A Low-Tech Way to Track COVID-19 Symptoms Focused on Elderly

A team from the Tufts schools of engineering and medicine came together quickly to devise solution to monitor health changes at the community level
A woman holding a flip phone. A team from the Tufts schools of engineering and medicine came together quickly to devise solution to track COVID-19 symptoms in the elderly at the community level.
“The main idea is to safely and easily catch new cases and get people the help they need as early as possible while preventing them from coming to a hospital unless absolutely necessary,” said James Intriligator. Photo: Depositphotos
April 15, 2020

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From a public health perspective, identifying new coronavirus infections—and isolating those patients early—can be a powerful way to slow the spread of disease.

New technology, like the Covid Symptom Tracker smartphone app launched in the UK, can aid those efforts by letting the public self-report symptoms and map high-risk areas nearby. Inevitably, though, high-tech solutions exclude large parts of a city’s population.

Older adults, the demographic that has been hit hardest the COVID-19 pandemic, may not have the same digital access and literacy skills of their younger neighbors, says Lisa Gualtieri, associate professor of public health and community medicine at Tufts University School of Medicine. So how can medical personnel contact and monitor those who are most at risk?

Gualtieri is part of a new effort at Tufts working to solve that problem. It’s called the Social Temperature Observation and Monitoring Project, or STOMP-Covid, and is taking a decidedly low-tech approach to tracking the disease.

Instead of using smartphones, the project will use automated text messages and old-fashioned phone calls to recruit people sixty-five and older and ask them to report their temperatures twice a day. If a participant’s temperature spikes, they’ll receive an automated follow up call to help them determine next steps.

“Isolation is already a problem for many older adults, and the current situation makes it even worse. We want to make it as easy as possible to connect with those people, learn about any fluctuations in temperature, and make sure they receive help if they need it,” said Gualtieri.

“If you look at the way the virus is spread in China, much of the communication and transmission happened within households,” added James Intriligator, professor of the practice in mechanical engineering at Tufts, who is co-principal investigator on the project. “If we can spot beginnings of an infection by seeing a person’s temperature change, we could ask them to monitor their condition every hour instead of twice per day, and tell them to stay away from everyone else in their house,” he said.

In order to help treat patients at home, STOMP-Covid might also be able to connect them with human volunteers from Tufts School of Medicine for advice, or even provide them with swabs for testing and other important equipment.

“The next step up could be delivering a test kit to your front door and picking it up off their front porch, or sending oxygen to your house if needed,” he said. “The main idea is to safely and easily catch new cases and get people the help they need as early as possible while preventing them from coming to a hospital unless absolutely necessary.”

In that regard, a system like STOMP-Covid could relieve enormous pressures on emergency departments during the pandemic, and prevent infected patients from coming into contact with other people.

Quickly Overcoming Obstacles

Work on the program is in its early stages, but is progressing with an extraordinary speed and urgency, said Intriligator, who is also director of the Human Factors program at Tufts. The concept for the project was born only two weeks ago after Anthony Monaco, president of Tufts, asked ten faculty members in the engineering and medical schools to brainstorm ideas for fighting the virus.

The researchers immediately started a flurry of messages back and forth, settled on a basic concept, and within three days created rudimentary software to enable it. That effort, led by computer science associate teaching professor Ming Chow, E02, E04, used off-the-shelf technology provided by text and voice-over-IP company Twilio, which has partnered with Tufts to make STOMP-Covid available to the public.

Although the technology itself is ready for a trial rollout in Medford and Somerville, the researchers still face a few hurdles from the policy and legal side, notes Abani Patra, director of the Data Intensive Studies Center at Tufts.

“Patient privacy is among the top challenges we’ll need to solve,” he said. Even a person’s temperature is protected information under the 1996 Health Insurance Portability and Accountability Act, or HIPAA, meaning that STOMP-Covid will need to find servers with the appropriate level of security for medical data.

Fortunately, said Intriligator, the team may be able to partner with medical data experts at Brigham and Women’s Hospital to get around that obstacle. The hospital, it turns out, has been developing its own automated system for medical treatment and triage, and already has HIPAA-approved servers—but fortuitously, does not yet have a working front end for contacting the public. If the two teams are able to combine their efforts, it may be possible to introduce STOMP-Covid throughout the greater Boston area in the near future.

Even if it comes too late to provide a benefit during this pandemic, however, the program will still help lay the groundwork for a rapid response in future public health crises, Intriligator said. In addition to stopping the spread of disease, it could create valuable data for researchers, help identify and map hotspots, and prevent hospitals from being overrun.

“Our longer-term vision, once we get this running, is to document how we did it, and release both the software and the process to the public,” he said. “I’d like to make it so this is something any city can do themselves.”

David Levin is a freelance science writer based on Boston.