Track infections through resting heart rate
github.com> Infections elevate your resting heart rate
This is not always true and I would recommend not to rely on it.
I recently had a sore throat, nothing more than redness, and felt sleepy all day for 6 days in a row. My Rhr had tanked to 50 consistently (manually verified) and I was concerned, but had no other issues than feeling a bit fatigued and mostly feeling sleepy. I did feel feverish, but had no fever (re-verified with multiple thermometers). I checked for any chest issues using a stethoscope at home, even though I did not have any respiratory problems.
Two days into it and on a second throat inspection, I found I had follicular tonsillitis - probably caught from my kid. A bit of a relief as I knew how to deal with it - but still no body fever. In the last two days, my Rhr then jumped back to 65-80 and it was the only time I had a fever once (101.5F), but my body was already feeling better and recovering from the infection.
An increased resting heart rate can be caused by many things, and we have no false negative/positive rate for increased heart rate wrt this virus. Whilst the intention is good, this app will end up sending many more people to hospitals, doctors, and pharmacists than necessary, furthering the straing on the healthcare system.
Data like this could (or might have the potential to) be used by the authorities to determine in which areas to test more. But otherwise it shouldn't send people anywhere, I don't think that was the intention.
This is hearsay, but I recall being at the Precision Medicine Conference recently and one of the speakers said that when sick with, say, flu, your heart rate spikes maybe 30-60 minutes before you'd otherwise know (have a fever, headache, etc.). So it didn't seem like a very useful test.
Maybe coronavirus is different though. I would check up on sources.
I use a garmin watch and I can confirm this. I had a very high fever about a month ago, so I got to see all the metrics in action. My resting heart rate did not spike until I already had symptoms, making it a useless predictor. Heart rate variability did steadily decline for several days before the onset of symptoms, so that could actually be a useful predictor of infection.
Appreciate the intention, we should all be applying our skills to solve this problem we're all facing but just playing devil's advocate here, my resting heart rate has gone up lately.
And it's not because I have the infection (I don't), it's because I've been stuck working in my apartment in Seattle for the past 3 weeks and I feel like I'm living a boring dystopian novel. I also stopped weightlifting, as the gym is closed. So my 'convict conditioning' workouts aren't giving me the same dose of endorphins as before, which helped keeping me happy and with a steady calm heart rate (I'm a huge hypochondriac). People I run into when I buy food also seem on edge.
Not sure how relevant something like this would be for someone living in the middle of the outbreak, which is probably the exact target of such a tool. Yes, I am aware that I'm aware of my stress (as you stated in the readme) but again, it wouldn't help me or others by tracking my heart rate and associating it with an infection.
It's non-invasive, doesn't require the breaking of quarantine and relies on infrastructure that is already in place. More information is better than less and the author has some degree of professional expertise in the subject, according to statements on the page linked.
There are always going to be outliers and what not. I knew someone who used to intentionally lower their heart rate to like 30 beats per second when getting their heart rate taken to screw with medical staff because they thought it was funny. Combination of good fitness and meditation techniques.
Nothing is perfect. But this seems like a rather good idea compared to expensive tests that potentially expose the person being tested to risk and potentially expose others to them at a time when they may be contagious.
This seems like a rather poor time to "just play devil's advocate" without some real and serious objection.
> More information is better than less
False positives come at a cost. For example there is considerable debate about the use of routine mammograms, because of the potential stress caused by false positives.
I read a paper recently on the Chinese outbreak of COVID-19 that found approximately 80% of the positive test results on people without symptoms were false positives.
Too much noise to signal for this to be reliable.
I’ve tracked my resting HR for years, and there’s so many other things that can affect it, including (in rough order of magnitude) alcohol & dehydration, lack of sleep & stress, ambient temperature, other illnesses, and finally exercise (which has a big impact long-term, but also gets lost in the short term noise).
