This week Fred and I discuss the anecdotal reports on infection rate differences between shifts taking place at different times. There has been some data that demonstrates a higher incidence in two otherwise identical cohorts of individuals undergoing training. The daytime group operating during daylight hours has a much lower rate of COVID19 infection based on the testing that takes place daily than the group that trains during the night time hours
We discuss potential causes including
🛏The impact of sleep on the immune system
🌒Possible selection bias based on those in the night shift
🛒Different activities and exposure outside the training time
The data is intriguing and warrants a more detailed look to see if there are any patterns to discern that night suggest causative effects
Raw Transcript
Nick van Terheyden
Hi, this is Dr. Nick, I’m the incrementalist here with incremental insights for better business better health.
Fred Goldstein
And I’m Fred Goldstein with Accountable Health here helping employers payers and healthcare systems work on their population health improvement programs. Now, Nick, we’ve been discussing some interesting stuff over the years now that we’ve been doing this. And something that sort of you brought up a little earlier that we discussed was this issue of workforce, and training programs and differences in COVID. Rates, it seemed fascinating, I think it’d be a great discussion. So what is it?
Nick van Terheyden
Yeah, so lots of organizations going through the challenge of remote working. And you know, there are some places where you can’t have remote working, you can’t do training, as an example, in a remote circumstance, different places where that would occur. And to try and maximize limited capabilities. And you know, some of this is about the trainers and available trainers in the space and so forth. What some organizations are doing is doubling up. So by that, I mean, they’re putting in shifts the training. So you train the same thing, in cohorts, and you have a cohort in the morning, and you have a cohort at nighttime. And in fact, if you really pushed it, you could probably have three cohorts and do three, but, you know, they’re doing just two. And he was the data point. And, you know, this is a little bit anecdotal, but I thought it was really intriguing. They were seeing, so they’re testing, they’re doing all the right things, and, you know, trying to make this as safe as possible, and a test on a regular basis. And the two cohorts, as best as you can determine are the same, there’s no sort of separation, you know, or picking as a result. And the cohort that trains at nighttime has seen a huge, higher incidence of COVID occurring upon testing of the individual. So those tests that those individuals that test positive are taken out of the training program get isolated, and then they get reinserted into another cohort at some point later. And the question arises, why would that be the case? Everything else is the same, they’re going in the same equipment, the same place? Train, it must be a different set of trainers, because they obviously aren’t working 24 hours a day? Why would that be the case?
Fred Goldstein
So I’m gonna throw that right back at you, Nick, what? With your medical expertise, etc? Why might that be different with nighttime training versus day?
Nick van Terheyden
So I know we’re going to talk about this. But the the first thought that comes to mind as I think about this is, we know that your immunity decreases at nighttime, one of the important elements that we have from a wellness and health and it’s the one that I’ve talked about, had a whole company that was set up around his sleep. And if you don’t get sleep, or you’re chronically tired, and and for the most part, people that work nights tend to be chronically tired, because they’re not getting the best sleep, everything is noisy, it’s light, and so forth. So the first thing that occurs to me is, is it because that group has a poor immune response to the same challenge of exposure to essentially roughly the same experience with COVID?
Fred Goldstein
And let me ask you this, too. So obviously, as you said, those people who work nighttimes have a have lower immunity, is that also potentially due to the circadian rhythm stuff? Is that sort of what it ties into?
Nick van Terheyden
Well, I think we’re still learning this. I mean, you know, we, we treated all of these things as it just happens, and we didn’t really track it. But I think there’s a couple of things. So there is some circadian rhythm that may contribute to it. But also sleep sleep is a revitalization and, and it might seem, you know, a little bit surreal to sort of talk about the cells needing rest, but that’s the only sort of conceptual framework that I have for this, your immune system needs a rest. And you know, it gets that at nighttime if it’s not getting it because you’re not getting the power of sleep. And to be clear, if anybody asks, we don’t really know what sleep does, we just know that it’s essential for life, but almost every organism on the planet, but it’s sort of it’s like charging a battery and it charges the immune system.
Fred Goldstein
Interesting. And I understand also, as we discussed this, that the individuals themselves selected which group they wanted to be in, so some people might be more night people or not. And do you think there’s anything potentially associated with the selection of that that might also lead to some of this maybe some different behaviors based on which people like to stay up late at night versus those that like to work during the day? err,
Nick van Terheyden
yeah. So that’s much harder to tease out, in part, because I’m not a night owl, I’m certainly an early riser. So I don’t have a good understanding of those individuals, is there something about their behavior, or their lifestyle that makes them less healthy? I don’t know if that’s the case, but maybe that’s the case. Maybe it’s associated with food, for example, because you’re in the nighttime cohort, you’re not getting good sustenance, because you don’t feel hungry. That’s not sort of the norm, even though you’re in that fixed period. And, you know, it’s training for six days, as I understand, and then one day off on Sunday for both groups. I don’t know, you know, perhaps that’s contributing in some way. Yeah. And I
Fred Goldstein
wonder also, if you might see some sort of a difference in activities. So when somebody shops, or something might also be an impact, or just things like that, that might also cause some of these potential exposures to be higher based in one group than another. Because of the time of day they’re doing something, or things like that. It’s really a fascinating problem, you could dig into this one really deep, but it’d be interesting to understand it. And then also interesting, Nick, to kind of think about, what would you recommend doing to try to alleviate that?
Nick van Terheyden
Yeah, so I’m sure I’m sure the groups that are doing this are obviously focusing on that, because if they’re seeing this big discrepancy, they’re wondering, you know, and you would look at the data and say, at what point is it occurring? Is there a some sort of spike at a particular time? I don’t have access to the data? I would love to do so. But you know, that’s the first thing I do to see if there’s any patterns that are discernible. And are the spikes the same across the two groups? Look at the behaviors. Is there something about the transportation? Is there something about maybe the air handling is turned off at nighttime?
Fred Goldstein
Great point. That’s possible.
Nick van Terheyden
Haven’t we heard and seen that covering and one of our 96 episodes?
Fred Goldstein
Absolutely. Yeah. It’s really a fascinating problem, it’d be, it’d really be interesting, because it’s something you could take and begin to dig into other industries and apply across a lot of spaces. Once you begin to understand better, what were the specific things that might have caused that to happen?
Nick van Terheyden
Right. And it’s not just training to be clear. I mean, think about this, any shift work? I, as I heard this, I’m thinking, Wait a second, does this happen in hospitals? Has anybody looked at the circadian rhythm of COVID incidents of shift workers, you know, so you have night shift workers, nurses and so forth? Have we seen a higher incidence in them of, you know, suffering from COVID? Or diseases? I don’t know.
Fred Goldstein
It’s really a fascinating question. And that you could then tease out as you said, and get a better feel for what do we need to do to solve that? I don’t know that anyone’s looked at it, but it’ll be interesting to do some research on and see if we can find any articles. So once again, Nick, another fantastic week discussing COVID This is Fred Goldstein with Accountable Health. If you’d like some more information, please go to Accountable Health. llc.com
Nick van Terheyden
and this is Dr. Nick, I’m the incrementalist here with incremental insights for better business, better health.
