
Show HN: An attempt to spot Covid-19 outbreaks using wearable devices - helloworld
https://detectstudy.org/
======
helloworld
How can we spot the "silent spreaders" of SARS-CoV-2 -- the people who are
infected and contagious, but have no symptoms? [1] Our digital medicine group
at Scripps Research Translational Institute has just launched a health study
[2] to explore one possible approach: crowdsourcing data from wearable devices
like the Apple Watch and Fitbit, and then attempting to use machine learning
(or less grandly, linear regression) to identify COVID-19 infections.

In January, my colleagues at Scripps published a study in the Lancet that used
heart rate and sleep data from about 47,000 Fitbit users in the U.S. to
predict which areas would be hardest hit by flu. [3] The correlation with
actual reports from the Centers for Disease Control was very high: 0.9.

We’re hoping that we can do something similar for COVID-19 infection. In
particular, elevated resting heart rate appears to be a reliable indicator of
viral infection. [4] We’re wondering whether it might also be a leading
indicator, i.e, spiking to a detectable degree before any measurable fever. If
it were, we might be able to identify COVID-19 infections in individuals --
and areas with outbreaks -- before people even have any symptoms.

To figure this out, we’re going to need a lot of participants. And that’s
really the greatest challenge for us now. A similar project in Germany [5],
which was inspired by our Lancet flu study, already has more than 160,000
volunteers. But they have the advantage of being sponsored by a national
research institute. We don’t.

If you have suggestions about how we might reach people with wearables who
want to help out -- or if you have questions about the DETECT study -- please
add them to the comments.

Thanks, Danny

[1] Substantial undocumented infection facilitates the rapid dissemination of
novel coronavirus.
[https://science.sciencemag.org/content/early/2020/03/24/scie...](https://science.sciencemag.org/content/early/2020/03/24/science.abb3221)

[2] Pivoting health research to take on COVID-19.
[https://www.weforum.org/agenda/2020/03/pivoting-health-
resea...](https://www.weforum.org/agenda/2020/03/pivoting-health-research-to-
take-on-covid-19-detect-lessons)

[3] Harnessing wearable device data to improve state-level real-time
surveillance of influenza-like illness in the USA.
[https://www.thelancet.com/journals/landig/article/PIIS2589-7...](https://www.thelancet.com/journals/landig/article/PIIS2589-7500\(19\)30222-5/fulltext)

[4] Fever and cardiac rhythm.
[https://jamanetwork.com/journals/jamainternalmedicine/articl...](https://jamanetwork.com/journals/jamainternalmedicine/article-
abstract/606966)

[5] Germany launches smartwatch app to monitor coronavirus spread.
[https://www.nytimes.com/reuters/2020/04/07/technology/07reut...](https://www.nytimes.com/reuters/2020/04/07/technology/07reuters-
health-coronavirus-germany-tech.html)

------
nicthesailor
I just tried to download the android app, but it says it's not available in my
country.

You might get more volunteers and data if you remove the geographic
restrictions.

~~~
helloworld
Sorry about that! We're hoping to roll it out to other countries before long.

------
a2x0
For those of you that are located in Germany and want to help with their data:
the RKI has an app[1] like that and uses heart rate, resting heart rate,
sleep, and steps to determine the spread throughout the country

[1]: [https://corona-datenspende.de](https://corona-datenspende.de)

~~~
helloworld
Thanks for sharing that. I hope there's eventually some way for Scripps and
the Robert Koch Institute to pool our data.

------
exabrial
I really wish Apple, Garmin, Google, Fitbit would start working on body
temperature sensors. It doesn't need to be realtime like a heartbeat sensor to
be useful, but seeing a 0.5-1.0 average daily body temperature increase could
encourage A LOT of people to stay home or go get tested

~~~
andor
My Garmin watch has a thermometer, a heart rate sensor and an oxymeter.

Temperature is only recorded during activities, and as it's measured inside
the watch the value is somewhere between body and environment temperature.
Unless environment and fit of the watch are controlled, I would not expect
useful readings.

The oxymeter is also not very good, probably because the position at the wrist
is suboptimal and the sensor isn't opposite of the LED. The light shines into
the skin, not through it, as with the oxymeters that are clipped onto a
finger. Measurements take about 20 seconds and are wildly off and
inconsistent. I just measured 99-100% saturation with a clip-on oxymeter and
92% with my watch.

The value I trust most is the resting heart rate. It's not just the minimum
value recorded, the watch seems to apply some heuristics to figure out whether
a measurement was clean or not. The sensor data itself must be very noisy.
When the "abnormal HR" feature is turned on, I get false alarms multiple times
per day. I had a colleague who thought her HR was pretty constantly at 60,
because that was the default value of the Fitbit that she wore like a loose
bracelet.

To provide some anecdotal data, I had a bronchitis last year and the RHR went
from 49 to 69 at its peak. At the same time, the "Body Battery", which is
calculated from HR data, also went down to 0%. I was surprised that the
feature actually works, but definitely didn't need it to figure out I am sick.

