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As people build up immunity to SARS-CoV-2 through vaccines, boosters, and infections, the most commonly reported symptoms of COVID-19 have shifted, making the deadly pandemic infection more difficult for many people to distinguish from standard cold-weather viruses.
That’s according to recent survey data collected in the ZOE COVID Study, an app-based study with over 4 million users that was created by researchers at Massachusetts General Hospital, Harvard University, King’s College London, and the health science company, ZOE.
Since COVID-19 emerged, the common symptoms that have topped standard lists include fever, chills, a persistent cough, and shortness of breath. As the virus spread around the planet, loss of taste and smell were also reported as telltale signs. But these days, those symptoms are almost completely absent from the top five.
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A new study from Mount Sinai researchers published in the peer-reviewed Journal of Medical Internet Research found that wearable hardware, and specifically the Apple Watch, can effectively predict a positive COVID-19 diagnosis up to a week before current PCR-based nasal swab tests.
The investigation dubbed the ‘Warrior Watch Study,‘ used a dedicated Apple Watch and iPhone app and included participants from Mount Sinai staff. It required participants to use the app for health data monitoring and collection, and also asked that they fill out a day survey to provide direct feedback about their potential COVID-19 symptoms, and other factor including stress.
During the course of the study, the research team enlisted “several hundred health care workers” to participate, and collected data over several months, between April and September. The primary biometric signal that the study’s authors were watching was heart rate variability (HRV), which is a key indicator of strain on a person’s nervous system. This information was combined with information around reported symptoms associated with COVID-19, including fever, aches, dry cough, gastrointestinal issues, loss of taste and smell, among others.
The Warrior Watch Study was not only able to predict infections up to a week before tests provided confirmed diagnoses, but also revealed that participants’ HRV patterns normalized fairly quickly after their diagnosis, returning to normal roughly one to two weeks following their positive tests.
As to what the study could lead to in terms of actual interventions, the study’s authors note that it can help anticipate outcomes and isolate individuals from others who are at risk. Most importantly, it provides a means for doing so remotely, allowing caregivers to anticipate or detect a COVID-19 case without even doing a physical exam or a administering a nasal swab test, which can help take precautionary measures in high-risk situations when cases are suspected, possibly preventing any spread before someone is highly contagious.
The study is ongoing, and will expand to examine what else wearables like the Apple Watch and their onboard sensors can tell us about other impacts of COVID-19 on the health of care workers, including what factors like sleep and physical activity can have in association with the disease.
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Echoing much of the existing data and research on the subject, SF-based Color released data today showing that based on its own testing program, most individuals who test positive for COVID-19 display either mild or no symptoms, including even running a fever. The results, taken from Color’s own testing of over 30,000 people to date across its California testing stations, shows that despite continuing efforts underway across the U.S. to reopen local and state economies, widespread testing is still key to any true recovery program.
Color notes that 1.3 percent of the people who it has tested to date have received positive results for COVID-19, and says that among those, 78% reported only mild symptoms, or said they were asymptomatic, meaning they displayed no observable symptoms whatsoever. What’s more, only 12% had a fever of over 100 degrees, which is bad news for efforts to contain potential transmission of cases through the reopening through measures like temperature checks at workplaces and shared use facilities.
Color’s data matches up with recently released information from the WHO that indicated as many as 80% of individuals who test positive display either mild or no symptoms. Color also shared more specific information around what symptoms those who did report some said they had, with most saying they had a cough – though the most highly correlated reported symptom with an actual positive test result is loss of smell, making it a much better indicator of a positive test result than fever, for instance.
Other notable findings from Color’s testing to date, which includes testing San Francisco’s frontline essential workers in partnership with the city, include that most of those who test positive are young (68% are aged between 18 and 40) and that Latinx and Black communities showed much higher positive results on a per capita basis than either white or Asian populations. Color’s data in both these regards support results shared by other organizations and researchers, backing up concerns around who will be most negatively affected by any hasty and unconsidered reopening efforts.
A team of researchers from the West Virginia University (WVU) Rockefeller Neuroscience Institute (RNI), along with WVU’s Medicine department and staff from Oura Health have developed a platform they say can be used to anticipate the onset of COVID-19 symptoms in otherwise healthy people up to three days in advance. This can help with screening of pre-symptomatic individuals, the researchers suggest, enabling earlier testing and potentially reducing the exposure risk among frontline healthcare and essential workers.
The sudsy involved using biometric data gathered by the Oura Ring, a consumer wearable that looks like a normal metallic ring, but that includes sensors to monitor a number of physiological metrics, including body temperature, sleep patterns, activity, heart rate and more. RNI and WVU Medical researchers combined this data with physiological, cognitive and behaviroral biometric info from around 600 healthcare workers and first responders.
Participants in the study wore the Oura Ring, and provided additional data that was then used to develop AI-based models to anticipate the onset of symptoms before they physically manifested. While these are early results from a phase one study, and yet to be peer-reviewed, the researchers say that their results showed a 90 percent accuracy rate on predicting the occurrence of symptoms including fever, coughing, difficulty breathing, fatigue and more, all of which could indicate that someone has contracted COVID-19. While that doesn’t mean that individuals have the disease, a flag from the platform could mean they seek testing up to three days before symptoms appear, which in turn would mean three fewer days potentially exposing others around them to infection.
