Anchorage doctor looks to expand COVID detection study to Nome

Since the start of the COVID-19 pandemic, doctors and researchers have been scrambling to collect as much data on the SARS-CoV-2 virus and its transmission as possible. Now, one Alaskan doctor is working with researchers in California to expand an ongoing COVID-19 monitoring study all the way to Nome and the surrounding region.

Dr. Steven Steinhubl lives in Anchorage, where he works as a clinical cardiologist at Alaska Native Medical Center. His other job is as the Director of Digital Medicine at the Scripps Research Translational Institute, which is based in California. “Everything in digital medicine is really about, how can we take clinical research and clinical care directly to individuals?” he said. “So instead of people having to come to a doctor’s office or research medical center, how can we do things directly in people’s homes?”

In January of 2020, Steinhubl helped to publish a study using wearable health monitoring devices – including the Apple Watch, Fitbit, Garmin, and others – to better monitor the spread of influenza. The study looked at heartrate and sleep data from 200,000 people over a two-year period and compared that data to the rates of flu in their locations.

“And we found there was a very close correlation,” he said. “In locations that were having higher flu rates, more of the Fitbit wearers had higher hearts rates, more sleep, and less activity.”

He added that, at least in theory, a slightly elevated heart rate can indicate a person might be getting sick before they feel anything. “We think, from some of our early studies in humans and other studies in animals, that things like your heartrate will start going up as much as two days before there’s a fever or other symptoms,” he said.

The idea, then, was to create a program for people’s wearable fitness trackers to let them know they may be infected with the flu before they noticed any symptoms, allowing them to stay home and prevent them from infecting others.

Then came COVID-19, and Steinhubl’s research suddenly had a new urgency. If he and other scientists could help people better detect COVID and thereby slow the spread, it could potentially save countless lives.

So, last spring he and his team created the study DETECT. “We created this study within one month, from the time we thought of it to the time we started it, which is really unusual,” he said. “But we had a lot of people who were really supportive of it, especially on the software end.”

His group partnered with Fitbit and another group from Stanford University to roll out a nationwide study that’s been running continuously since the start of the pandemic.

Groups from Duke University and the University of California San Francisco are running similar studies as well, he added. In Germany, the German equivalent of the CDC has pushed out one of the largest monitoring studies of its kind, with half a million participants.

Participants sign up by downloading an app for their wearable fitness tracker, which uploads their heart rate, respiration, and other health data to the scientists’ database. With enough participants, researchers can compare how this data is affected by the spread of COVID, and assess if it can be used to predict outbreaks.

Even after the end of the pandemic, Steinhubl hopes that infection warnings from wearable fitness trackers can become widespread for influenza, COVID, and any other viral diseases. “So even though this was accelerated because of COVID, it’s not a COVID-specific thing,” he said.

One of the biggest advantages of digital medicine over traditional studies, Steinhubl explained, is its ability to expand beyond the confines of the research lab. “One of the problems with research has always been that the only people we can really research are people who live right next to a large epidemic medical center,” he said. “So, we want to show what’s possible through digital research programs, directly to people.”

He got interested in Nome when he saw that the Norton Sound Health Corporation had a program giving out fitness trackers to employees. If enough people in Nome and the region enrolled in the DETECT study, he thought, they could get valuable data on populations that would otherwise go under the radar.

He’s also helping organize a push with the University of Guam, in a similarly remote region that doesn’t get much medical research. “Part of our goal in this is saying, look, if we can do this in Nome, Alaska, if we can do it in Guam, then we can do in anywhere.”

Another big piece of the effort is equity. A lot of medical research involves students and other volunteers associated with medical institutions that tend to be overwhelmingly white and wealthy, skewing medical knowledge and disadvantaging underserved communities. “We have a lot of great data on wearables in Caucasians, and in people with high school and above education, with people whose socio-economic status is typically not in the lower tier,” Steinhubl said. “And we need it to be fair, and really understand the different things that affect people’s response to COVID. And that means we need to get a much more diverse community.”

By promoting the study in Nome, he hopes to get a more complete picture of COVID-19, especially among Alaska Natives and other Indigenous populations, which the CDC reports as having a COVID-19 mortality rate 1.8 times that of Caucasians.

To start, Steinhubl is in conversation with Norton Sound Health Corporation about promoting the study among its employees and is encouraging local residents with wearable fitness trackers to sign up by going to detectstudy.org.

He’s also hoping to receive funding to give away Fitbits and other devices to regional residents who don’t already have them. “Alaska’s always going to be an understudied area, but digital technologies can allow us to get a much more representative and more fair sample,” he said.