WHOOP Podcast - Researchers Use WHOOP to Track COVID-19 Recovery Process

Episode Date: May 6, 2020

WHOOP data continues to be used by doctors and researchers as they try and learn more about coronavirus. The Duke University COVID-19 Research Taskforce is putting WHOOP straps on coronavirus patients to track how they are recovering from the disease, both in the hospital and after they are discharged.  Lead Clinical Medical Physiologist Dr. Jeroen Molinger discusses his coronavirus research (3:27), the ICU experience (5:10), creating survivors and not victims (8:14), buying time with ventilators (8:56), what researchers are hoping to learn about BMI’s role in coronavirus outcomes (9:19), why heart rate variability could be a good predictor of post-COVID immune response (10:42), study goals (14:53), why we still don’t know enough about asymptomatic cases (19:57), the importance of tracking HRV (23:10), COVID’s effect on sleep (24:29), and what he’s learned from his WHOOP data while working during the pandemic (25:51).Support the showFollow WHOOP: www.whoop.com Trial WHOOP for Free Instagram TikTok YouTube X Facebook LinkedIn Follow Will Ahmed: Instagram X LinkedIn Follow Kristen Holmes: Instagram LinkedIn Follow Emily Capodilupo: LinkedIn

Hello, folks. Welcome to the WOOP podcast. I'm your host, Will Al-Aid, the founder and CEO of Woop, and we are on a mission to unlock human performance. We build technology across hardware and software and analytics that's designed to continuously understand the human body. We measure things like heart rate and respiratory rate and heart rate variability and capacitive touch and movement. We provide all that information on a dashboard that's going to tell you things like how well you slept, how fast you're recovering, what kind of strain you're putting on your bodies, which hopefully right now hasn't fallen off too much in this time of COVID. And in addition, we're doing a lot of research right now around COVID-19. You can listen to some of our previous episodes about how

respiratory rate may be a key indicator for whether or not someone has COVID-19. And if you have never joined Whoop or you're not a member, you can get 15% off a Whoop membership by using code Will Ahmed, W-I-L-L-A-H-M-E-D. Our guest this week is Jerome Mullinger from the Duke University Medical Center COVID-19 Research Task Force. Yes, that is a very important task force. And Woop has partnered with Duke to study the recovery aspect of COVID-19. What does that mean? It means when a patient who has gotten COVID-19 actually leaves the hospital, what happens to their health, what happens to their recovery, what happens to, in particular, their heart rate variability, which we touch upon a lot. So researchers are putting whoops traps on people

admitted with coronavirus, admitted to the hospital, to gain a better understanding of how their bodies are reacting to the disease, both in the hospital and after they're discharged. And then experts at Duke are trying to better predict how certain high-risk patients might respond to the ICU experience. I thought this was really fascinating. I think it's really important work that's being done. I'm glad Woop is part of it. And Geron and I discussed really the numerous health complications that they're seeing after someone leaves and is cleared of coronavirus. There's been a lot written about heart implications, about declining heart rate variability, about organ failure, And it just seems like there's still that a lot we don't know about COVID-19.

So anyway, this is a very powerful conversation. And again, I'm proud that WOOP is playing a small role in helping out researchers understand this disease. Without further ado, here's Jerome. Geron, welcome to the WOOP podcast. Thank you. Thank you for having me. So how do you like to describe the work that you're doing right now? Oh, wow, that's a good question.

Literally talking about this is really pre- and post-COVID area right now in our research here at Duke. Before the COVID, we did our primarily research in curative care. So looking at different metabolic phenotypes being at risk prior to major elective abdominal surgery or cancer. Right now, we have a complete different kind of way of approaching because the operations here at Duke are minimal. There is no other research done right now. always focused on COVID. Right now we're looking at how can we define the systemic metabolic phenotype throughout the infected period, even pre and post-infective period, to define and to dissect more

where are people being at risk as risk as now? And why is there such a huge correlation with BMI or social status and the worst outcome we've seen right now being on the vet for a significant period of time and having all kind of issues, presumably if you are surviving in a post-survivor COVID time, which we are not there because I think that will be another big issue. We are right now dealing only with the effect of them being on the ICU. But again, looking forward, looking at what we see right now in use on the second wave, and I think that's very true. I think we should definitely look out for the third and for the second wave end of this year or so. We're getting next year. But

