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it is not unheard of for something at level x to be developed to level 2x so if it can do 24h now, with higher sample rate and better maths, what if it got to 48h in tractable time?

to the watch-in-a-ward point: valid. But, if this technique did get to 48h+ predictive quality, and was available to wearers of smart watches outside of wards would you still have hesitancy to consider it useful?

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The utility of the test decreases with reduced risk. A 99% specific test is good when there are high levels of disease going around (e.g. covid in a hospital). In the community, rates are much lower, so the positive predictive value of the test is much lower, even with 99% specificity. My conclusion is that if you tried this in a community setting, the number of false positives would far outweigh the true positives, and lead to dismissal of alerts.

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