Wearables in the COVID-19 Spotlight

“Wearables” is an umbrella term for a category of wearable technology and electronic devices that can be worn hands-free, embedded into accessories and fabrics, tattooed on or adhered to the skin or even implanted inside the body. Wearable devices have motion or other sensors that track information in real-time and transmit it wirelessly. While the origins of wearable technology can be traced back to the 13th century with the invention of eyeglasses, modern wearables are sophisticated devices with the computing power of the microprocessor, many with wireless connectivity.

The rapid evolution of wearable devices, made possible by miniaturization of microprocessors and growth of high-speed mobile networks, also coincided with the rise in the Internet of Things (IoT). The applications for wearables are wide ranging. From the early uses in the military and space program, to medicine and healthcare, to fitness trackers, smart watches and head-mounted displays, the field of wearable technology is exploding. At the Consumer Electronics Show (CES) in January 2020, health care was the fastest growing category with a 25% increase from the prior year. Wearables were a star of the show, with many new form factors and use cases.

This article focuses specifically on the applications of wearables in healthcare and how wearable medical devices are changing the medical technology landscape, a growing trend that has been further accelerated by the global coronavirus pandemic.

What makes designing wearable medical devices uniquely challenging

Skin is remarkable, it’s a primary barrier to the external world and is the body's first line of defense against infection and damage. It’s our largest organ, helping regulate key functions such as body temperature and internal fluid balance. An average adult will exfoliate old and grow new layers of skin every 10 to 20 days. In addition, there are other skin variabilities due to the age, sun exposure and overall individual health .

To design a device that can be wearable on the skin for an extended period of time, can minimize potential damage to the delicate layers of the skin and while at the same time adhering strong enough is a challenge. Other design factors that need to be considered are material breathability for proper moisture control and comfort, as well as wear time. Wear time is particularly important in deciding on the type of adhesive, backing and housing to use. It will also influence other design decisions, including material selection, application and removal, power management and durability.

On top of the requirement of working with the skin, a living organ like no other, additional aspects of the wearable medical device are compounding design challenges. For those patients that use wearables to manage a serious chronic condition, a sudden loss of power to the device could be potentially life-threatening. The severity of medical condition together with physical space for a battery, charging options and battery capacity all need to be considered. Another design consideration is whether or not a wearable requires sterilization.

Designing with these considerations in mind will ensure proper wearable device performance, create a good patient experience and enhance compliance.

Unique role for wearables during the Coronavirus pandemic

In a short period of time, COVID-19 has altered our individual and collective behavior, changing both healthcare and workplaces. Technology offers tools to meet these new challenges. When it comes to health, work and economics in the era of COVID-19, wearables have a role to play in the entire continuum of care, as well as in our work and leisure lives.

Prevention and early detection

Good population health approaches and personal hygiene practices like wearing face masks and handwashing go a long way towards helping to slow the spread of the coronavirus and flattening the curve of the pandemic. But beyond these measures, technology can be a powerful ally. New research shows promise in wearables’ ability to detect early coronavirus symptoms. Stanford Medicine’s 2017 research demonstrated that health data collected from wearables can help detect infectious illness days before any noticeable symptoms emerge. Recently, Stanford Medicine researchers, in collaboration with Fitbit and Scripps Research, have launched a new effort aiming to detect early signs of viral infection through data from smartwatches and other wearable devices.

Because wearables, including smartwatches, make hundreds of thousands of measurements per day, they make for powerful monitoring devices. We know that when a human body fights off an infection, there are some signs, including rise in skin temperature and elevated heart rate. By continuously measuring these, wearable devices could help alert us well before humanly perceptible symptoms appear. This technology, combined with smart algorithms, could not only warn an individual of the onset of their infection, but could also be used at a population level to track contacts and potential infection transmission in communities, helping curb the spread of viral infections such as SARS-CoV-2.