Next up, the study hopes to expand to cover as many as 10,000 participants across a number of different institutions in multiple states, with other academic partners on board to support the expansion. The study was fully funded by the RNI and their supporters, with Oura joining strictly in a facilitating capacity and to assist with hardware for deployment.
Many projects have been undertaken to see whether predictive models could help anticipate COVID-19 onset prior to the expression of symptoms, or in individuals who present as mostly or entirely asymptomatic based on general observation. This early result from RNI suggests that it is indeed possible, and that hardware already available to the general public could play an important role in making it possible.
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The ongoing COVID-19 pandemic is resulting in big shifts across industries, but the development of more long-term solutions that address a future in which what we need to do is mitigate the impact of the new coronavirus seems like a worthwhile place to invest time and effort. Projects like a new one from Northwestern University researchers working with the Shirley Ryan AbilityLab in Chicago that resulted in a wearable to potentially provide early warnings to COVID-19 patients are a prime example of that kind of work.
The wearable is designed to be worn on the throat, and it’s already in use by around 25 individuals, who are providing early data via at-home and in-clinic monitoring about its effectiveness. The hardware involve monitors coughs and respiratory activity, and then feeds that into a set of algorithms developed by the research team that can identify what might be early symptoms of COVID-19, and potential signs that the infection is progressing in a dangerous way that could require more advanced care.
The gadget is designed to be worn around the clock, and provides a continuous data stream. This has the advantage of providing insight as it becomes available, instantly, instead of relying on regular check-ins, or waiting for when symptoms are clearly bad enough that someone needs additional help, at which point it’s usually past the stage of early intervention. The wearable essentially looks like a thin bandage the size of a postage stamp, and it can monitor not only cough sounds and frequency, but also chest movements, heart rate, body temperature and respiratory rate.
It’s tuned specifically to what health experts have generally tagged as the most common early symptoms of COVID-19, which include fever, coughing and problem breathing. The ‘suprasternal notch,’ which the technical name for the site on the throat where the wearable rests, is “where airflow occurs near the surface of the skin” through the respiratory pathways of the body, according to Northwestern researcher John A. Rogers who led the device’s development team.
This hardware can potentially be useful in a number of ways: First, it’s a valuable tool for frontline healthcare workers, offering them what will hopefully be an early warning sign of any oncoming illness, so that they can avoid infecting their colleagues and get the treatment they need as efficiently as possible. Second, it could be used by those already diagnosed with COVID-19, to potentially provide valuable insight into the course of the infection, and when it might be getting worse. Third, it could eventually also be used to tell scientists working on therapies what is working, how, and how well with live information from test subjects both in-clinic and at home.
The device is also relatively easy to produce, with the team saying they can do-so at a rate of around hundreds per week, without even needing to lean very heavily on outside suppliers. That’s a considerable advantage for any hardware that might need to be leveraged in volume to address the crisis. Plus, people can wear it almost unnoticed, and it’s very easy to use both for clinicians and patients.
There are other projects in the works to see how devices that monitor biometrics, including the Oura ring, and the Kinsa thermometer, can help contain the epidemic. The researchers behind this wearable have spun up an engineering company called Sonica to manage their device’s development, and will now be working with various agencies (including through funding by BARDA) to deploy it in more places, and see about potentially productizing the wearable for wide scale use.
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MIT has developed a new type of lightweight sensor that can be integrated into flexible fabrics, including the kinds of polyesters often used in athletic wear, to provide constant monitoring of vital signs including body temperature, heart rate and respiratory rate. These sensors are machine-washable and can be integrated into clothing that appears totally normal on the outside, and they can also be removed and re-used in different garments.
The research, which led to the design of a prototype that communicates with a smartphone and that could lead to eventual mass production with partners in China, has potential applications across the health industry, in athletics and even in space for astronaut vital sign monitoring. MIT’s research was funded in part by NASA and the MIT Media Lab Space Exploration Initiative, but its potential here on Earth has much more widespread benefit potential, particularly in the era of COVID-19 and the healthcare landscape that will result even once it’s more under control.
In particular, this could be a cost-effective and easy way for patients with chronic conditions that require regular monitoring and check-ins with their physicians to keep on top of reporting that is often manual and difficult to maintain consistently. Rather than relying on updates either in-person, or even via telemedicine, these individuals could provide a steady stream of biometric data to the healthcare professionals monitoring their treatment. It could automate the process to an extent that makes it easier for both individual and their caregivers to keep on top of the situation in real-time.
Remote healthcare solutions are already seeing massive spikes in demand due to COVID-19, as patients and healthcare professionals seek ways to continue to manage healthcare needs while lessening COVID-19 exposure risk, especially among the most vulnerable, which includes individuals with chronic or pre-existing conditions.
Some companies are already experimenting with variations of this approach, including U.S. primary care startup Forward, which is distributing biometric sensors to its patients for at-home monitoring. Connected sensor company Kinsa is also showing the value of aggregated anonymized biometric data with a map that employs its sensor data to track a potential leading indicator of COVID-19 spread: the prevalence of fever in a community.
Wearable sensors embedded in clothing have been tried before, and even productized, but MIT’s version looks like the most wearable and least disruptive to the wearer in terms of convenience and comfort yet. In future, always-on health data monitoring could inform the development of more and better pandemic modeling, too, so this is definitely an innovation space to watch.
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