WHOOP Podcast - What WHOOP can tell you about COVID-19

Episode Date: July 8, 2020

Our research team has been working around the clock to uncover insights about COVID-19, and a few weeks ago we announced a major finding that showed tracking respiratory rate with WHOOP can help detect coronavirus before you feel any symptoms. VP of Data Science and Research Emily Capodilupo dives deep into our respiratory rate findings, along with a separate study that showed WHOOP members have seen improvements in sleep and cardiovascular health during the physical distancing period. Emily and Will Ahmed discuss how WHOOP discovered the importance of respiratory rate (3:51), the COVID-19 detection study (5:59), unlocking your body's secrets (11:57), HRV and resting heart rate during coronavirus (16:35), exercise intolerance as a potential COVID warning sign (18:55), what you should look out for with your respiratory rate (22:42), the COVID-19 Resilience Project (23:53), how physical distancing changed WHOOP data (30:31), how small changes in sleep patterns can have meaningful health impacts, and what's next for our research (37:37).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 Ahmed, the founder and CEO of WOOP, and we are on a mission to unlock human performance. You guys know what we do. We have hardware, we have software, we've analytics. We measure important things about the human body, like how well you're sleeping and recovering and the strain you put on your body. And more recently, one of the most important things that we measure is respiratory rate. respiratory rate we've seen if elevated can be a sign that you have COVID-19. We've put out a lot of research around respiratory rate. We're working closely with research institutions and public policymakers. And we believe respiratory rate is something that everyone should be aware of as an

important metric to be measuring. If you are interested in a WOOP membership, you can use the code Will Ahmed, W-I-L-L-A-H-M-E-D and get 15% off a WOOP membership. Okay, this week's guest is The Wonderful, the Brilliant, Emily Capital Lupo, VP of Data Science and Research at Woop. Emily has been on many of our most popular podcasts, and today it will be no different because we go deep on all things COVID research. We discuss our latest findings on COVID-19 and respiratory rate, That is a study we have submitted for peer review with CQU.

This was a study we announced not that long ago, and man, we worked fast on this. The research team worked fast on this. It involves 271 subjects, and it shows that an elevated respiratory rate on WOOP can detect 20% of COVID-19 cases before symptoms, and 80% of cases by the third day of symptoms. So that's quite powerful. That's quite important research, I believe, that we're trying to contribute here to the public conversation on COVID-19.

And if you are interested in a podcast to talk about how using respiratory rate can prevent the spread of COVID-19, I suggest that you listen to our podcast with Nick Watney. That was podcast number 80. We put that out last week. week, highly suggest you listen to Nick and how he used respiratory rate to recognize that something was wrong in his body, although he didn't feel any symptoms. And he ultimately tested

positive for COVID-19 and prevented the spread on the PGA tour. Emily and I are also going deep here on the behavior change study that she's conducted at WOOP. We took a 50,000 person sample out of our overall whoop membership and looked at how their behaviors have changed during COVID-19. So we look at a period of time from January to March 9th, which is when the president declared a state of emergency in the United States and many lockdowns began. And then we look at March 9th forwards to today and talk about a lot of the different behaviors that have changed in people's lives. Are people sleeping more? Are they sleeping more consistently, or there are potentially some positive benefits to people's health during COVID-19?

Emily and I talk about that. I think you're going to love this one. Without further ado, here's Emily. Emily, welcome back to the Whoop Podcast. Thanks, Will. So it's always amazing getting to do one of these with you. It's truly a pleasure. And we have some amazing, amazing.

progress on COVID-19 and all the research and the studies that you've been doing. So why don't we start by you explaining the COVID detection study? Sure. So back in the very beginning of March, we had a who, unfortunately, he became sick with COVID-19. And we noticed in his data that his respiratory rate spiked really high, and that this spike actually started to climb up before the day that he said he started to feel sick. And so that kind of, you know, turned us on to this idea that potentially during the incubation phase of COVID-19, which is known to be anywhere from two to 14 days, that there might be detectable signs within the whoop data that we could used to potentially alert a user that something was going on.

