Add absolute, guideline-backed safety floors that escalate a freshly logged
reading — but only after a second, confirming reading inside a one-hour
re-test window, so a single oscillometric spike or a one-off finger-stick can
never raise a false alarm:
- blood pressure 180/120 or higher (re-check, contact your doctor; symptom-
coupled lifts to emergency copy) and a symmetric low-systolic-under-90
cautionary tier;
- glucose under 70 (low) and under 54 (very low), and a sustained very-high
250-or-higher tier. The 200 DKA criterion deliberately never shows an
all-clear and never urgently escalates on its own, since a value alone
cannot rule euglycemic DKA in or out.
The escalation reuses the urgent SYSTEM_ALERT path with a 24h per-reason
dedup, never names a condition, and gates glucose behind the glucose module.
An optional transient `symptomsPresent` flag on the measurement write lifts a
confirmed breach from the contact-your-doctor copy to the emergency copy. The
measurement POST runs the check fire-and-forget so a notification failure
never fails the user's write.
resolveRestMode is resolved from several surfaces in one request — the
snapshot builder, the recovery score, the analytics route, and coincident-
deviation — each firing an identical active-episode findMany for the same
account. Memoise the read per request keyed on (userId, asOf instant); an
explicit client bypasses the memo so transaction and test reads are never
served a default-client cached result.
The cross-episode insights route looped up to 24 episodes, each running a
sequential 10-vital scan with two serial reads per vital — ~500 serialised
round-trips on a year of episodes, starving the shared Prisma pool.
Pair the baseline + episode-window reads, fan the per-vital scan out under a
p-limit(4) cap, and run the per-episode correlations concurrently under the
same discipline. Series order and the gated outputs are unchanged.
Add an urgent dimension to dispatched notifications so a self-hosted
instance reaches every configured channel at its strongest level without
assuming APNs is present:
- APNs -> interruption-level time-sensitive + priority 10 (critical
only when APNS_CRITICAL_ENTITLEMENT=true; time-sensitive needs no
Apple approval)
- ntfy -> Priority 5 (max) + warning tag (suppressed in discreet mode)
- Web Push-> Urgency: high send option + requireInteraction
- Webhook -> priority "urgent" in the JSON body
- Telegram-> normal delivery (no urgency tier)
Wire the illness red-flag escalation (sustained low SpO2 / sustained
fever) to emit an urgent SYSTEM_ALERT through the dispatcher, owner-scoped
and module-gated, de-duplicated per episode via the push-attempt ledger.
Normal events are unchanged.
The illness module shipped opt-in/default-off via a bornGated flag, the
inverse of the standard disabled-allowlist. Make it a normal optional
module that defaults on (opt-out), matching labs and its siblings.
No module used bornGated other than illness, so drop the flag, its
isBornGatedModule helper, and the gate resolver's born-gated branch
entirely. The module stays a normal toggle under What you track and the
operator-level availability override is unchanged; an account that wants
it off sets an explicit false. Refresh the gate, doctor-report, labs and
biomarkers comments plus the OpenAPI route descriptions accordingly.
Wrap episode-create in withIdempotency so an iOS retry can't mint duplicates.
Enforce resolvedAt >= onsetAt on create, edit, and the resolve verb (a partial
edit is checked against the stored onset). Run the day-log upsert, its symptom-
link replacement, and the read-back in one transaction and return the full DTO,
dropping the route's second round-trip. Restrict symptom severity to 1-3 (a
link's presence already means present, so 0 is not a distinct state). Return
the standard { deleted: true } envelope from DELETE instead of a bodyless 204.
Anchor the physiological-return search after the first notable deviation so
an early in-band run-up can no longer be reported as a return before the
vital ever deviated (the spurious-negative-gap bug). Decouple the red-flag
escalation from the baseline-band loop: it now scans the raw episode days for
SpO2 and temperature against absolute clinical floors, so a rock-steady
(MAD=0) vital still escalates a low SpO2 or sustained fever. Union the day-log
feverC series into the fever flag and prefer per-day max so an evening spike
is not masked by the daily mean. Key every per-day series in the user's
timezone (rollup buckets and the raw fallback) so the vital series lines up
with the tz-keyed onset and felt-better markers instead of an off-by-one for
non-UTC accounts.
An active illness/condition episode annotates, it never penalises: the
measured number is untouched, only the narrative changes.
