**5. Heart rate variability (HRV) and networked wireless sensor parameters and applications**

As discussed in section three, HRV is an outstanding candidate for remote patient monitoring since increasingly unobtrusive, noninvasive, and efficient wireless sensor systems have been developed. Briefly, HRV is derived from the interbeat interval, which is defined as the period between successive R waves in the ECG signal and can be reliably and noninvasively obtained by photoplethysmography (PPG), which is included in many fitness training belts and smartwatches, as well as recently developed rings which capture interbeat data as well as three-axis accelerometer, temperature, and blood oxygen saturation data in longitudinal time series form. Further, this data can be transferred to a smartphone application that can store, analyze, and display those data to derive various HRV metrics, the most common being the root mean square of successive RR interval differences (RMSSD). Grounded in the theoretical and conceptual issues noted in section three, particularly polyvagal and neurovisceral integration theory, we have proposed deployment of the canary system, a geocoded networked wireless sensor system [10], based on existing proof-of-concept research [11] using the RMSSD HRV metric, which has been shown the ability to detect the onset of COVID-19 up to 9 days before the development of symptoms in symptomatic individuals and laboratory signs such as positive PCR results in both symptomatic and asymptomatic subjects [12]. Notably, Hirten et al. used a gradient-boosting machinelearning algorithm to detect circadian HRV variation in making the most accurate predictions. This targeted technology in response to the massive costs in mortality, morbidity, and socio-economic costs engendered by the COVID-19 pandemic, which is still producing variants of concern that may have both high transmissibility and virulence. Notably, the US DARPA has identified the important role of implantable aptamer-based biosensors to track ongoing health status of military personnel,

#### *Perspective Chapter: Edge Computing in Digital Epidemiology and Global Health DOI: http://dx.doi.org/10.5772/intechopen.110906*

especially in mission-sensitive settings, and has funded such development. As is typical, massive spending on military applications is rationalized as a national security priority, while the huge social and economic costs of the poorly managed COVID-19 pandemic are not identified as significant national and global security issues. In fact, concern regarding epidemics, pandemics, and transdemics is usually forgotten soon after the disturbance is deemed "over" by national governments, and funding and planning are cut or discontinued completely.

The role of the Canary System has been described above in application to the COVID-19 pandemic for several reasons. Most importantly, it is based on a rapidly scalable commercial technology of sensor devices and smartphones. Thus, its role in the detection of outbreak prevalence and spread is critical, with medical laboratory testing both expensive, time-consuming, and frequently inaccessible, while less expensive antigen tests are less reliable and subject to uneven application and reporting. The system is also well suited to the important but often neglected sentinel surveillance, which can massively improve response to outbreaks that otherwise can go undetected for weeks or months and, in fact, may facilitate original identification of new variants of concern. A recent Lancet Planetary Health recommendation [13] notes the urgency to identify "salient symptoms which need documentation of early routine evaluation of data validity, sentinel site designs and data collection methods to enable rapid implementation and analysis." Such sentinel site designs are applicable not only to high-risk populations but specific individuals.

An example of use by individuals or small operational groups is in military settings where infectious disease is not the only risk. The Canary System can also track mobility and operational behavioral status, which can be categorized in the typical simplified military jargon of green—"good to go" or fully functional; yellow—impaired capability; and red—nonfunctional or deceased. As explored by Thayer [5] and many others, HRV is not only a health biomarker but also an indicator of positive and adaptive psychosocial functioning. HRV has been used in tracking executive CNS function and in improving stress management and resilience enhancement [14]. When combined with longitudinal temperature, blood oxygen saturation, and activity level, HRV could also constitute a routine vital sign monitoring system useful in clinical medicine for both prevention activities and evaluation of clinical status of existing patients.

#### **6. Conclusion**

While the Canary System as currently conceptualized is premised on a wearable sensor system, the rapid development of microelectronics and materials science makes other enhancements feasible. Recently, an innovative use of the popular Raspberry Pi technology for ongoing EEG monitoring was described [15] and a wearable device has been shown to be able to accomplish single-neuron CNS recording [16]. The role of mosaic RBD nanoparticles in assessment and intervention in SARS CoV-2 virology has also been explored [17]. The use of wireless data transfer and battery charging has already been accomplished and will further the development of the Canary System. Developments in molecular biology may make it possible for implanted devices to be powered by internal body chemistry, as well. A related area of significant development We have described the positive uses of wireless networked devices here, which we advocate as a dynamic element of iP4 healthcare, which is an integrative approach to health that is personalized, preventive, prescriptive, and

participatory [18]. A related highly significant development is the use of genetic and epigenetic interventions in regenerative medicine, which may allow regrowing of damaged or dysfunctional organs such as teeth using native DNA [19].

It is also important, however, to be vigilant regarding misuses of such approaches. In particular, the maintenance of stringent personal data privacy and confidentiality is an issue that has been identified in other applications but would be acute in this type of application. EC must assure that local data is as secure as other settings such as "the cloud." Also, concern with data ownership is salient, since HIPAA provides for health data accessibility but not strict ownership. In the era of increasing data monopolization and commodification by huge commercial ventures intent on profiting from ownership of the data of individuals, it would be pathological for individuals to lose their own biomedical data to commercial interests such as proprietary concerns, healthcare systems, or professional providers. Only with such protections can the potential of such applications flourish. It is also essential to recognize the crucial role played by scientific psychology since all efforts to implement sound scientific and technological innovations and quality improvements are premised on skillful use of the principles of behavior underlying human nature.