And so we added a question to the WOOP journal, which at the time was only about, like, less than a week old, to track COVID-19 symptoms. And then within people who are reporting, experiencing COVID-19 symptoms, we also asked them if they had gotten tested and what the results of that test was. So in just a couple of weeks, we had almost 300 Woop users report to us. positive COVID-19 tests, and we noticed that there was this pattern of elevated respiratory rate in many cases prior to the onset of symptoms that we just weren't seeing in other situations.

So users who had COVID-19 symptoms but tested negative didn't have the same pattern, and we didn't see this pattern happen the same way with things like going from sea level to altitude, which can raise your respiratory rate because oxygen quantity in the air is lower, but the way that it gets elevated is distinct. It happens all of a sudden and then plateaus, whereas what we're seeing with COVID-19 is a specific pattern of it raising slightly during incubation, then all of a sudden, you know, kind of accelerating in the first couple of days of symptoms. And so we set out to see if we can quantify this pattern and to see how robust it would be.

we found that in about 20% of symptomatic COVID-19 cases, that this algorithm would identify these individuals one or two days before symptom onset and that it would catch 80% of symptomatic COVID-19 cases by day three. And we've submitted, it's still going through the peer review process, so a bit of a work in progress, but we've submitted a manuscript to the journal Plus One, basically to put this research out there in hopes that people can benefit from what we found.

Well, it's amazing. And I congratulate you in the entire data science and research team for moving so quickly on this. I think so much of our founding principles, Emily, and you've been there since virtually day one, first employee, first member of the team officially beyond the founding team. And so much of our DNA revolves around this idea of doing research and being a thought leader in research and physiology. And I think a lot of our DNA revolves around moving at an uncomfortably fast pace. And that combination turns out lends itself really well to fighting and beating COVID-19 because this is a time where everyone needs to be doing research and doing it at a breakneck pace. Let me make sure I've got this right for our audience.

20% of cases, whoops respiratory rate algorithm was able to identify two days, one to two days before symptoms. So these are people who actually don't feel sick and yet their respiratory rate jumps off the page. This is like the Nick Watney example. Yeah. Nick Watney, for those listening, is a professional golfer who was able to withdraw from a PGA tour event because he saw his respiratory rate so elevated.

Even though he didn't feel symptoms, he saw an elevated rate. respiratory rate, it went from 14 to 18, and he realized as a result, maybe he was sick, got tested, positive test, COVID-19, was able to withdraw from the tournament. So that's the Nick Watney example. And then you're saying 80%, the whoop algorithm caught 80% of cases by the third day of symptoms. Now, if someone is listening to this and they're kind of skeptical, why is that a big deal? Why is that good? Well, it's good for a number of reasons. You know, if you look at the data, And when people who have COVID-19 tend to get tested, it's usually closer to a week to 10 days in.

And so this can be an earlier indicator before you might be able to go get tested. Now, as testing is becoming more and more available, I imagine we'll see that people are going to start to get tested earlier. But in regions where they're getting hard hit by COVID and tests are being rationed sort of by the severity of disease, people aren't able to get them just, you know, at the first sign of any, like, little sniffle or anything. And so what we see a lot with COVID is that the first day, oftentimes the symptoms are a little bit nonspecific, you know, it could be nothing. It could be the beginning of getting sick.

And it takes a few days before it sort of gets, you know, really bad where you're like, oh, I should go see a doctor. And so we're typically able to identify COVID in that window. I think one of the other things that, you know, is powerful here is that in addition to catching 80% of cases by day three, we're also specifically like not catching the cases where people think they have COVIDs. They've like COVID-like symptoms, but ultimately go on to test negative. And that was a really interesting data set for us as well, because these people, they had clinical presentations that even their medical doctors thought, like, wow, you should get a COVID test. And so they looked a lot like COVID, and then they didn't get triggered. So in addition to actually, like the positive side of the equation of catching the things that are COVID,

we're also, for the most part with this algorithm, failing to, or correctly failing to flag the people who have COVID-like symptoms that aren't paused by the SARS-CoV-2 virus. And so it's both useful in sort of letting you know earlier than you might otherwise go get tested like, hey, something's really going on here, but also useful on the other side maybe to indicate that this isn't COVID. This is something else. So if someone's listening to this and they're looking at the respiratory rate every day and their respiratory rate has not changed and yet they get a cold or they feel somewhat sick, are the odds based on this data that they do not have COVID-19? Yeah.