But why I'm far more right now worried about is the way we're going to get from our post-COVIDs survivors. Because that will be people are having military-organ failure coming from ICU or just not that ICU, having kidney problems, having liver problems, having congestive heart failure, cognition problems, and then going to back, return to work, having issues with quality of life. And if they get sick, again, we can have a huge spike again with all admissions and looking at health consumption. Well, there's so much that's interesting about what you just said. Let's start with this idea that after you recover, and I'm putting recovering quotes as I say that, after you recover from COVID, this idea that it could come back or could cause

other failures that they didn't see when you were in the ICU. Talk a little bit about that. The chance of dying after your ICU admission, and that could be 8 to 12 months, is specifically high, about 20, 50%. So, that will be the case for the people already there. So if you're surviving, so you think, yes, I managed it, and you still have a lot of communities, and you still have a big issue coming around and making sure that we are taking care of those people afterwards, because I think that's the issue right now.

Are we here in the U.S.? Are we able to take care of those patients? It seems amazing, doesn't it, like how little in some ways it feels like we still know about this virus? Oh, no, absolutely. Yeah, yeah, yeah. And the thing is that's kind of weird and not great in a way is that the most of the focus on research goes right now to be vaccine and looking at Remisphere, all the kind of interventions

we can do during your infection on the ICU. But I think that's good and I think definitely has to go through and that has to have his primary focus, but we have to have another focus in looking where are people being at risk. And can we do even maybe in the admission to the floor, so not yet to the admission to the ICU, but also assessing their at-risk profile. And maybe we can intervene already there and not making sure that they not get admitted to the ICU. Because if you're admitted to the ICU and you get intubated,

the ability to win from the ventilator is presumably very hard if you have hard combative. So what happens then that you have a three, two, three, maybe even four weeks, on the vent, which on itself is a huge, huge, huge, huge, huge deal, and you're stress for the whole system. Explain that more. So you're saying that you can identify someone who's actually too at risk to go on an ICU? Yeah, that's one of the questions we have is also more kind of an ethical question we have. What kind of score or can you kind of a severity score or can you have a comorbidity

security score when you can say maybe, wow, maybe you shouldn't go to the, I see you and maybe you shouldn't be on the vent because we're going to make sure if you go in there, you will never ever get off the vent. And then you have issues in regard to what are you going to do with your life. I think that's the stuff where the intensive care positions right now are struggling with because that's the thing we don't know. Well, it reminds me of a paper I read, you know, a journalist did a deep dive in Italy. And this was maybe two, I want to say, three weeks ago when they were at the absolute peak. And you had doctors playing this game of choosing who they can treat, right?

Yes. And so the point you're making, I believe, is that there's some people who are so at risk for the ICU experience or treatment that it's actually not worth it to them to get the ICU treatment. Even if they're in bad shape with COVID, you're effectively giving them a cure that may be worse, if I'm framing that properly. Yeah, absolutely. And that's, I think one of the phrases my colleague Paul Wisemeyer always says, and I think

that takes it very well into perspective is we have to create survivors and not victims. We're creating victims if you're treating patients, we already know they're going to be having huge problems in regard to ICU stay and having huge adverse effects and use complications. Explain what the purpose of an ICU is and what like a ventilator actually does. In essence, it's very simple. What we're trying to do is putting people on the vent is literally just taking over the ventilation and making sure that the lungs are completely filled with air and that all the perfusion and the oxygen going into the lungs to the system

is always guaranteed and that the CO2 removal is always guaranteed. So that gives literally buying time. What we want to do is because we have no cure yet. We cannot give anything. We know for sure that helps. So what we're doing with ventilation is just buying time to make sure that the body, if possible, can recover from this virus, which sometimes it does and sometimes it doesn't.

And that's the things we just don't know. And the things we just don't know why. For instance, one of the things we saw in the Netherlands was, and I think it's also seen in the New York population, that BMI was very well correlated with adverse outcomes. So people, I think 80% of all admitted in the EU were in the Netherlands, had a BMI large in I think the same stuff we saw in Italy, but also saw it in New York. And one of the questions we had was, is BMI such a good predictor of being having an adverse effect on ICU stay?