~~~
helloworld
That "Body Battery" features sounds interesting. I just checked it out:

[https://support.garmin.com/en-
US/?faq=VOFJAsiXut9K19k1qEn5W5](https://support.garmin.com/en-
US/?faq=VOFJAsiXut9K19k1qEn5W5)

I wish that the formula used to calculate it were less opaque. If it were open
source, researchers might make use of it.

------
a9h74j
Not exactly wearable, but I have learned in the midst of all this that
fingertip pulse oximeters cost only $20-40 retail. Has there been any work to
see if falling oxygenation readings can serve as a precurser? In any event I
have started charting my own oximeter readings along with my temperature, both
for baselines. It looks like I should add pulse rate as well.

~~~
helloworld
Finger pulse oximeters can definitely provide useful data, but I suspect that
they're lagging indicators for Covid-19, because typically, severe respiratory
symptoms that affect blood oxygen levels appear later in the course of the
disease. (But my background is in behavioral science, not pulmonology, so I
might be wrong!)

~~~
a9h74j
Agreed, but I saw an unverified comment somewhere suggesting someone had a
less than <90% reading and was still mobile. I don't know if that is possible,
but I mentally filed that next to incidents of people just collapsing on the
street. To the extent hemoglobin disorder might??? be involved (per Chris
Martenson), there could? be a mechanism for low blood oxygen without
lung/respiratory disorder per se.

~~~
helloworld
There's so much we don't know about this disease. Maybe there will be
surprising findings.

------
a9h74j
As you might be aware, California Governor Newsom in his TV briefing yesterday
referred to encountering an abundance of tech-inspired proposals -- as I
understood this, in the areas of monitoring and tracking. I also heard him to
say there will be some attempt made to "pick one" so-to-speak, for a focus in
participation, tech and data.

~~~
helloworld
Thanks, I hadn't heard that yet. This might be one of those situations where
it's preferable to "let a thousand flowers bloom."

For example, in another comment, I mentioned a study that's using the Oura
ring, which is a great product, but has a far smaller user base than the mass-
market Fitbit and Apple Watch audience that our study is focused on. So it's
really additive to have both of our research efforts going forward.

~~~
a9h74j
To be fair Newsom might have implied several winners, but same point taken.

ABC7 in SF just reported a collaboration as "Stanford and Fitbit", giving
innovators.stanford.edu (not working) as a site to sign up. Relatedly I find
the following:

[https://hitconsultant.net/2020/04/14/fitbit-scripps-
stanford...](https://hitconsultant.net/2020/04/14/fitbit-scripps-stanford-to-
study-role-of-wearables-to-detect-train-and-contain-infectious-
diseases/#.XpeXJhnYrnE)

I could imagine participants in any device-specific work opting-in to sharing
anonymized data with one-or-more broader-based studies/analyses, if that is
not part of opting-in to the device-specific work in the first place.

~~~
helloworld
It would be great if there were a way to join multiple studies at the same
time. At the moment, though, you have to sign up separately for the Stanford
COVID-19 Wearables Study: [https://innovations.stanford.edu/#section-
wearables](https://innovations.stanford.edu/#section-wearables)

------
tinus_hn
What do you want from people with Fitbits? If you just want them to use your
app and send you data I think all you need to do is ask.

~~~
helloworld
If you have a Fitbit that includes heart rate monitoring, please consider
joining the study.

Unfortunately, as a non-profit academic institution, we don't have any budget
for advertising. I wish we could run millions of dollars of ads online and on
TV to encourage people to join. Instead, I guess we'll have to rely on word of
mouth.

~~~
tinus_hn
I tried to install the app but unfortunately it is not available in my region.
I understand that this is hard due to privacy and legal issues.

~~~
helloworld
Also, we need approval from our institutional review board. That might
complicate making the study available in multiple countries.

~~~
acka
Why not cut through the red tape and collaborate with research groups in other
countries? These groups can release apps for their respective regions, and as
long as the data generated by the apps is compatible, it can be aggregated any
way you want.

~~~
helloworld
That's a great suggestion. To do that, though, I'm pretty sure that we'd still
need approval from our IRB. When you do research within an academic
institution, everything needs to be looked over by a relatively impartial
third party. And in general, I think that's a good thing -- especially when
the research involves human or animal subjects.