I mean, if you think about it, right, like long before COVID-19 was a thing, like we still had flu seasons or we still had colds. And, you know, what we're seeing globally is that the test positive rate for COVID is actually really low. So, like, of all the people who have gotten tested for COVID because they didn't feel well, it's like less than 10% of them have actually had COVID. So there's a lot of things that can cause COVID-19 symptoms. Like, I think one of the things that was so confusing at the beginning of the COVID outbreak, at least here in the U.S., was that we were actually having a really bad flu season even before COVID got added to the mix. Yeah. Lots and lots of people were sort of having these symptoms and they went from being like fairly dismissive of like, oh, whatever, like another seasonal cold, you know, because it's the end of winter, right, like when all these symptoms are super normal to all of a sudden it being this really scary thing because every sniffle was like, oh, no, I have COVID now.

For me, personally, it's been very valuable to look at this statistic every day. I was at the PGA tour event and, you know, you may have been around people who later end up testing positive for COVID-19. You know, now a week removed from that, I'm just looking at my respiratory rate every day and it's not changing. And so it gives me some assurances at least that something's not happening in my body that I can't feel. So much of what we talked about, Emily, in 2012, 2013, 2014 was this idea that there are secrets that you're body is trying to tell you that you can't feel. And if you could measure those secrets, you would have a huge lens into your body. And that's a founding principle for whoop. And what better example than this moment in time in COVID-19 where you could literally be sick with COVID-19 and yet

not feel it, not feel any symptoms. And the next thing you know is you accidentally spread it to someone else. And that person becomes deathly ill because of it. I mean, that is what's so powerful about COVID-19. And anyway, it's why I think this research is important. I think everyone should be doing this research, no matter what kind of a business you run, think about how you can contribute to helping humanity beat COVID-19. Yeah. And I think that, you know, that example you just gave is exactly why I think this research is so interesting, because I really don't see whoop, you know, in this COVID detection paper that we've put out there. You know, we're not trying to replace those PCR tests, like nasal swabs you get done

at the doctor's office. So we're trying to kind of augment in a world where, you know, they're not available everywhere and they're not available to everyone. Like one of my friends, you know, wanted to go away for a July 4th weekend and so wanted to go get tested despite having no symptoms, just, you know, thinking about going out of state. And you went to one of those clinics where they're offering them and it's 200, to get tested.

And so it's like, you know, we could all go whenever we're going to go out in the world or go see a relative and spend $200 a pop to get a PCR test. But, you know, that's not an option that's like really practical for most people. There's no world really where like the entire essential workforce is going to get a PCR test every morning before going into work. Like just the infrastructure doesn't exist for that. And so in a world where like you can't do that, the ability to kind of augment that with this other piece of information that, you know, is going to catch way more cases than just

like temperature checks, which is sort of one of the other things that that people are playing around with as a method of catching these cases. Because by definition, by the time you have a temperature, or by the time your temperature is elevated, you're symptomatic, right? A fever is a symptom. Yeah. Like quite literally, you're symptomatic already. And what we actually know about COVID is that it's most contagious up to two days, zero to two days before symptom onset. So it's actually like immediately before you get symptomatic, you're most likely to spread this. And so checking for fevers, you're already like a little bit too late. So anything that's going to give you any amount of a hint before symptom onset is going to be a value add.

And, you know, we're not a medical device. We don't believe that this is a replacement for PCR tests or, you know, replacement for being smart. You're experiencing symptoms. Whether it's the flu or COVID, you should probably still stay home. Like maybe the response is the same there while you're feeling sick. But I do think that there's a lot of room for wearables and for these other types of approaches to try and catch some of the cases that the infrastructure doesn't exist for like the gold standard to be used in every single person every day. Yeah, it's such a good point.