Diagnostics and testing with wearables and microfluidics

The global scale of the COVID-19 pandemic brought the need for scalable coronavirus testing and other COVID-19 related solutions into sharp focus. The decades-old multidisciplinary field of microfluidics offers some practical ways to aid in this pandemic. The field of microfluidics combines engineering, physics and nanotechnology with chemistry, biochemistry and biotechnology to design systems that can process super low volumes of fluids to preserve resources and achieve high-throughput screening and automation. There have been numerous advancements in microfluidic technology over the past several years, which is proving to be a timely development, given how important it is in the context of the global pandemic to gain immediate insights at scale without wide availability of traditional testing methods.

Among other uses, microfluidic devices play an important role for point-of-care COVID-19 diagnostics. Microfluidics make Lab-on-a-Chip (LOC) technology possible. LOC can be used in COVID-19 testing and offers specific answers and actionable insights without the need for complex in-office testing. With non-invasive and minimally invasive microfluidics, required answers can be obtained from a tiny blood sample. Compared to a more involved interaction during the medical office testing, reducing invasiveness is critical when aerosolized particles put patients and providers at risk of transmitting and being infected by the virus. LOC also makes the serology (antibody) testing for signs of a previous COVID-19 infection possible. While active COVID-19 testing capacity is still lagging in the US, antibody testing could identify individuals and populations that have had COVID-19. Understanding COVID-19 pervasiveness in our communities is important for public health and measures for enhanced coronavirus prevention.

Remote patient monitoring

With high risks of exposure to the coronavirus during the pandemic, many hospitals and doctors’ offices were mandated to close for months, and as a result, regular healthcare has been disrupted for millions of Americans. Here too, wearable technology can come to the rescue for some conditions. Wearables allow patients to track their vitals and overall health data, then share results with the healthcare provider without physically going to the doctor’s office. Other enabling technologies for virtual care, such as telemedicine, have also been widely adopted during this global pandemic. Telemonitoring, possible through wearable devices, is critical for patients, especially those with chronic diseases and other underlying conditions. Wearables allow patients access to their health data quickly, giving them, their caregivers and physicians insight into health “ground truth” status, so patients can better take care of themselves. Increasing use of wearable sensors will further empower patients to gain deeper insights into their health and wellbeing, allowing for a shift from Big Data to more individually actionable Small Data.

Workplace

With tectonic shifts in how businesses operate amidst the global pandemic, the workplace might never look and feel the same. Wearables have a role to play in helping people return to work safely and keeping them healthy in their workplace. For example, wearable technology can be used to track the proximity of employees to each other in order to ensure adherence to the social distancing guidelines. Another example is rapid COVID-19 testing on-site. We will continue to see expansion of capabilities and uses of wearables and microfluidic devices. Whether it is allowing employees to feel safe on the job, employers to ensure the health of their workforce, or other population health measures, these technologies will transform how we think about health and the workplace.

Improving the patient experience

COVID-19 is further accelerating shifts in healthcare that started even before the pandemic. Patient-centered and patient-empowered care has been increasingly gaining traction. Patients, their caregivers and families are looking for sustainable solutions to chronic disease management that are more cost effective and better fit their busy lives. Wearables are well positioned to become vital tools in helping to monitor people’s health, detect early signs of illness, empower patients and give medical providers a glimpse into their patients’ health-affecting habits and lifestyle outside the doctor’s office.

The increasing trend of consumerization of healthcare resulted in patients expecting personalization from all their devices, including health-focused wearables. For patients to be “compliant” with these wearable devices, they need to be designed and developed with the user in mind. Requirement to effortlessly fit into daily life would affect design decisions about the size, durability, battery capacity, among others. There is a need for wearables to be comfortable even with a prolonged use. When it comes to operating the device, being intuitive and easy to use is important to the success of the wearable, and especially vital in health applications.

Designing durable, lightweight wearable medical devices that can reliably help patients, their caregivers and healthcare providers monitor and manage chronic diseases is a challenge. The complex science, understanding of the human body, especially how adhesives interact with the skin, and medical device know-how all need to come together. When they do, the resulting products can, and do, change our lives for the better.