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Background: The Coronavirus Disease 2019 (COVID-19) pandemic has resulted in a high degree of psychological distress in health care workers (HCWs). There is a need to characterize which HCWs are at an increased risk of developing psychological effects from the pandemic. Given differences in the response of individuals to stress, evaluation of both the perceived and physiological consequence of stressors provides a comprehensive evaluation of its impact.Objective: In the current study the objectives were to determine characteristics associated with longitudinal perceived stress in HCWs and to determine whether changes in heart rate variability (HRV), a marker of autonomic nervous system (ANS) function, associate with features protective against longitudinal stress.Methods: HCWs across seven hospitals in New York City (NYC) were prospectively followed in an ongoing observational digital study using the custom Warrior Watch Study App. Participants wore an Apple Watch for the duration of the study measuring HRV throughout the follow up period. Surveys measuring perceived stress, resilience, emotional support, quality of life, and optimism were collected at baseline and longitudinally.Results: Three hundred and sixty-one participants (mean [SD] age, 36.8 [10.1] years; 246 [69.3%] female) were enrolled. Multivariate analysis found NYC COVID-19 case count to be associated with increased longitudinal stress (P=0.008). Baseline emotional support, quality of life and resilience were associated with decreased longitudinal stress (P <0.001). A significant reduction in stress during the 4-week period after COVID-19 diagnosis was observed in the highest tertial of emotional support (P =0.03) and resilience (P =0.006). Participants in the highest tertial of baseline emotional support and resilience had a significantly different circadian pattern of longitudinally collected HRV compared to subjects in the low or medium tertial.Conclusions: High resilience, emotional support, and quality of life place HCWs at reduced risk of longitudinal perceived stress and have a distinct physiological stress profile. Our findings support the use of these characteristics to identify HCWs at risk of the psychological and physiological stress effects of the pandemic. [ABSTRACT FROM AUTHOR]

Background: Changes in autonomic nervous system function, characterized by heart rate variability (HRV), have been associated with infection and observed prior to its clinical identification. Objective: We performed an evaluation of HRV collected by a wearable device to identify and predict COVID-19 and its related symptoms. Methods: Health care workers in the Mount Sinai Health System were prospectively followed in an ongoing observational study using the custom Warrior Watch Study app, which was downloaded to their smartphones. Participants wore an Apple Watch for the duration of the study, measuring HRV throughout the follow-up period. Surveys assessing infection and symptom-related questions were obtained daily. Results: Using a mixed-effect cosinor model, the mean amplitude of the circadian pattern of the standard deviation of the interbeat interval of normal sinus beats (SDNN), an HRV metric, differed between subjects with and without COVID-19 (P =.006). The mean amplitude of this circadian pattern differed between individuals during the 7 days before and the 7 days after a COVID-19 diagnosis compared to this metric during uninfected time periods (P =.01). Significant changes in the mean and amplitude of the circadian pattern of the SDNN was observed between the first day of reporting a COVID-19–related symptom compared to all other symptom-free days (P =.01). Conclusions: Longitudinally collected HRV metrics from a commonly worn commercial wearable device (Apple Watch) can predict the diagnosis of COVID-19 and identify COVID-19–related symptoms. Prior to the diagnosis of COVID-19 by nasal swab polymerase chain reaction testing, significant changes in HRV were observed, demonstrating the predictive ability of this metric to identify COVID-19 infection. [ABSTRACT FROM AUTHOR]