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Wearable technology and COVID-19 - The Lancet Respiratory Medicine

A basic smartwatch or fitness tracker can be purchased for under £40. It tells you how many steps you’ve taken, how many calories you’ve burned, and how well you slept. If you sit too long, it will track your heart rate and become nagging. Some models may even have blood oxygen and blood pressure monitors. More advanced devices can detect respiratory disturbances. Other features include an electrocardiogram, fall detector, and skin thermometer. It’s a booming market. One in four Americans is believed to own some form of wearable technology.

The impact on health care is enormous. “Wearables provide a near-continuous data stream. They monitor vital signs and help identify changes occurring in the body in real time,” says Mount Sinai, New York City, NY. said Robert Hirten, associate professor of medicine and artificial intelligence at the Icahn School of Medicine. His 2020 study of his more than 47,000 Fitbit users in the United States found that data on resting heart rate and sleep duration could significantly improve models predicting flu-like illness trends. concluded. In a study published last year, machine learning models used data acquired from wrist-based wearables to diagnose rhinovirus and influenza with high accuracy. It was also demonstrated that he could distinguish between different severities of the disease 24 hours before his symptoms appeared.
“The COVID-19 pandemic really pushed things forward,” Hirten said lancet respiratory medicineSome studies are using wearables to predict the onset of COVID-19. Hirten co-authored a paper that found that changes in heart rate variability captured by a smartwatch indicated the presence of SARS-CoV-2 infection in her several days before diagnosis. Other studies have explored the effects of vaccination on the body, which could lead to individualized dosing, and the time it takes for heart rate to return to baseline after an individual becomes infected with her SARS-CoV-2. is being investigated. Identify her COVID cases long, not just the course of the disease.
Researchers using wearables to detect whether the body is in the early stages of fighting an infection now tend to look at indicators related to heart rate, which are relatively easy to obtain. However, as wearables become able to collect more accurate data on features such as respiratory rate and skin temperature, and algorithms become more refined to take into account the impact of infection on markers of activity, the models are optimized. can. In 2020, he found that her study of 32 individuals with COVID-19 found that 26 of them showed changes in heart rate, daily steps taken, or sleep duration. In some cases, these changes occurred more than a week before her onset of symptoms.

All of this paves the way for a future where smartwatch and fitness tracker users receive alerts that their recent biometric data indicates an infection, and perhaps should consider quarantining. The use of the Global Positioning System (GPS) for contact tracing is already well established. Wearables warn individuals that they may have been exposed to the virus and then offer the opportunity to notify them if the exposure appears to have led to infection.

Hirten says that when machine learning approaches are applied to the large amounts of information extracted from wearables, they begin to elicit subtle physiological signals that suggest the presence of infection or other medical conditions. “There is proof-of-concept that inflammatory events such as SARS-CoV-2 and respiratory viruses such as influenza can be predicted, but that approach is not specific to one infectious disease or etiology,” he says. explains Mr. Combining data obtained from wearables with self-reported symptoms may prove productive, but users may not have the time or inclination to continuously provide updated information. I have.

“By setting your own personalized baseline, you can better understand your health and be alerted when you are outside your baseline,” says Scripps Research (La Jolla, Calif.). state, USA). She has had COVID for over two years. “For about six months after her first infection, she had brain fog, but it still happens if she overdoes it. Every day she has fatigue, headaches and chest pain,” Vogel said. . Individuals with long-standing COVID, including Vogel, typically experience flare-ups of symptoms up to 72 hours after engaging in excessive exercise. Carefully choosing when to be active and when to rest, a process known as pacing, helps you manage your condition.

“Pacing can help us avoid some of the prolonged COVID-related slump, but the problem is that we can’t always tell when we’re overdoing it, and there’s a lag before we feel the results. ” says Vogel. Manual labor is only one side of the story. The brain uses about 20% of the body’s energy supply. “It took me a while to realize that cognitive rest is just as important as physical rest, but it’s more about how much exercise you do than monitoring how hard your brain is working. It’s much easier to manage,” he said. Vogel.

The Body Battery feature on your Garmin smartwatch uses your physical activity, sleep and stress levels to give you a composite score from 0 to 100 that corresponds to how much energy you have left. “I use Body Battery to manage my symptoms. I’m working to my limit and that means my symptoms are pretty stable,” Vogel said. , is leading a planned study on whether wearables can help long-term COVID patients perform pacing. “Treatment is still needed to resolve her long-term COVID,” she stressed Vogel. “But for many people, managing symptoms through pacing can help improve their quality of life. Wearables can provide quantifiable data on how to do that.”

Marielle Gross is an Assistant Professor in the Center for Bioethics and Health Law at the University of Pittsburgh (Philadelphia, Pennsylvania, USA). She noted that wearables are entwined with serious ethical considerations. “We are reusing devices that have been designed and validated for specific applications and applying them to healthcare, but we are not asking what it means to change context in this way.” she says Gross. Manufacturers are typically not drawn from the medical technology community. Regulators must figure out how to deal with products that straddle the line between consumer goods and medical devices. I am terribly concerned that we may be sleepwalking into a state of biosurveillance. After all, wearables provide data not only about where people are, but also about the nuances of their physical condition. .

“Are wearables really improving patient health and well-being?” asked Gross. She speculated that for some people, sleep trackers may be more likely to accentuate anxiety than to ameliorate anxiety about nocturnal habits. No,” Gross said. Wearables generate enormous amounts of data even in a single day. There are many companies willing to purchase this information. Advertisers can end up knowing more about consumers than consumers know about themselves.

“People are giving up vast amounts of highly sensitive personal data, but do they realize the consequences of this? Who really benefits?” says Gross. Data obtained from wearables is often much more detailed than what is contained in medical records or captured during clinical trials, but it is also much less protected. I propose to decentralize power. You can establish a system similar to online payments where the buyer does not reveal all their credit card details, sending biometric data collected from the wearable.

There are also questions about whether the emergence of wearables will exacerbate inequalities. Users tend to be drawn from wealthy and well-educated parts of society. Some may find it uncomfortable to operate electronic devices that spit out endless numbers related to a series of bodily functions. “As wearables become more sophisticated and more players enter the space, we expect prices to drop,” he said. “It should help improve their availability, but great care must be taken to ensure that the benefits they can offer apply across socioeconomic groups so that no one is left behind. Vogel says that as the evidence base grows, there will be unanswered cases of wearable devices being covered by American health insurance companies and public health systems elsewhere regularly prescribing them. I hope that.

Meanwhile, the field continues to expand at breakneck speed. Smart face masks that can detect the presence of viruses in the air could be the hallmark of the next pandemic. The combination of telemedicine and wearable technology can eliminate the need for many in-person appointments. If respiratory biomarkers for lung cancer are developed, wearables could be adapted to detect them. You will be monitored and may be recalled to the hospital if your vital signs worsen. “The line between the physical and digital realms will only become more and more blurred,” concluded Gross.

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