- rest-mode.ts: one server-authoritative resolver (module-gated, fail-soft)
for "is the account in Rest Mode + which episodes back it". iOS mirrors the
resolved context, never recomputes the suppression.
- health-score: /api/analytics attaches a value-free Rest Mode annotation;
computeHealthScore stays pure (score never adjusted).
- recovery-score: computeRecoveryScore carries the Rest Mode context as of the
scored day; the persisted blend is unchanged.
- coach-nudge: pause cadence-nudges during an active episode (new
skippedDuringIllness counter, gate sits before the trigger search).
- achievements: bridgeFrozenStreakGaps freezes (does not break) every
day-streak across illness days; never invents a streak, a non-illness gap
still breaks.
- coincident-deviation: reframe a fired flag as illness-explained; vital
numbers untouched. Surfaced as a neutral line on the insights card.
- coach snapshot: illness history + active illness as load-bearing context so
the coach knows about Rest Mode (no decrypted note reaches the prompt).
- FHIR: illness episodes map to Condition (generic disease root, label on
code.text, patient-reported/unconfirmed) + a bounding Encounter.
- doctor-report: module-gated illness section in the aggregator + PDF table
(retrospective, neutral palette); FHIR Condition section in the bundle.
i18n x6 for the report + reframe copy. Tests: score-annotation-not-
penalisation, streak-freeze, coach-nudge pause, FHIR Condition/Encounter
mapping, doctor-report inclusion, Rest Mode resolver. typecheck/lint/test
green, openapi in sync, knip clean.
Add the retrospective correlation engine for illness episodes: a pre-onset
anomaly scan (deviation in robust SDs from the user's own median±MAD
baseline), the nadir / what-dropped across the active span, and the
recovery-gap (physiological return-to-baseline vs the felt-better marker).
CHRONIC_ONGOING is excluded from the gap. Every derived number is gated by
the shared coverage/confidence model — a thin signal asserts nothing rather
than showing a wrong figure.
The baseline window ends strictly before the pre-onset lookback, so an
episode's own days can never contaminate the baseline it is measured against.
Reads are DAY-native (rollup tier with a live-SQL fallback), reusing the
baseline engine's read path so the rollup-vs-live parity carries over.
Surfaces:
- GET /api/illness/episodes/{id}/correlation — per-episode findings (gated
Derived wire shape; red-flag escalation for sustained low SpO2 / fever).
- GET /api/illness/insights — cross-episode retrospective ("sick N times ·
typical recovery gap X days"), with the typical-gap withheld below the
min-sample floor. Retrospective only — never a predictor or diagnoser.
Reliability battery: golden-fixture recovery-gap math, rollup-vs-live parity,
baseline-contamination guard, thin-data / coverage-gate, red-flag escalation.
Born-gated + owner-scoped; server-authoritative DTO (iOS renders). i18n ×6.
Introduce a retrospective illness/condition journal: episodes with a
lifecycle (acute / chronic-ongoing / recurring / flare) and a daily
symptom timeline forked structurally from the cycle log-day surface. The
journal is a record, not a medical device — no prediction or diagnosis UI.
- Register `illness` as a born-gated (opt-in / default-off) module. The
gate resolver flips the disabled-allowlist default to off for born-gated
keys, so the surface stays dark until the account opts in from the
Modules hub. `isIllnessEnabled` + `requireIllnessEnabled` delegate to the
module foundation (one source of truth) and re-stamp an illness errorCode.
- Episode CRUD under /api/illness: list / create / get / edit / resolve /
delete, plus a per-episode-day day-log upsert on (episodeId, date). Every
route wraps apiHandler, Zod-validates with returnAllZodIssues, narrows
userId from auth, builds data field-by-field, and gates the module.
Free-text notes encrypt at rest through the shared Bytes codec.
- Log-day sheet (cycle fork): ~8 Jackson/WURSS symptom chips 0-3 + a
functional-impact group + fever + an encrypted note, one row per day.
- Episode history page + a born-gated nav entry, neutral palette, status
via a neutral Badge, retrospective-only copy. i18n across all six locales.
- Cover the new routes in the module-route-gate inventory; unit tests for
the day-log upsert, the gate enforcement, and the born-gated resolver.
The /api/auth/me module map now projects the `illness` flag (openapi.yaml
regenerated).
Marc-André Bombeck