As of Dec. 8, there have been over 14 million cases of COVID-19 in the United States alone, and over 1.5 million people have lost their lives worldwide. While these statistics are devastating, and COVID-19 has had a drastic impact on all of our lives, some of the ways in which the global public can ultimately get under control is through frequent testing as well as contact-tracing exposed individuals. Despite the importance of testing, it has become increasingly difficult to get tested in the US, especially for people who are not (or are not yet) showing symptoms.
To better understand the necessity of frequent and appropriately timed testing, it is important to discuss the implications of presymptomatic and asymptomatic cases, and why it is important to catch them early. Presymptomatic cases of COVID-19 occur in individuals who have contracted the virus but have yet to show symptoms. This window is typically the 48-hour period before the onset of symptoms, yet is the most contagious time period, as this is when peak viral-shedding occurs. Asymptomatic cases of COVID-19, on the other hand, occur when individuals test positive for the virus and never show symptoms yet are still contagious to others, although the extent of how contagious they are is uncertain. When testing those without symptoms, it can be difficult to initially tell the difference between these cases, except presymptomatic cases will develop symptoms within one to two days of being tested. In both cases, a person with COVID-19 can believe they are healthy and, often without realizing it, actively spread the virus to others. Frequent and timely testing, therefore, is pertinent to keeping the spread of the virus to an absolute minimum.
As many Boston College students have realized throughout the course of this semester, it is not always easy to get a coronavirus test—especially beyond BC’s campus. Nine months into the pandemic, there is still unequal access to testing nationwide, and many insurance providers will only cover the cost to get tested for patients who are symptomatic, have been contact traced, or require it before being admitted to a hospital. Outside of these conditions, there is little incentive for regular testing among members of the public, and consequently COVID-19 becomes more likely to spread among seemingly healthy people. With access to a promising vaccine still a ways away for the general public, despondency towards testing might occur. While the public can rely on personal integrity for symptom monitoring, and in some cases track the temperatures of patrons upon entering public spaces, this is not a feasible long-term solution to preventing the spread of COVID-19 beyond an effective vaccine. So how can individuals ensure that they are keeping the people they encounter safe when they are unable to be tested or vaccinated?
In addition to watching out for the more noticeable symptoms such as fever, body aches, and cough, monitoring vital signs is a non-invasive way of signifying whether or not someone’s body is functioning normally. These vital signs include heart rate, respiratory rate, blood pressure, and pulse oximetry. While changes in these are typically indicative of illness, they are especially relevant to COVID-19, a lower respiratory tract infection, since upper respiratory tract infections do not cause such drastic changes in vital signs. Changes in vital signs would indicate illness in the body in both presymptomatic and asymptomatic cases of COVID-19. That is, even before people show symptoms.
How does one know that normal vital signs are skewed or spiking? In order to recognize when drastic changes occur, people can note what their base-level values are when healthy, as numbers will vary for each person based on preexisting health conditions. With this knowledge of personal vital statistics, individuals would be prompted to self-isolate in situations when their vital signs change to stop the spread of the virus to others and, if necessary, receive treatment before allowing the condition to worsen. Changes in vital signs are not proof of infection, and COVID-19 tests are still the most accurate way to determine if someone is positive. Nevertheless, most people infected with COVID-19 get tested over a week after the onset of the virus, so noting changes in vitals sooner might allow for earlier testing.
While it is possible for people to monitor vital signs using devices such as blood pressure monitors and pulse oximeters, or to count the number of breaths per minute to determine respiratory rate, the technology behind fitness trackers has advanced such that this can all be done in a constant, passive manner. Fitness trackers give people valuable insight on energy output, pulse, recovery, sleep, and other health data.
Many athletic organizations are utilizing fitness trackers to monitor their players without fully disrupting their seasons. The National Basketball Association (NBA) and Women’s National Basketball Association (WNBA) did a tremendous job using technology to handle COVID-19 cases, and did not have any outbreaks among players nor interruptions to their season. They kept all the players within a “bubble” and ensured that everyone followed strict protocols, such as wearing titanium Oura rings that track vital signs in players. Oura rings, one of the most expensive fitness trackers on the market, claim to detect symptoms three days in advance with 90% accuracy, and monitor body temperature, heart rate variability, respiratory rate, resting heart rate, and much more. These values are measured on a nightly basis during sleep, as they will be more consistent from night to night instead of fluctuating throughout the day. Nascar asks both drivers and staff to wear Oura rings as well.
The Professional Golfers’ Association of America (PGA) has its players monitor their vital signs by wearing WHOOP bands. WHOOP bands track heart rate variability, resting heart rate, and respiratory rate during sleep, all of which combined produce overnight recovery data. The company has conducted much research surrounding respiratory rate, particularly since March, when many of its users who later tested positive for COVID-19 had spikes in respiratory rate before showing symptoms. WHOOP is the only wearable fitness tracker that has been validated by a third-party clinical trial to accurately measure respiratory rate, and its passive nature makes this simple. The band’s algorithm is able to detect 80% of symptomatic COVID-19 cases simply based on changes in respiratory rate, and found that in 20% of presymptomatic individuals, there was a rise in respiratory rate prior to the onset of symptoms.
Other fitness trackers, such as the Apple Watch and Fitbit, do not contain the same breadth of tracking abilities as the Oura ring or WHOOP strap, but still track vital signs in a manner that gives users a baseline. The newest Apple watches serve as blood oximeters, which is technology that is not seen in any of the other trackers on the market. Fitbit has produced studies about detecting COVID-19 cases early in its users, citing that they can “detect nearly 50 percent of COVID-19 cases one day before participants reported the onset of symptoms with 70 percent specificity.” Although Fitbits come in a wide variety of styles with different capabilities—and not all models can track vitals beyond heart rate values—even in their most basic forms, Fitbits can provide users with valuable data surrounding some baseline vital statistic values.
In a nation where access to testing is increasingly difficult, even on BC’s campus, wearable fitness trackers to monitor vital signs provide individuals with opportunities to have autonomy over their health and to prevent furthering the spread of COVID-19. Perhaps encouraging BC students to monitor vital statistics, in addition to filling out the daily self-assessment, would help to mitigate the spread on our campus as well.
For more information on all things COVID-19, I recommend subscribing to this email newsletter by Jamie Babin, a crisis management consultant who specializes in the mitigation, preparedness, response, and recovery of large-scale crises, such as public health threats like COVID-19. I wrote into Babin’s newsletter this summer with concerns spreading the virus without realizing it, and she encouraged me to look into the WHOOP strap (which I later purchased).