Add to that the underlying stress we’re all under these days, and RHR has even wider variation.
I keep close tabs on my resting heart rate to assess when I’m pushing the limits, and it’s been higher than usual these past few weeks...
Still, I do agree that in some instances it increases noticeably (I had the flu a while back and can confirm it rose a bit half a day or so before My throat started getting sore). But I don’t think it should be used as the only/main indicator for infection.
I was diagnosed with tachycardia when I was a child, during a mysterious illness that hospitalized me and that is suspected to have been a cytokine storm. I recently got my heart checked out (about a year ago). They never found the cause. I think it got better since I was a kid, but my resting heart rate still tends to be in the 90s. It does not cause any impact on my life. I exercise a lot, and just feel normal. Then again since I've had it my whole life maybe my 'normal' is actually not normal to people who have a lower heart rate.
I'm still not sure if this puts me at any sort of elevated risk should I get infected with COVID-19. I am self isolating just in case, but my country is not really taking very drastic isolation measures right now and part of me just feels like I am being paranoid with no clear way to know if I am predisposed to any complications or not.
> tachycardia when I was a child
You might have been misdiagnosed based on the information available at that time. Children have different statistics on various body parameters at various age groups. You could compare your reports with recent research to see if you actually had tachycardia
> resting heart rate still tends to be in the 90s
It is within the normal age but on the higher end, but you should get your blood pressure checked. I do not know your age, but it might change once you go above 25 or 28. When Rhr drops with age, it is a sign that your metabolism is slowing and you should start measuring body-fat.
> any sort of elevated risk should I get infected with COVID-19
There is no real correlation or evidence. But in your case if you have mild fever and feel nauseous - that would be the first red flag. It may be just because you ate something, but if it is Covid19 or any flu causing SARS then the other symptoms like dry cough and higher fever may follow in 8-24 hours. You may not even see mild respiratory/breathing problems or severe fatigue or low blood pressure until 48-72 hours. Seeking medical attention and getting good diagnosis and prognosis quickly should be a priority, many people go to the emergency after 120-144 hours and then end up on ventilators in a matter of 4-6 hours. The survival rates on ventilators are not good enough.
Note: I'm not a medical professional. I have known these things out of my curiosity in medicine and accidental experience in hospitals with some talented doctors and intensivists.
Thank you for your input. I am already 31 and when I got this checked out the doctors did say my heart rate was faster than normal, but just didn't find a cause. I'm hoping that it is as you say - still relatively normal! My blood pressure has historically been totally fine.
Unfortunately I don't have reports from when I was a child. This was in a post soviet country in the early 90s and I doubt those medical records are still obtainable. At the time I was experiencing some kind of reaction causing high fever, hives and swelling everywhere, and inability to move due to bone and joint pain. I can't remember how long it lasted, I think it was weeks. The doctors couldn't figure out what was wrong and thought I was dying, but in one of their tests they did pick up on the tachycardia.
I'm a little disappointed because I am a rather fit and athletic person, so I'd expect my resting heart rate to be lower as we see with other athletic adults! When I exercise it almost immediately goes to the very high 100s, and sometimes to 200 after strenuous exercise, but I don't consider that to be worrying like a high heart rate at rest.
I will be sure to watch out for the signs and the progression you mention. But in terms of seeking care early - I'm not quite sure what good that would do. If I don't need a ventilator yet and just have normal cold or flu like symptoms (which I'd usually stay home for) how would they be able to help? It isn't like there's a cure right? I would be concerned with going to the doctor and being turned away as there's nothing they can do, but in the meantime taking up valuable time and resources from people who may be more severely ill.
From what you mentioned, your childhood tachycardia looks more like a symptom/result of some allergic reaction.
> When I exercise it almost immediately goes to the very high 100s, and sometimes to 200 after strenuous exercise
At age 31, "immediately goes to the very high 100s" - if you go above 140 fairly quickly and you are not in endurance sports, it is concerning. You should consult a cardiologist when times get normal. Typically athletes involved in endurance sports also have lower than normal Rhr.
