Like most companies, Apple's plans for 2020 were upended with the rise of COVID-19. After initial hits to its production line, on-and-off store closures and remote working arrangements, executives said during Apple's fiscal fourth-quarter 2020 call that the tech firm weathered the storm with all-time records for revenue, earnings and cash flow – and that's before taking a look at its skyrocketing stock ticker. 

"Apple products have been a window to the world for users as the pandemic continues, and our teams have met the needs of this moment with creativity, passion and the kinds of big ideas that only Apple can deliver,” CEO Tim Cook said in a statement to investors. 

For those keeping an eye on Apple's health tech moves, the year's developments seem to be a split between planned projects coming to fruition and the pivot into software-based COVID-19 resources. From Apple Watch updates to health studies to an unprecedented collaboration with Google, read on for a collection of Apple's digital health headlines during 2020. 

New software tackles an unexpected pandemic

Shortly after lockdowns began in the U.S., Apple updated Siri with a new conversation tree triggered by questions related to the coronavirus. The personal assistant would review users' symptoms and potential recent exposures to gauge their condition. By the end of the conversation, users were either directed to CDC web resources or a selection of consumer telehealth apps – and, in severe cases, advised to call 911. 

In the weeks to follow, the tech company expanded this early symptom checker with a more robust online screening tool built alongside the CDC, the White House Coronavirus Task Force and FEMA, and eventually updated it to directly report its results to the CDC for public health monitoring. To help users track down nearby testing options, Apple opened up a web portal that allowed providers, labs and other businesses to register as verified COVID-19 testing locations and be featured in the Apple Maps app. 

However, it was the company's collaboration with Google to build an interoperable, system-level COVID-19 contact tracing tool that garnered the most attention from the industry and health officials alike. First announced in early April, the opt-in tools used Bluetooth to inform users of likely contact with another device owner with a confirmed case. The Exposure Notifications system was built to keep these individuals anonymous but also relay necessary information to public health authorities.

"Privacy, transparency, and consent are of utmost importance in this effort, and we look forward to building this functionality in consultation with interested stakeholders," Apple and Google wrote in joint announcements.

The contact tracing system went live in late May and received a slew of updates that added new dev tools and cross country interoperability in July, as well as streamlined user enrollment and pre-made white label apps for public health organizations in September. 

Latvia, Italy, Germany, Denmark, Poland, Gibraltar and Uruguay were among the first countries to roll out some form of an Exposure Notifications-based system, with others like the U.K. taking more time as they explored whether a more centralized version of the tools would be more effective before eventually signing on. Deployments in the U.S. have varied from state to state, starting with Virginia in August and now, as of about a week ago, California. See this running tally on Wikipedia for a breakdown on national and state rollouts.

Apple maintains its clinical research momentum

After signaling a major interest in digitalized clinical research back in 2019, Apple kept up the momentum with a bevy of pharma and academic partnerships. 

Kicking off the year was the launch of the Heartline Study with Johnson & Johnson and Evidation Health. This digital health study aims to measure the impact of Apple’s devices and a study-specific engagement program on cardiovascular outcomes among the Medicare population, and opened enrollment to seniors in February. 

In August, word came that the tech company had backed a University of California, Los Angeles study focused on depression and anxiety. The three-year investigation will provide participants with Apple devices, such as an iPhone or Apple Watch, and a Beddit sleep monitor, as well as a downloaded research app to collect behavior data from participants.

In conjunction with the reveal of its latest wearable around mid-September, Apple pulled back the curtain on three different research studies. 

Chief among these was a collaboration with Anthem, CareEvolution and the University of California, Irvine called the Digital Asthma Study. This two-year, 900-participant investigation combines the Apple Watch, the Beddit sleep monitor and an asthma management app, and aims to assess engagement and long-term intervention value. 

The other two research projects consisted of a study on how metrics, including blood oxygen, can be used to manage heart failure, in partnership with the University Health Network and the University of Toronto; and a study on how heart rate and blood oxygen can signal an early onset of respiratory conditions like the flu and COVID-19, with the Seattle Flu Study and the University of Washington School of Medicine.

