The NBA is planning to resume its season in an Orlando, Florida bubble without any fans in the stadium and one of its tools to prevent teams from becoming infected with the Coronavirus is the Oura Ring, a wearable ring that has primarily been used as a sleep tracking and improvement tool.
Multiple studies have been conducted using the Oura Ring with one saying that its data will give the NBA players three early warning days before a person has a fever, a cough, or shortness of breath. This would give players time to be able to be tested and as a result reduce the chances of infecting others if they test positive.
Using my own Oura Ring data from the past 10 months, I wanted to see how to use the wearable for Coronavirus detection. I looked at several studies as well as how Oura Health, the company that makes the wearable, describes how the ring can help monitor for sickness.
Using the Oura Ring to Detect Sickness
It's important to make clear, the Oura Ring does not detect the Coronavirus. Symptoms are shown by the ring that could also be from the Coronavirus, but you still need to take a test to determine if have the infection.
"When you get sick, your immune system has a lot of strategies it can deploy to help you heal," the Oura Health website says. "All of this action requires a lot of energy and usually shows up as signs of strain in your body that you can read through your body temperature, heart activity, respiration, and sleep or activity patterns." The Oura Ring detects and reports on all of these in its app.
Increase in Body Temperature
When the immune system being to fight an infection, the body raises an inflammatory response. Inflammation heats up the body and severe infections can even turn up the heat enough and generates a fever.
Increase in Respiratory Rate
If a respiratory infection or cough is impacting the body, an elevated rate may appear in the Oura app.
Increase in Resting Heart Rate or Decrease in Heart Rate Variability
As the body fights an illness, it engages the sympathetic, fight-or-flight nervous system. This would increase a resting heart rate and decrease heart rate variability (HRV).
"The company says the ring’s heart rate measurements have a proven reliability of 99.9%, compared to electrocardiograms, and measures how the heart rate varies with 98.4% reliability," according to WebMD. "It can detect temperature changes as small as .05 degrees."
Changes in Sleep or Activity
If the body is needing rest, you'll be spending more time in bed to recover. This would show up in one of the app's reports.
Which Patterns Should I Look For?
These are the three key questions Oura Health says to ask yourself when using the Oura Ring and its app's reports to detect sickness, including the Coronavirus.
When you start to feel sick, do you see an increase in your temperature?
Do you notice other signs of stress in your body when your temperature changes (e.g., lower heart rate variability, higher heart rate, increased respiration rate)?
Are there recovery routines that help your body rebound, like getting more sleep?
What the Research Studies Say
Mood check in tool for the RNI app’s Health Diary.
Researchers at West Virginia University’s Rockefeller Neuroscience Institute (RNI) reported that Oura Ring data can help predict illness before a person has a fever, a cough, or shortness of breath.
According to their announcement, the RNI platform uses the Rockefeller Neuroscience Institute app, the Oura Ring, and artificial intelligence guided models to forecast and predict the onset of COVID-19 related symptoms three days in advance with over 90 percent accuracy.
I'm participating in another study that is also underway at the University of California, San Francisco to help identify COVID-19 patterns so the ring can eventually pick up signs even better.
Professor Ali Rezai, the RNI's director, told the Washington Post that "the technology is valuable because it’s tuned to reveal infection early on, when patients are highly contagious but don’t know it. He calls the combination of the smart ring and app a kind of 'digital PPE,' or personal protective equipment.‘
While these two studies were cited as proof that the Oura Ring can help with early detection of the Coronavirus, the report also pointed that neither have yet to be peer reviewed. Reports state both studies have funding from Oura Health.
What I Learned From My Oura Ring Data
While I haven't been tested for Coronavirus, my partner has been and tested negative. I was tested for the antibodies through a test at Labcorp, which turned out to be negative as well. I did get a flu shot in January. Other than an injury requiring surgery back in November, I didn't recall or log a sickness at any time during the past 10 months.
I was curious then what I would learn looking at the data. Using the Oura Health guide on sickness as well as what the studies are looking into, I examined the data points from the Oura app over the past 10 months for my body temperature, heart activity, and respiration.
