bioethics and Health Law at the University of Pittsburgh (Philadelphia, PA, USA). She pointed out that wearable devices are enmeshed in serious ethical considerations. “We’re repurposing devices that have been designed and validated for a particular set of uses and applying them to healthcare, but we’re not asking what it means to change the context in this way,” Gross said. Manufacturers are generally not from the health technology community. Regulators need to figure out how to deal with products that sit at the interface between consumer goods and medical devices. Big worries that we were sleepwalking into a state of biomonitoring. After all, wearable devices provide data not only about the location of people, but also about the nuances of their physical condition.

“Do wearable devices actually improve patient health and well-being?” asked Gross. She hypothesized that, for some people, sleep trackers might be more likely to increase anxiety about nighttime habits than improve them. “Quantifying life isn’t necessarily therapeutic,” Gross said. Even in a single day, portable devices generate large amounts of data. Many companies would be willing to buy this information. Advertisers might end up knowing more about consumers than consumers know about themselves.

“People are giving up huge amounts of sensitive personal data. Are we aware of the consequences? Who really benefits?” Gross said. Data derived from wearable devices is often much more detailed than that contained in medical records or obtained in clinical trials, but the protections are much looser. Gross suggests decentralizing the ownership of the data, so that it stays with the person whose body is its source A system similar to that put in place for online payments, which are made without the buyer revealing all the details of their card credit, could be set up to transmit biometric data collected from wearables.

There are also questions about whether the advent of wearable devices will worsen inequalities. Users tend to be from the wealthier and better educated sections of society. Some people may be uncomfortable browsing electronic devices that generate endless numbers related to an array of physical functions. “We expect as wearables become more advanced and as more gamers enter the field, prices come down,” Hirten said. “This should help improve their availability, but we will still need to be very careful to ensure that the benefits they can bring are applied to all socio-economic groups, so that no one is left behind.” Vogel hopes that as the database grows, there will be a strong case for US health insurance companies to cover wearable devices and for public health systems elsewhere to routinely prescribe them.

Meanwhile, the field will continue to grow at breakneck speed. Smart masks, capable of detecting the presence of airborne viruses, could characterize the next pandemic. A combination of telemedicine and wearable technology could eliminate the need for many face-to-face appointments. If a respiratory biomarker for lung cancer were ever to be developed, a wearable device could be adapted to detect it. Patients who would have previously required intensive care could be allowed to recover at home, monitored by wearable devices and called back to hospital if their vital signs deteriorate. “The line between the body and the digital realm will only become increasingly blurred,” Gross concluded.

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