And especially the one on temperature checks, right? Like if there's anything you might be able to feel, it's a fever, right? Do I necessarily need someone to take my temperature? I've got that obvious of a fever. I'm trying to think of a time where I had a fever of 101, but I couldn't feel it. That's a fairly obvious thing. I think your point on the PCR test is right. You know, it's like obviously you still need to validate that you've got it. And I in general think more testing at cheaper cost is better. So that's critical to be part of the overall solution. And again, to your point, like we aren't claiming to be the overall solution. And that's not what

this research is showing. What this research is showing is that respiratory rate is an incredibly important metric that everyone should be paying attention to. Did I categorize that fairly, Emily? Yeah, I think that's a great way of putting it. It's just another piece of information the same way we're maybe going to check in with ourselves and be like, do I have a cough, do I feel good before I go and help my mom do her grocery shopping or whatever it is that we're doing. It's just another piece of information that you can add into that equation to minimize the risk both to yourself and then of course to everybody around you and that's ultimately how we're going to you know prevent the spread of the pandemic now independent from respiratory rate if you get sick or let's say you have

COVID-19 what are other things that you typically see change on loop so we're seeing of course you know higher resting heart rates lower heart rate variability the reason why we specifically did not include those metrics in this paper and in the analysis for COVID-19 is because those are extremely nonspecific markers. So, you know, my resting heart rate goes up after a really, really hard workout. That doesn't mean I have COVID. It's also going to go up when I have food poisoning or I'm drunk or whatever it is. And so those, they respond exactly the way you would expect them to respond to you to when you're sick, but they're non-specific. And what we see about respiratory rate that's really interesting is it actually tends to be really, really

consistent from night to night and to stay relatively consistent, you know, even like when people have food poisoning, we don't see their respiratory rate skyrocket, but we do see the resting heart rates go up when people, you know, are drunk. You sometimes you see the respiratory rates go up a little bit, but, you know, certainly not like what we see with COVID. And so, you know, it's a more specific indicator that COVID-19 or, you know, likely lower respiratory tract disease is going on. And so that's why, you know, we haven't been talking about resting heart rate and heart rate variability in the context of COVID as much as maybe some people might have expected us to. It's because they do respond.

It's just it's harder to read into that response without the other context. Yeah. I mean, I've gotten data from a lot of WOOP members who have been willing to share it. And it has been interesting to just look at graphs they've sent me. but more often than not, you really do see some profound changes in resting heart rate and heart rate variability, even in the cases that are asymptomatic. Again, going back to this, you know, this idea that you can't feel necessarily what's going on in your body, Nick Watney, professional golfers, super fit person, normally puts strain

of 15 to 18 on his body every day. He's now putting strain of less than six on his body. You would expect when that happens to see things like heart rate variability go up, resting heart rate to go down because your body's getting well rested, it's actually the flip because he's fighting COVID-19. And again, he's been asymptomatic. So anyway, people are interested in and more on that specific example because it was an interesting one. Nick and I did a podcast last week on it. Yeah. And I think to add to your question, another kind of more subtle thing that we're seeing in the WOOP data from people who have COVID-19 is exercise intolerance,

which is sort of the inability to complete the workout that you intended. So for those of you on WOOP, after every workout, we ask you in that little pop-up survey, you know, were you able to complete the workout you intend? And what we see from people immediately before the onset of COVID-19 symptoms is that if they do work out, they're saying no. And so we're seeing them kind of attempt to work out. And so maybe you feel kind of fine, but then when you try and challenge yourself, you just cannot rally those resources and get that work out there.