But while Apple played an active role in these big-name research studies, the impact of its devices and health features also received some scrutiny from the research community – with mixed results. 

Among the standouts was a Scripps Research Translational Institute study using Apple Watches alongside other popular consumer wearables to spot early COVID-19 cases, and an independent Italian study that found that experts using Apple Watch's ECG could be used to spot ST-segment changes among patients with acute coronary syndromes. On the other end of the spectrum, Mayo Clinic researchers published a study warning that the Watch's abnormal pulse detection feature is fueling a wave of unnecessary healthcare visits. 

New tech offerings for the health-minded consumer

Of course, Apple is best known for its consumer devices and software. The company barreled onward through 2020 with a wave of new products, feature updates and services – a healthy number of which prioritized health and wellness. 

Chronologically, the tech giant came to its annual virtual developer conference in June with a collection of new fitness and health capabilities for the Apple Watch. These included the long-awaited addition of sleep tracking and personalized sleep health guidance, an app that detects and guides users through proper handwashing technique (which one exec noted was in development long before COVID-19) and motion tracking that specifically can follow wearers' dancing patterns. 

Other WWDC updates didn't make it to the prime time of the opening keynote but are worth keeping an eye on for those interested in digital health. These include updates to the Watch's Noise app that track and record how long a user has been exposed to dangerous noise, and the ability to track eight new movement metrics (low-range cardio fitness, walking speed, stair-ascent speed, stair-descent speed, six-minute-walk distance, double support time, step length and asymmetry).

Fast-forwarding to September, Apple launched the Apple Watch Series 6 and its built-in blood oxygenation sensor – a feature that, much like sleep tracking, has been available for some time on competitors' devices. At the same time, the Cupertino, California, company revealed a premium subscription platform called Fitness+ that ties Apple's entire wellness ecosystem to on-demand workout videos and performance tracking. 

Fitness+ launched just this week with iOS 14.3, and came alongside the rollout of a new V02 Max feature for the Watch that doesn't require users to participate in a high-intensity workout. Around this time, MobiHealthNews also learned of a new FDA clearance for the Watch involving an "ECG 2.0" that can better classify the type of atrial fibrillation a wearer is experiencing. 

Other odds and ends

Outside of these major focus areas, Apple's year included a small handful of new and old health initiatives. 

Among the more unexpected is LumiHealth, a digital health partnership with the Singapore government aiming to help the country's population adopt healthier lifestyle habits. Through a mobile and smartwatch app, the program delivers personalized reminders, programs, activity coaching and incentives encouraging daily wellness or regular health screenings and immunizations. 

Meanwhile, Apple scored a major inroad with the (pre-pandemic) fitness and workout industry at the top of the year. Through its Apple Watch Connect program, brands like Crunch Fitness, Orangetheory, YMCA and Basecamp began rewarding members for linking their Apple Watches and other services to the companies' digital ecosystems. The deals also involved new feature additions for members' workouts, such as workout machine integrations for more accurate performance tracking. 

Since its launch in early 2018, Apple Health Records has continued to expand to more and more organizations. The personal health record platform made steady progress throughout the year, but hit a milestone in October with its first international rollouts in Canada and the U.K. As of that announcement, Apple said its platform was supported by more than 500 U.S. institutions and 11,000 care locations.

All of that being said, it wouldn't be a yearly Apple roundup without some mention of patent filings or contentious lawsuits – an interesting pair of which landed side by side just a couple of weeks ago.

The former involves a new patent describing new methods of non-invasive blood pressure measurement via wrist-worn devices. The latter comes from mobile ECG company AliveCor, which filed a complaint against Apple alleging that the Apple Watch's ECG feature infringes on three different patents the tech giant was aware of. In addition to Apple halting the alleged infringement, AliveCor is seeking payment for damages to its company for its attorney fees and for other fees associated with the suit.