Over the past week, my resting heart rate averaged 56 beats per minute, I took between 10 and 26 breaths every 60 seconds, and my skin temperature hovered around 92.7 degrees Fahrenheit.
I know this because a device the size of a key ring has been stuck to my chest monitoring these metrics on a minute-by-minute basis.
Working at my computer, swimming in the ocean, playing tennis or relaxing by the pool, the device is silently recording my biometric data. Every breath I take, every move I make, it is watching me.
And the results it generates could hold the key to early detection of COVID-19.
For first few days, the BioSticker is a minor irritant – an unfamiliar presence just beneath the shirt pocket that idle hands instinctively want to scratch.
But fairly quickly, the only thing I notice about it is the stream of data flowing into my email inbox.
I am wearing the original version of the device – a body sensor that aims, in the words of its inventor Dr. Jim Mault, to provide a ‘4K movie’ of a patient’s vital signs.
It was designed and received US Food and Drug Administration clearance in the US for monitoring seriously ill patients convalescing at home.
By tracking breathing rate, temperature and heart rate, it can reliably alert medics to signs of a respiratory infection.
When COVID-19 arrived on the scene, Mault, CEO of Silicon Valley med-tech firm BioIntelliSense, saw an opportunity to adapt the device for the pandemic.
“We were one of the few technology companies in the world that was positioned with a wearable device that is medical grade and could monitor a variety of vital signs including temperature, heart rate and respiratory rate that are among the early indicators of a COVID infection,” he told the Cayman Compass.
The Dart group has brought in 200 of the BioStickers as part of a pilot to test the technology.
The company has also ordered 1,000 BioButtons – the COVID-focussed version of the original. The principle difference is that the newer device is designed to be more user-friendly.
It is the size of a coin and links to an app that uses an algorithm to analyse the data, feeding it back to the user through a simple notification of their COVID status – cleared or not cleared.
Filtering the noise
According to Mault, the algorithm knows the difference between the kind of spikes in these baseline metrics that are caused by an infection and those that would be caused by exercise or sunbathing.
He said it filters out ‘the noise’ to give a clear and consistent, continuous picture of relevant health data.
Mault said the BioSticker, which takes a reading every minute and uploads the information via Bluetooth to a smartphone application, is far more precise than traditional monitoring.
“In the course of one day, you have 1,440 temperature measurements and the same for heart rate and respiratory rate. That is a big difference when you compare it to someone taking their temperature with a thermometer twice a day. It is like a 4K movie versus two photographs.”
Another key to the device’s utility, Mault said, is that it knows what normal is for me, rather than for an ‘average human’ – a classification which covers a wide range of possible body types and physiologies.
The BioSticker puts my heart rate at 56 beats per minute. So while a reading of 90 bpm is within the ‘normal’ range, for me it might be something to be concerned about.
“The sticker can literally watch the data from your body and establish what is the baseline curve for you,” Mault said.
When the device starts to see statistically meaningful deviations from that baseline, it would alert the user and could be programmed, depending on policy, to trigger some form of public-health intervention. In the COVID-19 scenario, that is most likely to involve a recommendation to isolate and get tested.
Mault believes BioButtons can provide an early-detection system that can effectively screen sections of the population and evaluate their risk for COVID in real time.
Those that are ‘all clear’ can go about their day, those that are not can take steps to protect themselves and others.
In the vast majority of the 208 COVID cases recorded in the Cayman Islands, the symptoms were so mild that the patients didn’t notice they were sick or report any illness to the authorities.
Would a device like the BioButton detect changes that are not necessarily distinguishable to the patients themselves?
Mault believes that it would.
Is he confident that every case of COVID-19 would show up on this device?
There will always be outliers, but statistically, he believes the vast majority of cases would be picked up through subtle changes in the data points tracked by the body monitors.
This is not yet settled science.
The BioSticker is FDA-cleared for monitoring outpatients for respiratory illness, not currently as an early warning system for COVID. But Mault says the principles are the same.
And even without the further research needed to prove its specificity for COVID, he is confident it can accurately diagnose infection.