So that's an interesting symptom too. When I go for runs, I end with an all-out sprint to just ensure that my body because I want to know that my body can sprint and like get, you know, kind of go to that max heart rate. That's probably a little bit more of a silly psychological thing than actually good science. No, it actually is good science. Oh, really? Yeah, because what's happening during,

incubation and the reason why your respiratory rate is elevated even though you feel fine is because our bodies, we basically have excess capacity, like that we don't need at rest. And so we're compensating. And so like while our excess capacity starts to shrink, we don't feel bad yet because we still have all the capacity we need to do what we're trying to do. And then when we try and exercise, especially when we try and exercise hard, that's when we're going and trying to access that excess capacity. And so when it just happens to not be there, you know, you're not going to be able to hit those top speed. So for me, too, it's been like there's a track about a quarter mile from my house, and I've been finishing my runs there and

just trying to, you know, do a quarter mile as fast as I can, like right at the end. And I know that if I can get my speed kind of where I think it should be that I'm probably fine. So it's been it's goofy, but it makes me feel better. I like that. Now, let's say you're listening to this and you look at your respiratory rate and it's gone up. One, what is considered a lot having it go up? And two, what are some things that could make it go up that aren't COVID-19? So a big one's altitude. If you go from sea level to a meaningful altitude, a couple thousand feet,

you're definitely going to see your respiratory rate go up because the air is thinner. And so, like, basically your respiratory rate's going to respond to two things, the environment and the health of your lungs. So you can think about, like, you don't actually need a certain number of breaths. What your body needs is a certain amount of oxygen. And so if the air quality stays constant, then a certain number of breaths equates to, like, a consistent amount of oxygen. But if the air quality goes down, so there's less oxygen. in the air, the air is thinner at higher altitudes, you're going to need to inhale and exhale more air volume in order to get that same amount of oxygen. So when your respiratory rate goes up

due to the altitude change, that's not a bad thing at all. But you will see potentially, you know, depending on how well you respond to that and how much altitude you gained, you could see a pretty significant increase. That's actually not going to look like COVID-19 to our algorithms because when it happens like that, it happens really suddenly, right? You go from sea level to altitude and, you know, from one sleep to the next, you get this big jump. What we're specifically, we're modeling in the paper that we submitted is the subtle increase that we see throughout incubation.

So it's much less about like the total amount of, you know, how many more breaths per minute that your respiratory rate went up. It's less about that, and it's more about the pattern at which it rose. So with Dylan Fertelli, who's another one of the, you know, PGA professional golfers who realized that he had COVID-19 because of his respiratory rate on whoop, it actually didn't even go up that much. It just followed our pattern. But with other people, we've seen it go up, you know, three, four respirations per minute.

So jump from like 13 breaths per minute to 17 breaths per minute over the course of two days. And so that's, you know, that's a huge. percentage-wise increase. But we're seeing different people respond in very different ways. And I think there's some interesting research to be done in terms of like why that might be happening. I know we have one ultra-endurance Ironman athlete on who got COVID and his respiratory rate went up such a teeny tiny amount. And you have to think that like somebody who competes in Ironman probably has such strong lungs to begin with. So maybe there's, you know, some protective things we can all be doing like endurance training right now that'll help us. That's interesting. You don't hear much about people talking

about what are things that you can do to make your body more resilient right now? Yeah. And I mean, if you think about it, like until there's a vaccine, which is still estimated to be, you know, as much as, you know, a year, not two years away, there's going to be some amount of risk. And so, you know, that's plenty of time to make meaningful changes to your endurance capacity. And so I do think there's some really interesting research to be done, you know, can we be training right now, you know, with COVID resilience in mind instead of with, you know, my 5K time in mind or marathon time? Like, what is the proper training we should all be doing right now for COVID? Yeah, I love that. And I think that, you know, we talked in the podcast we did with Dr. Chuck