So, one of the ethical questions we had in the Netherlands was, can we somehow use BMI as a risk, at risk score for saying yes or no being submitted to the ICU? I think you cannot do that at all, because right now we don't know why the BMI is so predictive. I think it's kind of a proxy. Interesting. And your point about choosing who to admit into the ICU, I think, is a good one because, you know, there is always this question of, is the cure better or worse than the problem? No, absolutely. I think, and that's what's the stuff we're trying to find out also, if HRV in the COVID patients, and literally I want to dissect the patients from, literally from

just infected going from the floor, from the floor to ICU, from ICU getting intubated, getting estuaded, going back to the floor and getting back home, how that trajectory will go. But also looking and assessing patients who are survivors, because the HRV could be a very good predictor in the immune response post-COVID. And we have to have an ability to assess patients in a large amount of people. And just looking here at Duke, where we have a large amount of people going to surgery around 75,000, 80,000 people here a year. We don't know how many post-cove pages there will be

because we're still having issues with testing at all. So we have to assess them. We have to follow them up also at home to see how they can somehow being guided or being supervised in their training, in their nutrition, in their recovery, et cetera. Yeah, so you're talking about HRV, which is heart rate variability,

which for all the WOOP members listening will know is one of the leading metrics that we use to give you a recovery score every day. And I think what's powerful about this is you're suggesting, I think, that if you could know the heart rate variability and some of these baseline physiological metrics of every person before they walked into surgery, you would have a better understanding of someone's preparedness for that surgery. Is that fair? That's completely right.

Yeah. Let's talk about the study that we're doing together. and that whoop is involved in. I understand the studies focused on the recovery aspect of COVID-19. So talk about that. We have two parts. One of the parts will be the following up. So we will be giving people who are on the floor admitted to Duke.

So still awake, needing oxygen from two, four, five meters or so. To give them a new hoop and to see how they're following up. So we can following up all there. Sorry, just clarify, clarify that. You're giving it to which people exactly? people who are being admitted to the Duke hospital but on the floor so not on the ICU okay also you have to ask for consent for the specific assessments so if you're on the ICU with no family around we can't do this we're going to do consenting so we have to make

sure that people are aware of the study and they can do consenting also on the floor and that gives us also the ability to follow them up even if they go to the ICU so that's the first part so we have the floor and maybe for non-incu and going back home. And if people going back home, then we'll be included to our second study. There will be a post-COVID rehab study. So then we will see what kind of outcomes do we need to have to have a very well-supervised, guided kind of an intervention, which they can do at home. I myself, I'm very curious to see in those patients how looking at the group outcomes,

how the strain will look like in those patients from a day-to-day base. I know my strain. I know what I'm doing right now and what I'm seeing also in the ICU. Yeah, you're wearing a... I'm wearing right now. It's kind of a cool thing because I had the ability to see how I did before I went into the rooms

because we are assessing patients, three or four patients a day. Just imagine I have to do all my PPE stuff. So I'm around one hour and a half in the room doing all the assessments. It's kind of a hard, hard research work. That's fine. I think I'm proud doing it.

Yeah, it's intense. Yeah, absolutely. Also, for my point of view, looking at my health and my rest itself, it's very helpful for me to see what I need to do because right now we're only looking at patients, but I think it's very, for us, primarily vital, primary focus that we stay safe also because we have to make sure we get our rest, we did our stuff, we do our training, do our nutrition and all. And I already see in my strain, in my recovery nostril in my sleep analysis, is you definitely lead a lot of sleep to get bad. into shape right now. And I'm very curious to see how that our subjects and our patients will do because sleep hygiene is so important also in regard to doing any intervention at all. Well, first of all, very proud to have you on Woop and the rest of the team on Woop and to be doing this study with you guys. I think the work that you're doing right now is so

important. How long do we think the study is going to take and how many people are we going to do this with? Yeah, that's not a good question. Right now, that's one of the part we just don't know yet in hopefully right now we're trying to assess in our leave COVID study around 200 patients yeah with 100 controls and controls will be the non-COVID RDS patients so about 300 people yep so it will be it will be a significant data set we're going to drive from and also and that's the most important thing that we have data set not only from the home environment itself but we can compare home to floor and ICU and some patients also floor ICU floor home. And that's novel. It's never been done to look into those data sets and how people

change. And I'm very curious to see not only the data set in the absolutes, but more how do the slopes go, how do the trends go? Because that's very typical in our COVID patients that you see around day eight, day 10, where you think it's going well. You literally are at a crossroad. You're going to the left and you're going to get better. You come to the right and you can get worse. and we don't know why. I've actually talked to friends who've gotten COVID-19, and this has happened to them. The phenomenon is you get it, you feel the symptoms,

it gets progressively better, the same way you would get better from any kind of cold, and you think you're out the other end, and all of a sudden it gets worse, or it comes back hard, right? That's what you're describing. Right on. And I believe your point is also that if you're in a certain category of person,

A more at-risk person. Maybe it's because you have a high BMI, as you were talking about earlier. Maybe it's because you have a low heart rate variability. That individual could be at even significantly more risk when that comes back. And we have to figure out, we being society, how we're going to treat those people. Exactly. Here's my question with reinfections. Is it actually that you're exposed to one example of this coronavirus?