> in terms of seeking care early
For Covid19, because of its scale, you can't do much other than vaguely understanding the line of treatment and going to the hospital when symptoms appear. Do not think: "I will give it one more day". 90% covid19 infected people do not need a ventilator. When in doubt, get a test done. But note that the tests may result into a false negative if you appear without the symptoms. Do not panic. For future doctor visit, keep a fever record with time and comment any progression of symptoms. Stay hydrated and get enough rest.
It definitely does go above 140 fairly quickly during exercise, and easily goes over 100 when walking. I have consulted a cardiologist as I mentioned as recently as a year or so ago. I went because this was something that was not really followed up on when I was a child and I wanted to make sure I wasn't dying of some undiagnosed heart issue. They did a basic EKG, had me wear a device to monitor my heart for a few days, and then also did a blood test to check for things like thyroid issues. Nothing came up. They said my heart rate was high, but did not find a cause.
Good to know regarding doctor's visit should it come to that, thanks!
Infections raise resting heart rate. so resting heart rate is a good indicator of an infections.
I've made an app that collect heart rate data from the apple watch and posts it to a public server together with an approximate location. Data is anonymized.
Apple rejected the app, since it relates to human subject research and need IRB approval.
The app and backend are open source. If anyone want to push this through their university and do some research, you have my full support.
-- rejection
Hello Peter,
Thanks for your time on the phone today.
As we discussed, we noticed that your app is conducting health-related human subject research however the seller and company names associated with your app are not from a recognized institution and we were unable to verify independent ethics review board approval.
We have now rejected your app for the App Store Review Guidelines detailed below.
Guideline 5.1.3 - Legal - Privacy - Health and Health Research
Your app is conducting health-related human subject research, but we were unable to verify independent ethics review board approval.
Next Steps
Apps conducting health-related human subject research must secure approval from an independent ethics review board. You can attach proof in the App Review Notes section of App Store Connect.
Guideline 5.1.1 - Legal - Privacy - Data Collection and Storage
We found in our review that your app provides services in a highly-regulated industry and requires sensitive user information, however the seller and company names associated with your app are not from a recognized institution.
Per section 5.1.1 (ix) of the App Store Review Guidelines, apps that provide services or collect sensitive user information in highly-regulated fields should be submitted by a legal entity that provides these services, and not by an individual developer.
> Infections raise resting heart rate. so resting heart rate is a good indicator of an infections.
This does not logically follow. There are many reasons your resting heart rate could be increased and most will be unrelated to infections.
This is the classic logical fallacy “affirming the consequent”. Look it up.
Thanks for supplying the formal name. It escaped my mind this morning :)
Bloody bureaucrats. Is there some way you could get a recognized institution to back you?
I'll tweet out a request see if someone is willing to take it up.
On the other hand, this is quite sensitive data, which is why a respected nonprofit organization would be much more trustworthy, and which is why I understand the decision of the referees.
People install apps voluntarily, they should be able to make these sort of decisions for themselves.
It's one thing to protect users from malware, quite another to treat them like legal incompetents.
There is nothing wrong with Apple having some standards for the app store.
Just like they made the decisions for themselves when faced with the Cambridge Analytica quizes, right? Regulations are there for a reason.
You know, my HIPAA training is out of date and it's possible that new legislation applies. One of the more aggravating parts of my insurance job was dealing with people who thought I wanted them to sign an authorization because the insurance company was a meanie face trying to screw them out of their money and I would explain "No, ma'am, we need this to comply with federal law. Please and thank you." and they would be all chagrined and get me the auth, at long last.
But I only see App Store guidelines cited, not federal legislation. So the odds are good that someone in the company has the power to overrule that.
Given the circumstances, it seems to me this would be an appropriate time for an executive to say "Yea, verily, fuck them there guidelines. Let this person do this thing."