Seisler about how sleep is actually immunoprotective and that you're less likely for certain strains of the cold and certain strains of the cold that are related to the coronavirus that if you get exposed to them when you're sleep deprived, you're more likely to contract those colds than if you get exposed to them when you're rested. And so it's interesting to start to think about like why are we seeing such different respiratory rate responses and different people? And to what extent does fitness play a role in that? And does that mean that over the next 12 months we can be doing things, you know, with our own fitness and our own training to meaningfully offset some of that risk but I think there's a lot of work to be done there to understand that. Now smokers,

where do they fit into the respiratory rate equation? So it's actually interesting. There's some mixed research coming out of France. So you would think that lower respiratory tract infections would mean that smokers are at a big disadvantage because, you know, they already have some accumulated, you know, damage to their lungs. They're sort of starting behind. But there's a paper that came out of France where they have very high incidence of smoking and it showed that the people who were in the ICU were like disproportionately not smokers and it led them to conclude that potentially smoking was protective. It's a very counterintuitive results. You know, definitely do not recommend smoking to protect yourself from COVID-19. We have seen some of these funky

results sometimes where the way that one thing can mess with a cell can make it harder for the virus to infiltrate. So maybe there's something actually protective going on there. A really interesting example that we've known about for a long time is that people with sickle cell anemia don't get malaria because the malaria virus cannot set up shop. Right. Interesting. So I don't know if like the specific way in which smoking is damaging lungs is doing anything there. But, I think probably we need a little bit more research. I think one thing that's interesting about the academic research environment that we're in right now is that COVID came out of nowhere.

We were super unprepared as like a medical community to respond to it. And so all of this research was coming out really quickly. And I do think we're going to have to have a moment where we like step back, look at everything. And was this like a kind of freak coincidence in this one hospital in France where the smoking data came out of or, you know, is there something actually really interesting going on there that we can learn about? Because if there is some way that, you know, smoking is making these people's lungs less susceptible to contracting COVID, that might be something we can exploit without smoking and take advantage of whatever the actual protective element is and turn that into a

potential treatment. So we've seen things like that in the past too. So I think lots more work to be done there, but some interesting data. I mean, it really just shows how crazy this moment in time. is. I mean, it's either that COVID-19 is just this unprecedented, confusing virus, or it's that research institutions are really struggling to move at the pace that they need to to understand the virus. And I think it's probably both. I think it's both of those things. I think COVID-19 is quite unique and complicated. And I think research institutions have demonstrated some flaws in the rate at which they work. The Lanset, I mean, they had a massive walkback on that hydroxychloroquine study, which we had like, you know, 800 people in a study, and then it turned out all the data

was false, and other governments were making policy decisions based on that study. And it's just, it's like a little spooky that these institutions that you want to rely on, you know, at times are either moving too slowly or their work isn't up to snuff. What do you think? Yeah, I mean, it's a really tough balance to get right because, you know, you want to make sure that you're being incredibly thorough, you know, so that you don't end up this sort of embarrassing and an awkward moment of having to walk things back. But you also want to make sure that because people are dying right now, that you're not holding up good science because you're afraid of making a mistake. So, you know, I do think it's not that surprising that happened. and I think we'll probably see a couple more, like things get out too quickly and get pulled back. And, you know, unfortunately, I think that that's why, you know, trying to focus on

prevention and stopping the spread really is like the most powerful thing we can be doing right now because, you know, we don't actually have an effective treatment right now. There are certain things we can do to manage symptoms and to try and buy people more time. But the people who are recovering, they're just getting better on their own and what the doctors are really effectively doing in a lot of cases is using things like ventilators and different medications to buy you time, but they're not actually like killing the virus or treating the virus directly. And so anything we can do, I mean, staying at home as much as possible, wearing masks when we go outside, you know, anything you can do on the prevention side is just going to be

so valuable right now because we do need to take some of the pressure off of the medical side, you know, where our doctors are, you know, they're so overworked and they're so busy and they just need to get a moment to breathe so that they can kind of put their notes together and, you know, start putting out more papers and sharing their research a little bit more and, you know, have the bandwidth to be digesting all of that so that we can come up with a treatment plan. Yeah, well, I think that's terrific advice. And look, Emily, you should be really proud of this research that we've put out at Woop. And I know I certainly am.

And, you know, it's a little surreal to be able to say that we measure something that can help in this moment in time. So that, but that is the truth. That's how we feel about respiratory rate. That's what the study shows. And I'd encourage people listening to check out the study. You know, read it first hand and get a good understanding for it. Now, you've been working on other studies. So help me understand what is the behavior change study.

