Like all the best ideas, this one started with a question – a question about how to slow the spread of the novel coronavirus; refined over a series of meetings between U.S. Army Medical Research and Development Command scientists and researchers in the early days of the pandemic. For Cmdr. Christopher Steele, director at USAMRDC’s Military Operational Medicine Research Program, it was a question that would ultimately guide what’s become a nearly year-long funding effort.

“For active duty personnel and civilians, we wanted to know – what does ‘normal’ look like from a health perspective?” says Steele, repeating that initial query once again during a conversation in early 2021. “And how do changes from normal translate to early detection of disease?”

The answer to that question may soon be found on your finger, on your wrist, or even around your neck. Just as a pair of vaccines for COVID-19 have become available to the American public, USAMRDC is pushing the limits of its virus research even further. The goal: to develop wearable technology to detect the virus before a person might even begin to notice symptoms – however slight or subtle – in the first place.

“Having some wearable measurements on how you’re doing leading to [infection] is extremely helpful,” says Steele, “because we can understand additional concerns about your health and if they need to be taken more seriously for quarantine procedures or for advanced care.”

USAMRDC’s quest to find technology capable of detecting pre-symptomatic exposure to the virus began in March 2020 – just weeks into the pandemic – as part of a joint funding opportunity between both MOMRP and USAMRDC’s Military Infectious Diseases Research Program. As part of a planned program announcement, a total of seven wearable technology projects were selected for funding through the Command via its partnership with the Medical Technology Enterprise Consortium; the latter entity using a unique contracting tool called an “other transaction agreement” (or, OTA) to facilitate the delivery of advanced technology prototypes for a wide array of military-relevant injury conditions. Of those seven investments, one of the more promising efforts is a proprietary algorithm being developed jointly by Dr. Ashley Mason, an assistant professor with the Department of Psychiatry at the University of California, San Francisco, and Dr. Benjamin Smarr, an assistant professor with the Department of Bioengineering and Data Science at the University of California, San Diego.

In a recent study, Mason’s team showed that wearing a so-called “smart-ring” – a wearable device that generates continuous temperature data – may foreshadow the presence of COVID-19, even in cases when infection is not suspected. By analyzing data from 50 people previously infected with COVID-19 who agreed to wear the ring (which, in turn, came equipped with the aforementioned algorithm) Mason and Smarr found the ring accurately identified higher temperatures in people with symptoms of COVID-19. Ultimately, the algorithm may help lead to earlier isolation and testing – thereby potentially curbing the spread of infectious diseases.

“Continuous temperature assessment allows us to look at [human patterns of change] by allowing us to analyze changes in temperature as processes,” says Mason, noting the difference between continuous and single-point temperature monitoring. “If we think about temperature as a process – imagine a wave – then we can start to ask questions that go beyond, ‘are you high or low in temperature,’ [and] we can examine the shape of the waves both within one person over time and we can compare the shapes of peoples’ waves to each other.”

Mason’s work was initially sponsored by Finnish company Oura Health (who agreed to provide the “smart rings” used in the study), which gave her team a substantial amount of early data on virus exposures compared to other external groups. In July 2020, MTEC began funding Mason’s multi-pronged TemPredict study, providing key infrastructure resources. Then, last month, Mason’s team published the study’s aforementioned initial findings in the peer-reviewed journal Scientific Reports.

“Having a device that’s doing surveillance on you at the time and to say, ‘hey there’s something different about you’ – those are potentially powerful opportunities to intervene before a situation becomes a lot more complicated to treat,” says Steele.

While it is not known how effectively the algorithm-enabled smart ring can detect asymptomatic COVID-19 infection, Mason’s team reported that in 38 of the 50 participants (or, 76 percent), fever was identified when symptoms were unreported or even unnoticed. According to Mason, the second leg of her TemPredict Study, which was launched in early December and has already enrolled tens of thousands of participants across the globe, will continuously apply the algorithm to the participants’ smart ring data, then alert participants when the algorithm suggests COVID-19 testing is warranted.

“[The algorithm] does seem to be working well,” says Dr. Jenifer Ojeda, Health Science Program Manager at USAMRDC’s Congressionally Directed Medical Research Programs, and additionally the science officer providing DOD oversight on Mason’s award. “It is detecting early – pre-symptomatic, if you will – cases, and with some degree of fidelity.”

Still, Mason’s algorithm – which is intended to be agnostic and not exclusive to any one particular device – is just one of many entrants in this particular race. Other performers receiving funding – including the makers of the Fitbit family of trackers and smartwatches – are using their own, internally-developed platforms, while others are utilizing off-the-shelf platforms to meet their end goals.

While Steele admits USAMRDC is likely months away from receiving an actual, refined product to review, it is possible such a product could be developed and then deployed during the current COVID-19 pandemic. That would depend, of course, on a chosen performer delivering the kind of clear and consistent data demanded by the U.S. Food and Drug Administration for such devices. Regardless, this kind of technology clearly has a role in any kind of future, similar public health emergencies, and would make a substantial impact on the ability to detect illness on the future battlefield as well. The latter, while an ancillary perk for now, may indeed provide a showcase for any wearable technology’s likely ultimate benefit: to provide a near-continuous level of support and resilience to any U.S. Soldier across the globe.

Says Steele, “Wearables may be the premise that allows for truly integrated telemedicine content because now you have the ability to measure a person from a distance, or outside the clinic, or anywhere.”

By Ramin Khalili