Owing to the massive outbreak of COVID-19, as of March 9, 2020, the virus has reportedly
caused 108,618 infections and 3,800 deaths globally. The World Health Organization (WHO) has
declared COVID-19 disease a public health emergency of international concern. As there has
yet been specific therapeutic or vaccine for the condition, rigorous implementation of
traditional public health measures including isolation, quarantine, social distancing, and
community containment is the principle strategy to control the COVID-19 epidemic. In addition
to the isolation of confirmed COVID-19 infected patients from noninfected population, it is
equally if not more important to quarantine asymptomatic individuals with possible exposure
to COVID-19 in order to reduce the viral spread. Indeed, quarantine measures have been
initiated in many countries and regions, which restrict movements of asymptomatic individuals
with COVID-19 exposure often with fever and symptom surveillance at home or designated
facilities for the presumed incubation period (14 days). While conceptually attractive, the
intermittency and high dependency of selfdiscipline for body temperature and symptom
surveillance undermine the practicality and effectiveness of the approach. Furthermore, it
has been reported that as many as 50% of COVID-19 infected patients had not had fever until
the full-blown disease, thereby body temperature surveillance per se may not be sufficient to
detect early disease progression.

In the past few decades, advances in sensor technology miniaturize electronic physiological
sensors that could be incorporated into wearable devices allowing continuous monitoring of
physiological parameters such as skin temperature, heart rate, respiratory rate, oxygen
saturation, perspiration and activity of ambulatory subjects in a 24/7 basis. Together with
current telecommunication platform capable of instantaneous and multi-directional massive
data transfer, it is possible to remotely monitor a large number of individual subjects'
physiological parameters in a real-time manner, and relay to managing physicians for timely
intervention. Nonetheless, such potentials have not been fully explored in the real-world
disease management. The current study will assess the impact of remote continuous real-time
physiological monitoring using wearable armband device Everion® (Biofourmis, Singapore) and
artificial intelligence-powered analytical platform Biovitals® Sentinel (Biofourmis,
Singapore) on detection of disease progression in asymptomatic subjects with COVID-19
exposure under mandatory quarantine at designated facilities in Hong Kong. The research
hypothesis is that by processing continuous physiological data collected using wearable
device Everion® and patient reported outcomes with a cloud-based analytics platform
Biovitals® Sentinel, it will possible to detect physiological changes and other clinically
meaningful alerts that indicate early clinical progression in quarantined subjects with
COVID-19 exposure.

The wearable vital sign monitor Everion® is capable to track multiple vitals sings including
heart rate, heart rate variability, blood pulse variation, respiration rate under rest,
activity, steps, skin temperature and etc. It is Bluetooth connected to a dedicated
study-smartphone that allows remote transfer of all the physiological data captured by the
wearable device in real time. A specially-designed application (APP) on the study-smartphone
enables the patient to participate in health monitoring by reporting symptoms regularly and
make aware of his/her physical and physiological patterns via the monitoring displays on the
smart-phone. The patient's passive physiological data from the device and the active data on
the symptoms and outcomes from Biovitals® analytics platform are automatically transferred to
the monitoring console on the cloud. Thus, the Biofourmis platform solution is proposed to
allow the monitoring team to effectively and remotely monitor COVID-19 patients and evaluate
the disease progression. Leveraging Everion, the smartphone APP, Biovitals® analytics
platform and the caregiver dashboard, biofourmis has built an end to end solution, Biovitals®
Sentinel to remote monitor and manage the suspected subjects.