key: cord-0079044-e09ubj53 authors: Xie, Linshan; Huang, Man; Geng, Wenye; Kan, Haidong; Xuan, Jianwei; Song, Yuanlin; Li, Jinghong; Bai, Chunxue; Yang, Dawei title: A study of viral respiratory tract infections based on new smart terminals date: 2022-05-25 journal: nan DOI: 10.1016/j.ceh.2022.05.001 sha: 6d6fb4fb1b91dce12a4460a78b23ba3cad9c9928 doc_id: 79044 cord_uid: e09ubj53 nan Omicron (B.1.1.529), a new SARS-CoV-2 variant of concern (VoC), was first reported in November 2021. It carries a considerable amount of mutations in spike protein, and features higher transmissibility and a longer infectious period. The immuneescape mutations enable the Omicron variant to evade some of the immunity from vaccines, leading to increased reinfection rates among vaccinated populations. 1, 2 In recent two months, the confirmed cases accumulated 0.6 million in Shanghai (25 million population), and the ICU beds in hospitals have suddenly surged with critical issues. The overwhelming healthcare burden urgently requested new trends of techniques, such as digital devices. Recent years have seen a rapid development in smart wearable devices, and they have become capable of monitoring health parameters in real-time, such as body temperature, blood oxygen saturation, and respiratory frequency. Through the collection of cough sound recordings and self-reported symptoms, ResApp Health Limited developed a cough audio-based digital tool for COVID-19 detection (https://clinicaltrials.gov/ct2/show/ NCT04864535). Lately, the Chinese PLA General Hospital (301 Hospital) and Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology initiated a respiratory health study based on Huawei wearable devices to screen respiratory infections. In this study, critically ill patients with COVID-19 in ICUs were enrolled, and the participants' information, including their physiological parameters and position senses, were collected from the smart terminals (Huawei watches and mobile phones) (The study protocol was approved by the ethics committee of Zhongshan Hospital Fudan University, approval number B2022-184R) (see Table 1 ). With the integration of artificial intelligence, we examined the performance of a screening tool for viral respiratory infections among infected populations in real world. Prone ventilation can effectively improve the oxygenation in patients with respiratory failure secondary to SARS-CoV-2. 3, 4 The smart terminals monitored changes in oxygenation in real-time, which were used for evaluating lung recruitment and determining the patient's sensitivity to the prone ventilation. At the same time, they recorded the position senses of the patient, and monitored the duration of ventilation in prone position. Heart rate variability can serve as an indicator of vagus nerve activity. Stimulation of vagus nerve induces bronchoconstriction, mucus secretion and bronchial vasodilation, thus involving inflammatory response. Study results showed that the dyspnea and respiratory failure caused by viral infections may also be associated with alterations in vagus nerve. 5 By recording variability in heart rate, the smart terminals could judge the patient's vagus nerve activity, and further predict patient responses to the prognostic factors. To achieve an optimal level of sedation, it is recommended that mechanically ventilated patients are kept awake or easily aroused, with effective pain control. Less sedation results in lower prevalence of delirium in critically ill patients with COVID-19, and is associated with better patient outcomes. However, it remains challenging how to reach a suitable level of sedation in clinical practice. 6 The smart terminals detected subtle hand movements of the patient to determine the level of sedation, and to facilitate the optimal approach to sedation for the patient. Through integration of multiple parameters, and data transmission and storage in the cloud terminal, they enabled the doctors and nurses to implement real-time monitoring, while reducing contact with the patients, and lowering the risk of infections. Given the high transmissibility of the Omicron variant, the number of COVID-19 cases rose sharply worldwide. 7, 8 Even if Omicron causes less severe symptoms than Delta, rapid spread could result in higher prevalence of infections, and overwhelm the healthcare systems. 9 The pandemic has highlighted the need for Clinical eHealth j o u r n a l h o m e p a g e : w w . k e a i p u b l i s h i n g . c o m / C E H long-term, continuous follow ups of the prognosis in a large population infected with COVID-19. 10 Therefore, the potential for development of smart terminals in the post-pandemic era is substantial. They can monitor the patients' physiological parameters, and predict the course of the disease for early interventions and improved prognosis. Smart terminals are also expected to help us analyze the correlation between vaccination and prognosis, providing evidence for further research on vaccines and their effectiveness. For the provision of more professional and convenient services for a vast number of patients, Zhongshan Hospital Fudan University plans to start outpatient services specialized in post-COVID-19 rehabilitation. Combining the latest Medical Internet of Things technologies, the hospital aims to make personalized, holistic rehabilitation programs, and provide diagnosis and treatment services throughout the course of the disease for patients who recovered from COVID-19. Furthermore, the specialized service facilitates data collection in terms of sequelae and adverse drug reactions, which will provide new evidence and inspire new ideas for COVID-19 treatment. Omicron SARS-CoV-2 variant: a new chapter in the COVID-19 pandemic Association between 3 doses of mRNA COVID-19 vaccine and symptomatic infection caused by the SARS-CoV-2 Omicron and delta variants Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study Awake prone positioning for non-intubated patients with COVID-19-related acute hypoxaemic respiratory failure: a systematic review and meta-analysis Lung innervation in the eye of a cytokine storm: neuroimmune interactions and COVID-19 Sedation in mechanically ventilated patients with COVID-19 Winter of Omicron-the evolving COVID-19 pandemic Modeling transmission of SARS-CoV-2 Omicron in China How bad is Omicron? Some clues are emerging Sleep and circadian health of critical COVID-19 survivors 3 months after hospital discharge