And if they don't want to or can't do that, it would be a good time for someone to hand walk it through the process and get it hooked up post haste with whatever doohickey would make everyone all happy.
It’s a crisis. This kind of thinking is what led the FDA to delay coronavirus testing authorization in the US by a couple months.
Any set of regulations needs a crisis mode.
I have had HIPAA training. TLDR:
"Certain other people, like doctors and insurance companies, need to comply with strict rules surrounding your privacy when handling your health data. You, on the other hand, can do any fucking thing you want with your personal health data. Sign here in triplicate to assign this right to others. Have a nice day."
(I might be making up the triplicate thing for dramatic effect. It might only be duplicate. shrug)
In most countries it takes way more ethics work than “you installed the app yourself” to get a human study approved.
It’s not unreasonable for Apple to demand similar steps.
I believe research is one of the most beneficial human activities.
But for some reason as a society we will let people sky dive, horseback ride, smoke cigarettes, or get raging drunk for any reason, but if it's for research we won't let subjects consent to even the risk of filling out a survey without IRB approval.
It's not unreasonable in normal times for normal situations.
Last I checked, "ethics" were supposed to protect life, not uphold some arbitrary abstract standard while people died by the raft loads.
But pay me no mind. I learned my ethics from military culture which deals with life and death routinely. So I might have some weird ideas about upholding the value of life as sacred or something.
I'm sorry but what then? We'll have 200 corona tracking apps backed by random people, with no ties to efforts that actually do something useful, no scientific review of efficacy and potentially a non zero number of apps that are either malicious or misuse the data later on.
It's not like we don't have precedent with the latter at this point. Apple's stance doesn't really seem that unreasonable here.
Who would that help?
There was some AI computer vision software that could process video from humans and deduce the heartrate with high accuracy.
A similar software like this Apple watch thingie could measure our heart rate through the web cams we have at our laptops.
Are you thinking of this?
There’s an app for that: https://heartrate.hedronvision.com/
The mic could monitor for coughing frequency.
That metric might not be useful on its own, too many people out there smoke pot or cigarettes. Could be a secondary metric, though.
First thing I was looking for was a download link :(
Why does Apple think I’m unable to decide for myself whether I want this or not.
Thats a sacrifice you make when you choose the ios ecosystem. It's a compromise between secure apps, privacy and inconvenience.
I don't think Android allows coronavirus apps either. If this were for Android it would be likely barred from the play store.
https://play.google.com/store/search?q=covid-19&c=apps
https://play.google.com/store/search?q=coronavirus&c=apps
0 results.
You could just install the apk file straight out of github though
I hope this becomes more common in the long-term. Something needs to break playstore's grasp on android.
At least Android allows sideloading.
...and i am being downvoted because?
Yeah, not gonna fly, that one. Although Apple could get off its ass and publish an official app to track if I've been in the proximity of a (self reported) infected person. And if they actually gave a shit, they'd convince Google to share data. And then I'd be able to delete the data from both when this is over. Is this too much to ask? Why this is still not a thing is beyond me, PR wins alone would be worth the ~10 person-days of engineering work this would take to put together (2 days, Apple 1FE, 1BE, Google 1FE, 1BE, and half a person from each company to coordinate efforts; conservative schedule).
I have a garmin that constantly has my RHr.
I knew i had COV-19, so I logged everything.
Friday (contraction of virus) to Tuesday (first symtoms) my RHR tanked each day incrementally from 62 all the way to 50. on Wednesday when my fever kicked in, RHR jumped to 64.
How have you been handling the disease since?
I had a cold last fall and the day before I really felt it, my Apple watch threw up a notice that my resting heart rate was unusually high.
I always wondered if cardiovascular fitness shortened cold and flu durations with the body getting more blood where it needs to be?
This is very interesting. Fitbit and such have great opportunity to contribute.