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From Exposure to Detection: Unraveling the Digital Signature of Infectious Diseases and Patient Behavior Using Smartwatches and Patient Self-Reporting

26 Pages Posted: 5 Mar 2024

See all articles by Shachar Snir

Shachar Snir

Tel Aviv University

Yupeng Chen

Stanford University

Matan Yechezkel

Tel Aviv University - Laboratory for Epidemic Modeling and Analysis

Tal Patalone

Maccabi HealthCare Services - Kahn Sagol Maccabi (KSM) Research & Innovation Center

Erez Shmueli

Tel Aviv University - Department of Industrial Engineering

Margaret Brandeau

Stanford University

Dan Yamin

Tel Aviv University - Department of Industrial Engineering

More...

Abstract

Background: Limited knowledge exists regarding behavioral and biomarker shifts during the period from respiratory infection exposure to testing decisions, a key phase affecting transmission dynamics and public health strategy development. This study aims to shed light on the timing of decisions related to altering social activities and seeking medical attention throughout the progression of the disease.

Methods: We analyzed data from a two-year prospective cohort study involving 4,795 participants in Israel, incorporating smartwatch data, self-reported symptoms, and medical records. Our analysis focused on three critical phases: the digital incubation period (from exposure to physiological anomalies detected by smartwatches), the symptomatic incubation period (from exposure to onset of symptoms), and the diagnostic decision period (from exposure to the decision to undergo testing) for influenza, COVID-19, and group A streptococcus (GAS).

Findings: The delay between initial symptom reporting and testing was 39 [35-44] hours for influenza, 52 [48-56] hours for COVID-19, and 40 [33-47] hours for GAS, with 72 [67-77] hours from anomalies in heart measures to symptom onset for influenza, 35 [31-39] hours for COVID-19, and 59 hours [52-66] hours for GAS. Analyzing the entire course of infection of each individual, the greatest changes in heart rates were detected 64·9 [95% CI: 60·2,69·5] hours prior to testing for influenza, 61·5 [95% CI: 59·1, 63·9] hours for COVID-19 and 58.6 [95% CI: 52·8, 64·4] hours for GAS. In contrast, the greatest reduction in physical activities and social contacts occurred post-testing.

Interpretation: These findings highlight the delayed response of patients in seeking medical attention and reducing social contacts and demonstrate the transformative potential of smartwatches for timely public health interventions.

Funding:  This work was supported by the European Research Council, project #949850, the Israel Science Foundation (ISF), grant No. 3409/19, within the Israel Precision Medicine Partnership program, and a Koret Foundation gift for Smart Cities and Digital Living.

Declaration of Interest: All authors declare no competing interests.

Ethical Approval: All participants received both oral and written advice about the study and provided written informed consent for participation. The study was approved by the Helsinki institutional review board of Maccabi Healthcare Services (protocol number 0122-20-MHS)

Keywords: Wearables, Incubation period, Heart rate, Infectious disease

Suggested Citation

Snir, Shachar and Chen, Yupeng and Yechezkel, Matan and Patalone, Tal and Shmueli, Erez and Brandeau, Margaret and Yamin, Dan, From Exposure to Detection: Unraveling the Digital Signature of Infectious Diseases and Patient Behavior Using Smartwatches and Patient Self-Reporting. Available at SSRN: https://ssrn.com/abstract=4746940 or http://dx.doi.org/10.2139/ssrn.4746940

Shachar Snir

Tel Aviv University ( email )

Ramat Aviv
Tel-Aviv, 6997801
Israel

Yupeng Chen

Stanford University ( email )

Stanford, CA 94305
United States

Matan Yechezkel

Tel Aviv University - Laboratory for Epidemic Modeling and Analysis ( email )

Tal Patalone

Maccabi HealthCare Services - Kahn Sagol Maccabi (KSM) Research & Innovation Center ( email )

Erez Shmueli

Tel Aviv University - Department of Industrial Engineering ( email )

Tel Aviv 6997801
Israel

Margaret Brandeau

Stanford University

Dan Yamin (Contact Author)

Tel Aviv University - Department of Industrial Engineering ( email )

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