
Track infections through resting heart rate - pkuhar
https://github.com/unrelatedlabs/infection-alert
======
smdz
> Infections elevate your resting heart rate

This is not always true and I would recommend not to rely on it.

I recently had a sore throat, nothing more than redness, and felt sleepy all
day for 6 days in a row. My Rhr had tanked to 50 consistently (manually
verified) and I was concerned, but had no other issues than feeling a bit
fatigued and mostly feeling sleepy. I did feel feverish, but had no fever (re-
verified with multiple thermometers). I checked for any chest issues using a
stethoscope at home, even though I did not have any respiratory problems.

Two days into it and on a second throat inspection, I found I had follicular
tonsillitis - probably caught from my kid. A bit of a relief as I knew how to
deal with it - but still no body fever. In the last two days, my Rhr then
jumped back to 65-80 and it was the only time I had a fever once (101.5F), but
my body was already feeling better and recovering from the infection.

------
bloogsy
An increased resting heart rate can be caused by many things, and we have no
false negative/positive rate for increased heart rate wrt this virus. Whilst
the intention is good, this app will end up sending many more people to
hospitals, doctors, and pharmacists than necessary, furthering the straing on
the healthcare system.

~~~
cosmic_ape
Data like this could (or might have the potential to) be used by the
authorities to determine in which areas to test more. But otherwise it
shouldn't send people anywhere, I don't think that was the intention.

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yovagoyu
This is hearsay, but I recall being at the Precision Medicine Conference
recently and one of the speakers said that when sick with, say, flu, your
heart rate spikes maybe 30-60 minutes before you'd otherwise know (have a
fever, headache, etc.). So it didn't seem like a very useful test.

Maybe coronavirus is different though. I would check up on sources.

~~~
jniedrauer
I use a garmin watch and I can confirm this. I had a very high fever about a
month ago, so I got to see all the metrics in action. My resting heart rate
did not spike until I already had symptoms, making it a useless predictor.
Heart rate variability did steadily decline for several days before the onset
of symptoms, so that could actually be a useful predictor of infection.

------
decebalus1
Appreciate the intention, we should all be applying our skills to solve this
problem we're all facing but just playing devil's advocate here, my resting
heart rate has gone up lately.

And it's not because I have the infection (I don't), it's because I've been
stuck working in my apartment in Seattle for the past 3 weeks and I feel like
I'm living a boring dystopian novel. I also stopped weightlifting, as the gym
is closed. So my 'convict conditioning' workouts aren't giving me the same
dose of endorphins as before, which helped keeping me happy and with a steady
calm heart rate (I'm a huge hypochondriac). People I run into when I buy food
also seem on edge.

Not sure how relevant something like this would be for someone living in the
middle of the outbreak, which is probably the exact target of such a tool.
Yes, I am aware that I'm aware of my stress (as you stated in the readme) but
again, it wouldn't help me or others by tracking my heart rate and associating
it with an infection.

~~~
DoreenMichele
It's non-invasive, doesn't require the breaking of quarantine and relies on
infrastructure that is already in place. More information is better than less
and the author has some degree of professional expertise in the subject,
according to statements on the page linked.

There are always going to be outliers and what not. I knew someone who used to
intentionally lower their heart rate to like 30 beats per second when getting
their heart rate taken to screw with medical staff because they thought it was
funny. Combination of good fitness and meditation techniques.

Nothing is perfect. But this seems like a rather good idea compared to
expensive tests that potentially expose the person being tested to risk and
potentially expose others to them at a time when they may be contagious.

This seems like a rather poor time to "just play devil's advocate" without
some real and serious objection.

~~~
mr_toad
> More information is better than less

False positives come at a cost. For example there is considerable debate about
the use of routine mammograms, because of the potential stress caused by false
positives.

~~~
perl4ever
I read a paper recently on the Chinese outbreak of COVID-19 that found
approximately 80% of the positive test results on people without symptoms were
false positives.

------
mr_toad
Too much noise to signal for this to be reliable.

I’ve tracked my resting HR for years, and there’s so many other things that
can affect it, including (in rough order of magnitude) alcohol & dehydration,
lack of sleep & stress, ambient temperature, other illnesses, and finally
exercise (which has a big impact long-term, but also gets lost in the short
term noise).

~~~
rcarmo
Add to that the underlying stress we’re all under these days, and RHR has even
wider variation.

I keep close tabs on my resting heart rate to assess when I’m pushing the
limits, and it’s been higher than usual these past few weeks...

Still, I do agree that in some instances it increases noticeably (I had the
flu a while back and can confirm it rose a bit half a day or so before My
throat started getting sore). But I don’t think it should be used as the
only/main indicator for infection.

------
drakonka
I was diagnosed with tachycardia when I was a child, during a mysterious
illness that hospitalized me and that is suspected to have been a cytokine
storm. I recently got my heart checked out (about a year ago). They never
found the cause. I think it got better since I was a kid, but my resting heart
rate still tends to be in the 90s. It does not cause any impact on my life. I
exercise a lot, and just feel normal. Then again since I've had it my whole
life maybe my 'normal' is actually not normal to people who have a lower heart
rate.