Sure. Yeah. So, I mean, we kind of approached all of our COVID research from two pretty different lenses. So the first lens was the one we just talked about. So does respiratory rate help us help keep our users safer by letting them know that, you know, they might be incubating or experiencing COVID-19. The other sort of completely opposite side of our COVID research was we're all in this incredibly unusual period where we're being subjected to these physical distance

mandates that are just absolutely changing our day-to-day lives in the most unprecedented and mind-blowing way, you know, because everybody was subject to physical distancing, saying most people aren't going to get COVID. And so we were really curious what's been going on. And, you know, this was kind of inspired just from some just goofy conversations with our colleagues where it's just like, you know, everybody, you know, because their gyms closed, you weren't getting up early to work out before your work. And, you know, because you had no social life, you were going to bed earlier on the

weekends. And so we wanted to see if these patterns that we were just noticing within ourselves, if they held up on the larger whoop population. And so we started looking at first just at changes in sleep. And we noticed that every that on average, so we looked at, chose a random 50,000 whoop users who had been on whoop since January 1st, which we just chose randomly at the beginning of the year. And we called the period from January 1st through March 9th was our control or baseline period.

And then the week of March 9th was when the World Health Organization declared COVID a pandemic and President Trump declared a state of emergency in the U.S., and that's when a lot of the physical distancing mandates went into effect. And so then the period from March 9th through May 15th, when we did the analysis, was our sort of physical distancing data period. And we noticed that people started immediately. It's like they fall off this cliff. So you see like really, really consistent across the first nine weeks of the year.

Everybody's going to bed at roughly a constant time every night. And then all of a sudden they start going to bed, quite a bit earlier. But what was interesting is that they weren't, they didn't change their wake-up time, just their bedtime to be earlier. And so everybody was getting a lot more sleep. We also noticed, and this was one of the things that Woop has been coaching our members to do for years now, is to have good sleep consistency. So to maintain a consistent bedtime and wake time. And because of the removal of all of the social activities that had been available to us people's weekend bedtimes and weekday bedtimes became a lot more consistent. And so overall

sleep consistency improved a ton. And one of the things that made some of these changes in sleep really interesting to us and became an inspiration for putting this out as a paper was that we saw that people's resting heart rates went down and heart rate variability went up over this period, which was something that we had seen if you separated users who have higher sleep consistency from users who had lower sleep consistency, that the higher sleep consistency ones tend to have higher heart rate variables and lower resting heart rates than like age-matched controls in the other group. But COVID-19 created these natural experimental conditions because it got 50,000 people to all of a sudden shift their behaviors. And so we were able to see

not just cohort one versus cohort two, but when people go from being in one cohort to being in the other cohort, so they're their own controls, which makes it statistically just a better study, that we're also seeing these improvements in these cardiovascular health metrics. And so what was really interesting about this study, almost having nothing to do with COVID, just a study that happened to be enabled by COVID,

is that we were able to show that these relatively small changes in sleep patterns can have meaningful effects in cardiovascular health metrics. And so, you know, for people who are wondering, you know, should I make this change and is it worth this effort, you know, to be able to quantify this across 50,000 people. And we saw it. We looked at, you know, male and female loop members. And also we broke everybody into age brackets by decade, 20s, 30s, 40s, all the way up to 80. and we saw this pattern in every demographic split that we looked at, that when they made these changes

and they all did it, every demographic group, that there was a cardiovascular improvement. This is the first paper ever to demonstrate the cardiovascular improvements associated with such small behavior changes. It's so interesting, isn't it? I mean, I love the way you put it. The COVID-19s created this perfect experiment, if you will, and like removing commuting. What does that do to your body? Now, what about the stress factor? Because it makes sense to me that people would be getting more sleep. Have we seen that there's been any offset against that additional sleep with, say, stress? You know, people are obviously nervous about the fact that we're in a global pandemic.