First, looking at my body temperature, I didn't see many significant changes. Oura Health says, "An individual’s body temperature typically changes by about 1.8 °F (1 °C) between its highest and lowest points each day. Anything outside of that range signals that something is challenging your body and preventing it from maintaining your ideal temperature range."
The only significant increases I saw were back in February when I flew to my home in San Francisco. The day of the flight showed a slight increase and the day after showed an increase of 2.7 °F. While I wasn't sick, we all know that air travel can have a significant impact on our bodies. Research has shown, you are more than 100 times more likely to catch a cold when you fly on a plane.
If I did pick something up on the flight, my body quickly recovered as my temperature was back to normal the next day. The Coronavirus was technically in the United States and in San Francisco at the time, so this would have been my most exposed moment.
Next was respiratory rate. A typical respiratory rate for healthy adults is between 12–20 breaths per minute (bpm). Anything above that 20 bpm or abnormal for my data would be cause for concern. My highest level was 16.1 back in November and never out of range.
Finally, I looked at heart rate and HRV. I actually monitor HRV pretty closely in general, which I've written about before. I find it a good leading indicator of general wellbeing. If it's declining for more than a couple days, I need to make active recovery, especially sleep, a priority. Using the Oura app's tagging feature, I can look back and see what impacted any of these data points. Usually, alcohol or overtraining have negative impacts on my HRV. This data point alone wouldn’t tell me enough about whether I was getting sick.
To help detect a sickness, including Coronavirus, you would need to look at all of these data points together along with how you feel. While this was mostly an intellectual exercise since I hadn’t been sick, I was happy to confirm that I haven’t had seen data that I would have had any significant infections in 10 months.
I’m also glad to know how to use this data as another tool in helping keep others safe if I do start to get sick and need a Coronavirus test. It's important to note, that the Oura Ring is not an approved FDA device and wearing one should be done in addition to all the suggested guidelines including wearing a mask and physically distancing.
Fitness Tracker to Sickness Tracker
For the NBA, wearing the Oura Ring is optional. It's simply another tool in its toolkit to do everything they can to keep everyone involved safe.
"But it does not replace any of the other things we should be doing, and the other steps that the NBA should be doing in terms of protecting their players, protecting their staff," Dr. Darria Long, an emergency room physician and clinical assistant professor at the University of Tennessee, told CNN. "They should still be doing pools of testing and regular testing -- all of those other things."
Another study I'm participating in is from Stanford and Scripps Research, called DETECT. They are looking to see if heart measurements from the Apple Watch, Fitbit and other wearables are enough to detect the coronavirus or other viral infections.
“One of the benefits of this algorithm is we want to be able to give people a personalized warning that says, ‘Hey, it's a good idea for you to stay home today,’” Dr. Steven Steinhubl, a cardiologist and director of digital medicine at the Scripps Research Translation Institute said to Forbes.
Finally, one other interesting project I'm contributing to is QuantifiedFlu.org from the Open Humans Foundation, which enables individuals to connect their data with research and citizen science. This includes a one click daily check-in to communicate any symptoms. It generates a report plotting your data. You can also opt-in to share the aggregated and de-identified data with researchers.
All of these studies are trying to answer if wearables can warn us when we're getting sick, and the studies will continue regardless of what ends up happening with COVID-19.
“Viral illnesses are not going to go away and there are going to be future pandemics. They're going to be future bad flu seasons,” Steinhubl said. “And we think this could be a valuable tool.”
Wearables to help detect sickness is an important evolution, if it can work. Moving from a fitness tracker to a sickness tracker will be a valuable step not only for the Oura Ring and other wearables, but it would also provide a significant benefit to public health.
If you want to support this effort, here are the links to participate in the research studies:
Scripps Research study using Apple Watch, Fitbit, Garmin and other wearables
Rockefeller Neuroscience Institute study using the Oura Ring
University of California, San Francisco (UCSF) study using the Oura Ring
QuantifiedFlu.org citizen science project using Oura Ring, Apple Watch, Garmin, and Google Fit.
Read my previous post: Improve Performance with Heart Rate Variability and the Oura Ring