You get it. You build the antibodies and you go back to your normal life. And then you interact with someone else that also has it and you get reinfected. Is that reinfection? Or is reinfection this phenomenon of I'm recovering, I'm recovering, I'm recovered. And then some period of time it comes back. And I think that is one of the questions we still need to get to answer because that will be maybe one of the important questions we need to have. in our upcoming post-COVID area, because the COVID infection will never go away. The virus is there to stay. Of course, we'll be having some vaccines for sure, but still, this is not going away at all. And we have to make sure how that kind of immune response or being immune at all, and the time frame that will take it and your phenotype take it will give rise to it. Maybe it's also kind of a, you say some, maybe it's also kind of a viral load

that you can get in a specific time frame will give rise to a reaffection. One of the things we saw, I think there was an article from China, where they say why they think it has an high, if you're being obese or having an end of having high BMI, why you're having such a high chance of getting admitted to the ICU, is that the ACE2 receptor is not only in the lungs, but also in the fat cell. So if you have a lot of around of fat cells, the ability to have a lot of areas where the virus can hook on is high. So your viral load will also be, in a specific time frame, much higher. What do you think of this phenomenon of, or this concept rather, that if I'm more exposed to this virus, I'm going to have a worse reaction to it? You know, there was an example, I believe it was in China. This is maybe even in January timeframe where, you know, young, healthy, 30-something doctor died of COVID-19. And part of the explanation was that it was because he was treating COVID-19 patients all day

and just got hit too hard with the virus. Do you buy that? Does that follow? I'm not sure. There are some reasons to believe that the acuteness of the viral load could be a indicator. And of course, and also looking at myself, as a health professional researcher right now, Duke, we are the ones who are in front and also the nurses, I think, even more that, and also the intubation teams who have all the erasization of the virus being

intubated. I'm not sure, because again, going back, the testing has not been done right now also from everyone involved in the healthcare profession. So we have to see who is being affected already, and or if we have a good defined test and being valid and being sensitive and precise enough to measuring antibodies, which we just don't have right now, we don't know. We just don't know. It's amazing how little we know about this. Yeah, no, it is. Now, the serology test, I've long felt that that's the biggest miss that we've had, at least in this country,

is that we don't have a real understanding of how many people have been exposed to COVID-19. And so as a result, we don't really know what the true fatality rate is of this. do you agree with that? No, absolutely. And I think it can go down, of course, if we see a lot of people already being affected with being asymptomatic. Or also one of the questions we have, of course, how do you define asymptomatic?

Is asymptomatic just not having any symptoms at all or having a slight headache or having a slight sore throat or whatever? And again, this period of time is still also, in influenza as to flu season. So we have also hay fever people. Yeah, right. Also going around. So we have a lot of bias surrounding people having symptoms with, and again,

the only way to make sure is testing. We have to be testing those people making sure that there's just a flu or just a high fever and not COVID-19. If we discover that a high percentage of the population, I don't know what that percentage should be, but let's pretend that we rolled out. over 300 million antibody tests tomorrow. Yeah. And we discovered that a high percentage of the population had antibodies.

Would it be safe for those people to be out and about again and to no longer be practicing social distancing? Or do you feel that we still don't know enough about this virus to actually say that because you have antibodies, you're fine? I think we still don't know enough at all to make sure that you can make those statements right now. One positive outcome that may come from all of this is people, I think, are going to realize how important it is to be fit and healthy.

It's not a surprise that when I talk to people about just how scared they are personally about getting COVID-19, the fear level directly correlates to how fit they are. I think there is a level of ignorance to that too, right? Because obviously there's so much we don't understand about this thing. but being fit and being healthy and knowing that your body functions properly just makes you approach these moments differently. It fundamentally does and it has a big psychological impact along with everything that you just described about how your body's going to function better. So let's go back to the study for a second. It's coming out right now that roughly one-third of COVID-19 patients

are developing cardiovascular complications, right? Right. Yep. So one of the goals of this study is to determine the effect of COVID-19 on your cardiac structure and function as well as body and fluid composition to effectively understand how you're doing after admission to hospital discharge. So let's play this out if you're wearing a whoop strap during this whole thing. And our audience obviously is pretty familiar with whoop. What might we see in someone's data who has a good recovery after COVID-19. One thing we'd want to see is we'd want to see their HRV stay flat or even increase, right, coming out of this.