“There is no debate that when someone is suffering an infection, their temperature goes up, their heart rate goes up, and their respiratory rate goes up. That has been black and white in clinical medicine for 2,000 years,” he said.
The capacity of wearable devices to screen sections of the population for COVID-19 is an emerging field of study in the US, with preliminary search suggesting heart rate spikes, in particular, can be an early warning sign for COVID.
How will it be used in Cayman?
Cayman had discussed the idea of using the BioButton technology as part of the reopening of the islands’ borders.
Chief Medical Officer Dr. John Lee revealed at a press briefing in July that he was wearing one as part of a test run of the technology.
Government mooted using the monitors in combination with PCR testing to allow people arriving in Cayman to have a shorter isolation period.
That plan was shelved, at least for the initial phase of border reopening, when officials decided to stick with a mandatory 14-day isolation period for anyone coming into the territory.
The BioButton has been used in the US to help reopen schools and colleges, but it has yet to be deployed as part of a country’s reopening plan.
“It is leading edge,” said Dave Guilmette, president of Health Solutions for Aon Global, who was part of a private-sector task force collaborating with government on ideas for the border reopening.
“This is a relatively new company. The BioButtons were just coming off of production in the middle of August.”
Regardless of whether the device is ultimately part of any border-reopening plan, it is likely to play a role in Cayman.
Jackie Doak, the president of business development for Dart, has been wearing a BIoSticker for several weeks.
The company, which owns the Kimpton Seafire and Ritz-Carlton resorts, among others, plans to offer it to hospitality employees and to use it as a tool to help manage its staff when the borders reopen.
“We all hoped COVID would just go away, but that doesn’t look like it is happening for the foreseeable future,” she said. “What this technology does is give government another tool in their toolbox in terms of how they continue to suppress this virus.”
Geofencing, blockchain health records and sharable biometric data could be legacies of COVID that persist through the pandemic and beyond.
There is something that sounds vaguely dystopian about a world where people carry digital health passports and access to a worksite, school or movie theatre could depend on your willingness to share your breathing rate.
But this is 2020 and the alternative is potentially less vague. We have already accepted massive restrictions on our freedom in the interests of public health.
It is less than six months since all businesses were closed, the beaches were off limits, and police helicopters patrolled the skies enforcing a nightly curfew.
Rather than a tool of oppression, advocates for the adoption of technology view these solutions as a means to claw back some lost freedom as the virus persists.
In the not-too-distant future, Guilmette expects people may want to carry and selectively share biometric data and health records in order to gain greater freedom of movement.
To access certain countries, travellers may eventually be required to swipe a QR code on their smartphones that testifies to their recent COVID-testing history and risk status.
“It could get to the point where it becomes standard,” said Guilmette.
People may choose to opt out, but they could be opting out of travel at the same time. He highlights a comparison with the stringent new airport-security measures introduced after the September 11 terrorist attacks.
“People may not want to walk through a metal detector or deal with taking their shoes off when they travel and that is fine, but they can’t get on a plane,” he said.
Privacy is likely to be a concern for some.
When I downloaded the app, I signed away permission for my vital signs to be uploaded to a cloud.
Despite assurances this was a secure process, I did so with a lingering anxiety that it could be hacked and sold to Facebook which, in time, would find a way to monetise my skin temperature, or to Amazon, who might try to sell me music subliminally synced with the rhythms of my heartbeat.
Guilmette acknowledges there will be concerns. But he said advances in blockchain technology were aiding greater data security than had ever been available before.
As for my own data, there is nothing in the measurements that I am not comfortable sharing on these pages.
The plot points in the graphs I am sent every hour mean very little to me.
Because I am using the BioSticker, rather than the newer COVID-focussed BioButton, I don’t have an app to interpret the data.
Mault assured me I am scoring “all As” on my BioReports.
There is nothing in there that indicates any concern for a viral infection. The longer I wear the device, he said, the more familiar it will become with my “physiologic and metabolic signature”.
So for now, I am ‘all-clear’. If that changes, the BioSticker will let me know.