I'm still not sure if this puts me at any sort of elevated risk should I get
infected with COVID-19. I am self isolating just in case, but my country is
not really taking very drastic isolation measures right now and part of me
just feels like I am being paranoid with no clear way to know if I am
predisposed to any complications or not.

~~~
smdz
> tachycardia when I was a child

You might have been misdiagnosed based on the information available at that
time. Children have different statistics on various body parameters at various
age groups. You could compare your reports with recent research to see if you
actually had tachycardia

> resting heart rate still tends to be in the 90s

It is within the normal age but on the higher end, but you should get your
blood pressure checked. I do not know your age, but it might change once you
go above 25 or 28. When Rhr drops with age, it is a sign that your metabolism
is slowing and you should start measuring body-fat.

> any sort of elevated risk should I get infected with COVID-19

There is no real correlation or evidence. But in your case if you have mild
fever and feel nauseous - that would be the first red flag. It may be just
because you ate something, but if it is Covid19 or any flu causing SARS then
the other symptoms like dry cough and higher fever may follow in 8-24 hours.
You may not even see mild respiratory/breathing problems or severe fatigue or
low blood pressure until 48-72 hours. Seeking medical attention and getting
good diagnosis and prognosis quickly should be a priority, many people go to
the emergency after 120-144 hours and then end up on ventilators in a matter
of 4-6 hours. The survival rates on ventilators are not good enough.

Note: I'm not a medical professional. I have known these things out of my
curiosity in medicine and accidental experience in hospitals with some
talented doctors and intensivists.

~~~
drakonka
Thank you for your input. I am already 31 and when I got this checked out the
doctors did say my heart rate was faster than normal, but just didn't find a
cause. I'm hoping that it is as you say - still relatively normal! My blood
pressure has historically been totally fine.

Unfortunately I don't have reports from when I was a child. This was in a post
soviet country in the early 90s and I doubt those medical records are still
obtainable. At the time I was experiencing some kind of reaction causing high
fever, hives and swelling everywhere, and inability to move due to bone and
joint pain. I can't remember how long it lasted, I think it was weeks. The
doctors couldn't figure out what was wrong and thought I was dying, but in one
of their tests they did pick up on the tachycardia.

I'm a little disappointed because I am a rather fit and athletic person, so
I'd expect my resting heart rate to be lower as we see with other athletic
adults! When I exercise it almost immediately goes to the very high 100s, and
sometimes to 200 after strenuous exercise, but I don't consider that to be
worrying like a high heart rate at rest.

I will be sure to watch out for the signs and the progression you mention. But
in terms of seeking care early - I'm not quite sure what good that would do.
If I don't need a ventilator yet and just have normal cold or flu like
symptoms (which I'd usually stay home for) how would they be able to help? It
isn't like there's a cure right? I would be concerned with going to the doctor
and being turned away as there's nothing they can do, but in the meantime
taking up valuable time and resources from people who may be more severely
ill.

~~~
smdz
From what you mentioned, your childhood tachycardia looks more like a
symptom/result of some allergic reaction.

> When I exercise it almost immediately goes to the very high 100s, and
> sometimes to 200 after strenuous exercise

At age 31, "immediately goes to the very high 100s" \- if you go above 140
fairly quickly and you are not in endurance sports, it is concerning. You
should consult a cardiologist when times get normal. Typically athletes
involved in endurance sports also have lower than normal Rhr.

> in terms of seeking care early

For Covid19, because of its scale, you can't do much other than vaguely
understanding the line of treatment and going to the hospital when symptoms
appear. Do not think: "I will give it one more day". 90% covid19 infected
people do not need a ventilator. When in doubt, get a test done. But note that
the tests may result into a false negative if you appear without the symptoms.
Do not panic. For future doctor visit, keep a fever record with time and
comment any progression of symptoms. Stay hydrated and get enough rest.

~~~
drakonka
It definitely does go above 140 fairly quickly during exercise, and easily
goes over 100 when walking. I have consulted a cardiologist as I mentioned as
recently as a year or so ago. I went because this was something that was not
really followed up on when I was a child and I wanted to make sure I wasn't
dying of some undiagnosed heart issue. They did a basic EKG, had me wear a
device to monitor my heart for a few days, and then also did a blood test to
check for things like thyroid issues. Nothing came up. They said my heart rate
was high, but did not find a cause.

Good to know regarding doctor's visit should it come to that, thanks!

------
pkuhar
Infections raise resting heart rate. so resting heart rate is a good indicator
of an infections.

I've made an app that collect heart rate data from the apple watch and posts
it to a public server together with an approximate location. Data is
anonymized.

Apple rejected the app, since it relates to human subject research and need
IRB approval.

The app and backend are open source. If anyone want to push this through their
university and do some research, you have my full support.

\-- rejection

Hello Peter,

Thanks for your time on the phone today.