So in this study in particular, we did not attempt to control for stress. We do anticipate that stress levels overall went up. It appears that, you know, to whatever extent, stress would have decreased sleep quality. Things like removing commutes and having more time in bed were in aggregate, maybe net better. One of the things that I'm really excited about with the COVID resilience project where we recently wrapped up data collection are going to start analyzing that data. in the coming days and weeks, but that we were able to look there specifically at things like stress and changes in mental health and to segment that data based on how COVID-19 actually impacted you. So here, everybody sort of lumped together with their age and gender demographic.

But with the COVID resilience project data, we're looking specifically at, you know, where were you? How close to COVID were you, you know, were you in a city that had a particularly bad outbreak versus a city that was less impacted. Did you know anybody who had COVID and trying to specifically capture how stress might play into some of these things? So you can almost think of this as like a pilot study leading into some of the more in-depth analysis where we'll start to break down some of those other factors that are definitely at play.

And I think really interesting to look into with the resilience project where we just collected a lot more of that situational data and demographic. data and I'm really excited to share that research down the road. Yeah, we've had an amazing number of responses to that. And if you're interested in that for people listening, you can check out the podcast that Emily did with Dr. Chuck Seisler on the COVID Resilience Project. Emily, what else? Where do we go from here? All of this research is the first batch of data that's come in. And I think it's going to be interesting, you know, on the COVID side, you, as we get more data to explore with a larger data set, what are some of the nuances,

why are we missing some of those cases? Can we catch more cases potentially before symptom onset? What does that look like? One population we haven't yet had access to, but would be interesting to study is people who have these completely asymptomatic cases. And also, I think, to look at COVID-19 can phenotypically have very different disease expressions. So some people they're saying, especially younger people, they're just having strokes and dying from COVID, no respiratory symptoms at all. And, you know, with kids, we're seeing these, like, weird rashes coming out of nowhere and then multisystem organ failure. And it's not starting with the same. Like, with adults, you tend to see this pulmonary first presentation, and that's not always the case.

And so I think, you know, trying to understand some of these other cases, like we were talking about earlier, too, I think, you know, trying to understand what we can be doing, you know, in the next 12, 18 months before there's a vaccine that might be immunoprotective. So obviously sleep, you know, I think we already know that that's going to be immunoprotective. But is there a good workout routine that people who are doing this are less likely to get infected? I think that would be fascinating if we could study that. And then I think, you know, on the, you know, just trying to understand how this moment in time has impacted people and, you know, all the work that we're doing with the resilience project to try and, you know,

really understand what needs people are going to have, you know, as the world returns to this quote unquote normal. Because, you know, I think the reality is, is that whether or not we get sick, we're all impacted from having lived through this. And so understanding that impact and understanding, like, what we're going to need differently and how our physiology has responded to this multi-month stressful event is going to be really important to the societal recovery. not just an individual recovering from the illness. So I think lots and lots of work to be done there, and I'm just really excited to be able to be a part of that

and to be able to contribute to the understanding of what's going on and hopefully help somebody. Well, look, I think a lot of the research you've been doing is phenomenal, and I know our members and our listeners are deeply appreciative. So we are going to continue to invest in this. We think it's really important. We think everyone, again, should come together to beat this virus. And Emily, thank you for spending time with us today.

Thank you, Al. If you do not have a WOOP membership, a reminder you can get 15% off using the code Will Ahmed, W-I-L-L-L-A-H-M-E-D, and if you're a W-WP wearer or a W-W-P podcast listener, and you're interested in joining the WOOP team. We are growing rapidly, and we're hiring talented people in particular for our members. membership services organization. That's right. That's the important group of representatives that work directly with our members. They work directly with our customers. They work directly with our professional athletes. We're growing fast and we need talented people to help us boost membership services. We ultimately want this to be something that people find is world class about the whoop experience. And we need really great people to do that. Check out whoop.com

careers and keep in mind it's a remote job these are remote jobs you do not need to be located in boston where our headquarters is located if you are great but we are looking really for anyone across the united states talented membership services that's all for now thank you everyone for listening stay healthy stay green and keep your respiratory rate flat Thank you. You know,