Wednesday, April 22, 2020

Covid & Flu: Using a GPS Smartwatch to Help Monitor for Changes in Oxygen Saturation and Respiration

Article by Sam Winebaum with Derek Li

With the Covid pandemic underway, recent studies and a physician's experience on the front lines at New York's Bellevue Hospital presented in this New York Times opinion article by Dr. Richard Levitan here, indicate that while many patients arrive at the hospital still conscious and conversing, with no seeming breathing problems, and even as they are being intubated, had Covid pneumonia with oxygen saturation as low as 50%, mid 90's and above being normal for most at sea level. 

This is quite unlike normal pneumonia patients, yet at the same time their oxygen saturation is dangerously low by the time they are admitted and their condition can decline precipitously. 

According to Dr. Levitan  The data is showing that monitoring blood oxygenation at home, even with minor symptoms, is a critical early warning sign of trouble. 
"All patients who have tested positive for the coronavirus should have pulse oximetry monitoring for two weeks, the period during which Covid pneumonia typically develops. All persons with cough, fatigue and fevers should also have pulse oximeter monitoring even if they have not had virus testing, or even if their swab test was negative, because those tests are only about 70 percent accurate. "
While not "medical grade", a number of current GPS sports watches have a Sp02 sensor on board, intended to measure altitude acclimatization, and several can also monitor respiration a yet earlier sign of potential infection. 

The article says that normal SpO2 levels for most people is around 94% at sea level. 
I have been monitoring my levels here in Park City at over 6800 feet / 2070 meters with the Coros Apex Pro's and Garmin Forerunner 945's pulse oximeter and range between 94-97%. I usually run the test twice (about 2 minutes while still).  I thankfully have had no Covid symptoms. 

Changes in your respiration rate can be a yet and earlier sign of trouble. My Polar Vantage V monitors respiration rate as well as heart rate variability, beat intervals, resting heart rate, and many sleep quality factors overnight comparing everything to a 28 day average providing a Nightly Recharge score.
The Forerunner 945 will also give you sleep and respiration data but for an easier and quicker full overview in the Connect app.  I prefer the Polar as it calculates and displays everything on the watch when you wake up.

Polar just announced that they had been selected by Elysian Labs for lead inclusion in a Covid-19 early detection study for the US Army National Guard using the Vantage V and H10 chest strap. Elysian Labs has utilized Polar products in warrior optimization and readiness studies for years.

In an interview with Tom Fowler, President Polar USA, we learned that Polar was in part selected for its 43 years experience in monitoring cardiac fitness, the 5000 scientific studies citing Polar in the last 5 years alone, the "cleanliness" of its data for analysis, and its focus on scientific rigor and long term fitness and health trends via its Polar Research Center

While metrics to be analyzed were not disclosed we expect respiration, heart rate variability, and heart rate at various moments during the day to be part of the study.

Garmin has recently posted an article on their blog here listing the potential benefits of sports smartwatches in early detection of infection (elevated heart rate, SpO2, beat to beat intervals, activity and sleep)  with links and mention of various studies and apps which can receive smart watch data

RoadTrailRun contributor Derek Li a physician in Singapore shared the following base line metrics and thoughts with us. (Note living or recently moving to altitude will affect ranges): 

I think it’s fine to monitor SpO2 if you have flu-like symptoms. Generally breathlessness starts before SpO2 drops because there is some compensation eg breathing faster (breaths/min) before SpO2 gets affected. SpO2 changes are generally a rather late sign. But there is no harm monitoring. 

Blood Oxgenation (Sp02)
Normal Ranges: 
96-99% at sea level 
<93% at sea level is a big red flag

Breathing rate (breaths per minute)
Very age dependent. 
Adults 12-20 breaths/min
>20 may be worrisome
>28 very big red flag
Garmin estimates mine at about 12 during sleep

Below a list of GPS sports watches with oxygen saturation (Sp02 sensing) and respiration monitoring

Garmin (Sp02 pulse oximeter and Respiration)
Vivoactive 4 and 4S, Forerunner 245 & 945, Fenix 6 and Fenix 6 Pro Series, Fenix 5X, Venu
You can select all day tracking, sleep tracking or both. Trends will be presented on the watch.

Coros (Sp02 pulse oximeter)
Apex Pro, Vertix
To access (if not at high altitude above 8250 feet) press and hold bottom right button and spin dial to "Altitude Performance" press and stay still for a measurement.

Polar (Respiration)
Vantage M and V
Calculated during sleep along with heart rate variability, beat to beat interval and compared to 28 day average to show trends.

Of course always consult medical professionals if you think you are sick.
Our reviews of most of these watches can be found here

Read reviewers' full run bios here
Comments and Questions Welcome Below!
Please let us know mileage, paces, race distances, and current preferred shoes

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very useful