key: cord-297197-klr208kp
authors: Weizman, Yehuda; Tan, Adin M.; Konstantin, Franz F.
title: Use of Wearable Technology to Enhance Response to the COVID-19 Pandemic
date: 2020-07-01
journal: Public Health
DOI: 10.1016/j.puhe.2020.06.048
sha: 
doc_id: 297197
cord_uid: klr208kp

ABSTRACT Introduction As part of the COVID-19 outbreak response, numerous technology-based solutions have been created to enable contact tracing, track movements of the population and ensure social control. Wearable biometric bracelets are widespread and commonly used in the form of wrist-worn activity trackers that are both familiar and liked by the general population. Objectives/Study Design/Methods The authors propose an innovative approach - a wearable bracelet that can be used to curb the spread of Covid-19. The bracelet would facilitate 3 functions; screening on a population level, digital contact tracing and real-time immunity status tracking. Results/Conclusions Utilising the Internet of Things, data would then be transfer over a network to interactive web-based dashboard and big data analytics employed to augment response within a defined geographic region.

In December 2019, an outbreak of pneumonia of unknown origin was detected in China and quickly determined to be caused by novel coronavirus -SARS-CoV-2. With highly infectious properties, the outbreak was declared a global pandemic by the World Health Organisation on March 11, 2020.

Combating the spread of the virus has been a global challenge. On the positive side, access to unprecedented technology and widespread communication networks are helping to enhance global response. From Australia to Israel, more than 30 countries have implemented systems for population surveillance and contact tracing, mostly in the form of smartphone apps.

In recent years, wearable sensors have become popular in many applications. These are electronic devices, worn on the body, containing sensors which log information on physiological parameters and user interaction with the environment. In 2017 in the U.S alone, 17% of adults used a wearable device [1] .

With advances in technology, there is now an opportunity to benefit from data collected from wearable devices at a population level. The Internet of Things (IoT) is a grid of interconnected devices, machines, objects or people with unique identifiers (UIDs) that transfer data over a network. IoT can facilitate extrapolation of associations, patterns and trends within extremely large data sets to provide near-real-time insights to ensure a data-driven, informed response to the pandemic.

Such wearables can offer a centralised solution for simultaneously tracking Covid-19 data and digital diagnostics at both individual and population levels. In this instance, we propose a customized biometric bracelet with a wireless communication circuit and a subscriber identity module (SIM card), that has three built-in features: (1) an Infrared thermometer, (2) a global positioning system (GPS), and (3) a radio-frequency identification (RFID) with an UID number. The bracelet would employ the IoT to transfer data over a network to an interactive web-based dashboard that tracks COVID-19 in real-time. Wearing the bracelet would be recommended within a predefined geographic area. Big data analytics could then provide a centralized bird's eye perspective of emerging trends and patterns to enhance response and containment.

The need for early screening at a population level has been one of the main challenges of the pandemic. With fever being one of the most common presenting symptoms, (43.8% upon hospital admission, 88.7% during hospitalisation) [2] many countries have employed devices such as 'temperature guns' to measure fever as a barrier of entry into public places. Still, tracking fever mostly requires people to self-report and actively seek medical care, leaving numerous cases unreported. As fever is easy to gauge objectively, a biometric bracelet could continuously measure fluctuations in temperature using an integrated infrared sensor. Thus, if a person has a fever, they could automatically be contacted by a healthcare professional, screened or tested for SARS-CoV-2, as required.

If an individual then tested positive for SARS-CoV-2, the database could automatically trace back anyone they had come in contact with in the past 14 days using a GPS feature (described below).

Potential carriers could then self-isolate, be tested and treated as required.

Contact tracing plays an important role in the control of emerging infectious diseases and has been utilized successfully to mitigate the spread of numerous past outbreaks including Smallpox and SARS [3] .

In this instance, the biometric bracelet's GPS feature would continuously track movements of individuals within a geographical area and communicate back to the Covid-19 database platform saving input on the population whereabouts at each timepoint. The database could then use advanced data analytics to extract a list of other people that were within a predefined distance of an infected individual at a certain day and time.

The bracelet could also send an alert using a beeping sound or vibration to people at risk of having been in contact with a confirmed positive case.

To date, only incomplete information is available on the host innate immune status of SARS-CoV-2 infected patients. Based on published research from other Coronaviruses, some form of active immunity can be expected [4] . The global race to develop and approve an accurate, widespread antibody tests for SARS-CoV-2 is well on its way. Although, several practical questions remain due to an incomplete understanding of how the virus triggers immune recognition and neutralisation [5] .

As more people are infected, most are likely to generate an immune response. This may lead to a need for a community-wide immunity status classification, for example: (1) previously infected, now immune, non-infectious, (2) currently infected, and (3) immunologically naïve, still susceptible to infection. In time, we may see different sets of restrictions/privileges for people with different immune statuses.

Importantly, as more people recover, we need to consider how to best utilise people with active immunity to reignite our economy, restore critical facilities and provide much needed relief to workers in healthcare and essential services. But how will we know an individual's immune status in real-time?

A Radio-Frequency Identification (RFID) within a biometric bracelet could be the solution. The bracelet would have a unique personal ID and be configured to communicate with a second deviceeither hand-held or freestanding. The second device can be located at the entrance to hospitals, public facilities, parks, grocery shops and workplaces. A quick scan of the bracelet could retrieve an individual's health status instantaneously displaying a 'clear' or 'block' signal to the device. Possible status codes could be colour-coded or show classifications such as: "currently sick", "recovered", "in quarantine" or "unknown".

Logically, any government-sanctioned surveillance programme raises privacy concerns regarding data security, potential leaks and hacks, access to private companies and more. However, during an extraordinary crisis, many governments are willing to decrease privacy restrictions to save lives.

Most democratic countries already have privacy laws in place to govern the regulation, storing and use of personally identifiable information, healthcare and financial information. As the coronavirus pandemic continues to spread, some Privacy Commissioners are lifting data restrictions for health officials to keep track of the outbreak. For example, in March, Israel passed an emergency law to use mobile phone data for contact tracing [6] .

Beyond protecting private data, a crucial role of government is to coordinate public health efforts to suppress and mitigate the pandemic. As the world braces for the next phase of the pandemic -why not leverage existing technology to design a centralised solution, a one-stop-shop to undertake three major tasks for enhancing a unified response to SARS-CoV-2.

All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Ethical approval was not required for this study as this is a short communication manuscript and no research conducted.

Mobile devices and health

Clinical characteristics of coronavirus disease 2019 in China

Immune responses in COVID-19 and potential vaccines: Lessons learned from SARS and MERS epidemic

Profile of specific antibodies to the SARS-associated coronavirus

Developing antibody tests for SARS-CoV-2. The Lancet

Coronavirus: Israel enables emergency spy powers