Yeah. If you see it start having a meaningful decline when they're supposed to be in a period of recovery, that may be a sign that they're, you know, in that third that's developing a cardiovascular complication. Yeah. Yeah, exactly. And that's the acute part. And the long-term chronic part will be, how do you see the slope and the trends throughout a seven-day-a-week period, for instance?

Do you see specific changes? And I must say, and that's also what we don't take into account, I think, when we're looking at the data from HRV in the ICU and in the floor, you also have a specific kind of type. So how does your body respond to specific periods and time on the day in the early morning or in the midday? If you are a post-COVID survivor and doing training at home, and what would be interesting for you to do is to see how do you quickly respond to your training itself within an hour. And also, how do you produce your high variability over a long period of time? Yeah, it's been interesting talking to WOOP members who have gotten COVID-19 and how much they talk about sleeping during it, you know, just like eight, nine, ten hours in bed a night to try to sleep this thing off.

I'm curious, maybe I don't know that data, but what I know over here, what I heard is there's a lot of people who have kind of very intense nightmares and dreams. What you've definitely been seeing also in the loop analysis to see how your deep sleep, your ramp sleep and your light and we'll go. We are seeing pretty interesting analysis from that. Some of this is still under embargo because we're doing research. I can't go into as much detail as I would like on it. but we are seeing, we are seeing stuff. It's a really good point. And people are having these incredibly high fevers.

And high fevers, you know, can cause hallucinations. They can cause crazy dreams. And that inevitably shows up in your sleep data. I mean, the quick of it is obviously the quality of sleep looks very different, right? If you look at a typical staging over the course of the night, light, awake, you know, slow wave, ram, and around again, it doesn't look like a normal night's sleep. So we're doing a lot of research. on that, and that's going to be part of the research that we publicize. Well, but super excited about this research with Duke. Look, I think it's amazing what you guys are doing. I'm really proud

whoop's part of this study. And I'm also just really excited to see what the research is that comes out of it. Because to your point, I mean, there's just so little understood from a big picture standpoint about this. Now, you've been on whoop. Tell me, how's your data evolved during this moment and time? Good question. Now, I had some drops in my recovery right now but what I'm what I was seeing right now and it was very distinct is I'm doing my training and all every single day that this that was fine I'm very sensitive to my sleep hygiene so I have to make sure I get my sleep yeah that that's distinct if I don't get it I instantly

see my numbers and look out to me recovery I see that changing and also also the way I get my literary the ability to get a specific strain during my during my training itself so I myself myself, as my metabolic phenotype, I see that my sleep hygiene is one of the most important things I need to look into and look after for. And again, as a researcher doing over here, doing the stuff, there's also among the most issues to get into, because I'm starting off here at 6 o'clock in the morning, and we are still 8 o'clock in the evening or so. It's a struggle to get my sleep hygiene in place. But, okay, we have to make sure that's because also I have

to be safe and healthy, that's important. You do, man, and your whole team around you does because the rest of the country needs you. We all need you right now. So look, thank you for everything that you do right now. Thank you for everything that your team does. I know I'm speaking on behalf of all of our listeners and we say that we feel fortunate to have you supporting this country. Thank you so much. Now, if people want to learn more about the Duke Lab or about you, or about the study, where can they do that? I think the best way that they can do is follow me on Twitter or LinkedIn. Twitter is one of the stuff I need to do very actively,

and we'll post all our results very early on and give people more insight in the stuff we're doing over there, too. Okay, good. Well, we'll include that in the show notes. Geron, thank you so much for coming on. Thank you, well. Thank you. Thanks so much.

Thanks again to Jerome for coming on the WOOP podcast and for all the incredibly important work he is doing right now with his team at Duke to fight COVID-19. Make sure to subscribe to the WOOP podcast, follow us at WOOP or follow me at Will Ahmed. You can find us on all the typical social platforms. And as always, stay healthy, stay green. Thank you for tuning in to the WOOP podcast. You know, You know,