As we discussed, we noticed that your app is conducting health-related human
subject research however the seller and company names associated with your app
are not from a recognized institution and we were unable to verify independent
ethics review board approval.

We have now rejected your app for the App Store Review Guidelines detailed
below.

Guideline 5.1.3 - Legal - Privacy - Health and Health Research

Your app is conducting health-related human subject research, but we were
unable to verify independent ethics review board approval.

Next Steps

Apps conducting health-related human subject research must secure approval
from an independent ethics review board. You can attach proof in the App
Review Notes section of App Store Connect.

Guideline 5.1.1 - Legal - Privacy - Data Collection and Storage

We found in our review that your app provides services in a highly-regulated
industry and requires sensitive user information, however the seller and
company names associated with your app are not from a recognized institution.

Per section 5.1.1 (ix) of the App Store Review Guidelines, apps that provide
services or collect sensitive user information in highly-regulated fields
should be submitted by a legal entity that provides these services, and not by
an individual developer.

~~~
jacquesm
Bloody bureaucrats. Is there some way you could get a recognized institution
to back you?

I'll tweet out a request see if someone is willing to take it up.

~~~
xenonite
On the other hand, this is quite sensitive data, which is why a respected
nonprofit organization would be much more trustworthy, and which is why I
understand the decision of the referees.

~~~
jacquesm
People install apps _voluntarily_ , they should be able to make these sort of
decisions for themselves.

It's one thing to protect users from malware, quite another to treat them like
legal incompetents.

~~~
decebalus1
Just like they made the decisions for themselves when faced with the Cambridge
Analytica quizes, right? Regulations are there for a reason.

~~~
DoreenMichele
You know, my HIPAA training is out of date and it's possible that new
legislation applies. One of the more aggravating parts of my insurance job was
dealing with people who thought I wanted them to sign an authorization because
the insurance company was a meanie face trying to screw them out of their
money and I would explain "No, ma'am, we need this to comply with federal law.
Please and thank you." and they would be all chagrined and get me the auth, at
long last.

But I only see App Store guidelines cited, not federal legislation. So the
odds are good that someone in the company has the power to overrule that.

Given the circumstances, it seems to me this would be an appropriate time for
an executive to say "Yea, verily, fuck them there guidelines. Let this person
do this thing."

And if they don't want to or can't do that, it would be a good time for
someone to hand walk it through the process and get it hooked up post haste
with whatever doohickey would make everyone all happy.

------
jsilence
There was some AI computer vision software that could process video from
humans and deduce the heartrate with high accuracy.

A similar software like this Apple watch thingie could measure our heart rate
through the web cams we have at our laptops.

~~~
jsilence
The mic could monitor for coughing frequency.

~~~
jonbaer
[https://thenextweb.com/artificial-
intelligence/2018/10/15/am...](https://thenextweb.com/artificial-
intelligence/2018/10/15/amazons-new-patent-will-allow-alexa-to-detect-your-
illness/)

------
Aeolun
First thing I was looking for was a download link :(

Why does Apple think I’m unable to decide for myself whether I want this or
not.

~~~
kyriakos
Thats a sacrifice you make when you choose the ios ecosystem. It's a
compromise between secure apps, privacy and inconvenience.

~~~
cryptoz
I don't think Android allows coronavirus apps either. If this were for Android
it would be likely barred from the play store.

[https://play.google.com/store/search?q=covid-19&c=apps](https://play.google.com/store/search?q=covid-19&c=apps)

[https://play.google.com/store/search?q=coronavirus&c=apps](https://play.google.com/store/search?q=coronavirus&c=apps)

0 results.

~~~
kyriakos
You could just install the apk file straight out of github though

~~~
Mirioron
I hope this becomes more common in the long-term. Something needs to break
playstore's grasp on android.

------
m0zg
Yeah, not gonna fly, that one. Although Apple could get off its ass and
publish an official app to track if I've been in the proximity of a (self
reported) infected person. And if they actually gave a shit, they'd convince
Google to share data. And then I'd be able to delete the data from both when
this is over. Is this too much to ask? Why this is still not a thing is beyond
me, PR wins alone would be worth the ~10 person-days of engineering work this
would take to put together (2 days, Apple 1FE, 1BE, Google 1FE, 1BE, and half
a person from each company to coordinate efforts; conservative schedule).

------
3327
I have a garmin that constantly has my RHr.

I knew i had COV-19, so I logged everything.

Friday (contraction of virus) to Tuesday (first symtoms) my RHR tanked each
day incrementally from 62 all the way to 50. on Wednesday when my fever kicked
in, RHR jumped to 64.

~~~
o-__-o
How have you been handling the disease since?

------
ja27
I had a cold last fall and the day before I really felt it, my Apple watch
threw up a notice that my resting heart rate was unusually high.

------
mrfusion
I always wondered if cardiovascular fitness shortened cold and flu durations
with the body getting more blood where it needs to be?

------
scotty79
This is very interesting. Fitbit and such have great opportunity to
contribute.

