A Wearable for Early COVID-19 Diagnosis?

The Skeptical Cardiologist previously reviewed the Oura ring as a sleep tracker and found it fairly useless as a sleep or “readiness” tracker, although I really enjoyed its design, wearability, and user interface.

Many of the health claims Oura makes for its ring are unsubstantiated. Recent marketing has been incredibly misleading and inaccurate related to alleged capabilities of its ring to detect COVID-19 prior to symptoms as well as what role the wearable device might play in safely restarting the NBA season.

Early Diagnosis

I received an email from Oura recently that strongly implied that its ring could diagnose COVID-19 in patients prior to symptom development.

The email linked to an article on the Ouraring.com website that linked to a press release from West Virginia University. The first paragraph implies that a major advance in COVID-19 diagnosis has been accomplished:

“The West Virginia University Rockefeller Neuroscience Institute (RNI) and WVU Medicine, in conjunction with Oura Health, have addressed a major concern regarding the spread of COVID-19. The RNI has created a digital platform that can detect COVID-19 related symptoms up to three days before they show up.”

Later in the article, this totally unreferenced and incredibly brazen statement is made:

“The RNI platform uses the Rockefeller Neuroscience Institute app, the Oura Ring, and artificial intelligence (AI)-guided models to forecast and predict the onset of COVID-19 related symptoms (e.g., fevers, coughing, breathing difficulties, fatigue, and others) three days in advance with over 90 percent accuracy. This technology can potentially serve as a critical decision making tool to help contain the spread of the virus, safely re-open communities, strengthen the economy, and facilitate public health containment strategies.”

Although no scientific references are given for this statement on the Oura or RNI websites, it appears to have come from a doctor at RNI:

“‘We are continuously monitoring the mind-body connectivity through our integrated neuroscience platform measuring the autonomic nervous system, fatigue, anxiety, circadian rhythms, and other human resilience and recovery functions,’ Dr. Ali Rezai, executive chair of the WVU Rockefeller Neuroscience Institute, said.”

With absolutely no data references, Rezai then makes the following statement:

“Our AI-driven models are currently predicting symptoms 24 hours prior to onset, and we are working toward a three-plus day forecast. This forecasting capability will help us get ahead of this pandemic; limit the spread to protect healthcare workers, their families, and our communities; and improve our understanding of health recovery.”

In an article published online on April 8, 2020 by WVUToday, Rezai — a neurosurgeon — begins to sound like a salesman for Oura:

“We have done extensive research in the wearable space, and Oura’s accuracy and usability is unparalleled to anything we have tested,” Rezai added, “We are proud to partner with Oura and its innovation to serve our population.”

West Virginia University should be ashamed to have its employees making these types of unsubstantiated claims. Oura should modify its marketing material to make it clear that the Oura ring has no proven capability for early diagnosis of COVID-19.

The NBA Efforts To Restart Amid COVID-19

Oura has also attempted to convince the public that the NBA is relying on the Oura ring to restart its season.

If you’d like to read a well-researched and balanced article on the NBA’s testing efforts related to COVID-19, I suggest you start with Ryan Basen’s July 16 MedPage Today article. Basen’s article discusses a Mayo Clinic/NBA antibody testing study and a Yale/NBA saliva study in detail.

However, readers are much more likely to encounter clickbait headlines like this one that appeared in Sports Illustrated:

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Pickman’s article begins with this confusing and horribly misleading paragraph:

“Despite Harpreet Rai’s favorite childhood NBA team, the Minnesota Timberwolves, not appearing in the league’s restart, Rai, the CEO of Oura, will be watching the resumption as intently as anyone. Amid the NBA’s thorough 100-plus page health and safety manual is a section on wearable devices, and though the Oura ring isn’t explicitly mentioned in the exhaustive memo, the company has partnered with the league and the ring could potentially be one of the most important technological devices found across the ESPN Wide World of Sports campus.”

The bulk of the information in Pickman’s article supporting the idea that the Oura ring is useful in early detection of COVID-19 or that the NBA will be relying on it in any way to mitigate COVID-19 spread comes from the mouth of Oura CEO Harpreet Rai. Similar to the WVU press release, this article reads like a plug for Oura.

The NBA/Oura connection was first reported by CNBC on June 17:

“According to the NBA’s health and safety memo for the restart of the season, which was obtained by CNBC, residents will receive a ‘smart’ ring, a Disney MagicBand, individual pulse oximeter and a smart thermometer to help monitor and reduce the spread of the coronavirus. The league is also investigating the implementation of a wearable alarm to help players and staff adhere to social distancing.”

CNN quotes the ring portion of the memo verbatim:

“To promote efforts to identify potential illness, upon arrival on the campus, each player and essential staff member will be given the option to participate in a process that uses a wearable device (worn as a ring) being studied and validated by the University of Michigan to generate a wellness assessment derived from metrics such as body temperature and respiratory and heart rate. The NBA will share additional details regarding the device and process for participation in a forthcoming memo to teams.”

This appears to be the only solid information from the NBA on the topic. I have been unable to find any information on University of Michigan involvement with Oura or with the NBA.

However, Oura CEO Rai was quick to spread misinformation about the importance of the Oura ring, for example in a June 23 CNBC “Squawk Box” interview.

CNBC‘s online article related to that interview implies Oura ring accuracy has been proven by “researchers.”

“‘It started with our users,’ Harpreet Rai, chief executive officer of Oura, said in a ‘Squawk Box’ interview. ‘One user of ours in Finland was traveling in early March. His scores were normally in the 80s or 90s and he noticed his readiness score dropped to 50 and that caused him to get tested. He was positive for coronavirus.'”

“The Oura ring costs upwards of $300 and measures and logs data ranging from sleep and body temperature to heart rate and respiratory function. Researchers said the device has been successful in recognizing Covid-19 symptoms up to three days in advance with 90% accuracy.”

The 90% accuracy statement links back to the Oura ring article/WVU press release as noted above.

The Oura CEO went on to state that the NBA has ordered lots of Oura rings, but it’s not clear from his phrasing if they paid for them:

“As the NBA heads to Walt Disney World in Florida, the league is making available a host of technological bells and whistles to both players and staff including the Oura ring. Rai said the league has ordered more than 1,000 Oura rings. ‘They felt like giving the players and staff an added rate of protection and frankly peace of mind,’ he told CNBC.”

Strangely enough, the NBA Twitter account announced the NBA connection to Oura by referring to that CNBC article and to what I now term the “Oura Big Lie” about accuracy in early detection.

The Oura ring is not the key to the NBA restarting. It is probably less important than the Disney MagicBand, individual pulse oximeter, or the smart thermometer that NBA players were issued. It is definitely less important than frequent COVID-19 testing.

NBA players were offered Oura rings and allowed to participate in data gathering, but there is nothing to suggest the NBA is using that data to “mitigate the spread of COVID-19.”

Readers, patients, and consumers should understand that they cannot rely on the Oura ring or any wearable medical device to reliably predict the development of COVID-19.

Anthony Pearson, MD, is a private practice noninvasive cardiologist and medical director of echocardiography at St. Luke’s Hospital in St. Louis. He blogs on nutrition, cardiac testing, quackery, and other things worthy of skepticism at The Skeptical Cardiologist, where a version of this post first appeared.

Last Updated July 20, 2020