#StartupsVsCovid19: How Healthtech Startups Are Fixing India’s Healthcare System

Unlike last year when the Covid-19 pandemic first struck, the year 2021 is more tragic as the situation is rapidly worsening in spite of a pool of vaccinations being developed all over the world in the shortest period.

India is no exception, either, but here is the catch. As a healthtech startup founder puts it, “India is not suffering from Covid-19 as the recovery rate of 98.8% (counted against the death rate) is among the highest in the world. However, the country is suffering from a lack of healthcare infrastructure, short-sighted or unplanned and reckless moves taken by the central government and authorities like the Election Commission and others. Most of the deaths have occurred due to the lack of adequate facilities, including hospital beds, oxygen cylinders and ventilators, among others.”

“If there is a shortage of (oxygen) cylinders, the government’s job is to address the shortage and not create a commission to decide who gets how much oxygen,” the founder adds.

Last week, Inc42 covered the state of testing infrastructure in India, detailing how startups are bridging the huge demand-supply gap. In this article, we will zoom in on tracing and tracking the Covid-19 spread and monitoring of Covid-19 patients through various predictive care mechanisms. Let us take a deep dive into how startups have come up with an alternative system that is boosting the Covid care infrastructure in India.

Forget Tracing And Tracking; Monitoring Is The Key Now

In 2020, the standard operating procedure was tracing and tracking the spread of Covid-19 with the help of the Aarogya Setu app and other systems. All these mechanisms helped identify active and potential cases and people who came in contact with them so that the latter could also be quarantined to stop the spread and break the chain of transmission.

But in 2021, India is trapped in a vicious circle of ineffectiveness and failures. Earlier in the Covid cycle, the country failed to take adequate measures in terms of tracing, tracking and isolation. Now that the numbers have surged, contact tracing has become a complicated, time-consuming and less essential Covid protocol. Cases have increased to such an extent that every third person tested is found Covid positive, while the caseload has gone up by 50% in cities like Kolkata and Delhi where the positivity rate currently stands at more than 35%. Simply put, tracing and tracking are no longer implementable or getting implemented.

Speaking about the tracing and tracking status in India, a startup founder who came up with a blockchain-based solution last year says, “There are many reasons behind the failure. Among them, the most prominent one is the government sponsoring an unknown app. Dozens of startups came up with different tracing solutions. In an ideal situation, all these solutions should have been promoted. Better still, these apps could have interacted with each other and incorporated the masked data without compromising on security. Plus, this would have allowed the apps to compete with each other and evolve into better tech tools. Instead, the Indian government chose just one app to carry out nationwide operations. As a result, there was no space for others.”

Last year, blockchain startups like QuillHash Technologies, Aiisma and Accubits Technologies, drone startups like DeTect Technologies, and other tech startups like TagBox, Hipla, Staqu and many more developed a slew of Covid-related solutions to track patients and trace their contacts. Founders of startups like Bounce, Vokal and Urban Company collaborated to create Quarantine app (Q-app). However, between March 2020 and April 2021, India has gone full circle, moving from one lockdown to another. So, the priorities of these startups have changed. “We need to look at what is happening right now as the numbers are huge,” says Vaibhav Tewari, cofounder and COO of Bengaluru-based healthtech startup Portea Medical.

As of now, the key issue involves monitoring Covid patients and providing home care to meet all their medical needs. This will reduce the burden on hospitals and break the transmission chain.

Covid Tracking And Monitoring Mechanisms

Bengaluru-based Dozee has developed a contactless health monitoring system that helps doctors, patients and hospitals maintain the social distancing protocol without impacting the quality of treatment. According to cofounder and CEO Mudit Dandwate, “With the shortage of ICUs plaguing most states, Dozee is turning normal beds at home into step-down and makeshift ICU beds, thus helping several state governments and private hospitals. Using our contactless and remote monitoring model, hospitals and doctors have been able to automate the entire monitoring of vital signs.”

It also claims to have set up patient monitoring cells within hospitals to ensure 24×7 on-ground support and alert escalations. The cell helps keep track of all patients and alerts doctors and nurses on any escalation. As hospitals are overwhelmed by rising cases and hospital admissions are limited due to shortage of beds and other essential medical infrastructure, Dozee has stationed a dedicated resource at these centres to help doctors prioritise alerts and monitor critical patients. This is helping doctors with the required data on each patient’s vital signs at the right time and enabling them to take necessary action.

Its system helps identify the critical stage well in advance, claims the company. Here is how it helps traditional medical facilities:

• Early identification of warning signs in 30-40% of Covid-19 patients who are then promptly treated in high dependency units (HDUs) without needing to shift them to ICUs.
• About 10-15% of Covid-19 patients move to the critical stage and must be shifted to ICUs for further treatment. Patients requiring intensive care are also detected early and it is possible to move them to ICUs/HDUs faster than expected.
• Doctors and nurses have become more productive as they do not have to manually monitor the vital signs of each patient in each ward 24×7.

Dozee is currently used by 4,500+ people at home to constantly monitor themselves or their loved ones. “Our AI-powered early prediction algorithms have saved lives in 70+ cases, predicting early cases of heart failure, TB, pneumonia and more. We are also working with 55+ hospitals in 15 cities and powering 3,000+ Covid-19 beds in step-down ICUs with our technology. So far, we have monitored 7,000+ Covid-19 patients in hospitals. Due to the rise in demand, the company has surpassed the last financial year’s sales in just one quarter this year,” says Dandwate.

Most of the sales are happening in Bengaluru and Nagpur. Government hospitals in Bengaluru, like Victoria Hospital and ESIC Hospital, are already using 100 Dozee devices to equip the facilities with remote monitoring capabilities. Similarly, Kingsway Hospital, Government Medical College and Indira Gandhi Government Medical College and Hospital in Nagpur are using 300 devices to monitor patients constantly without any physical contact from medical practitioners.

Healthtech startup MFine has recently launched MFine Pulse, an app-based SPO2 monitoring tool that enables users to track their blood oxygen levels using just a smartphone. During its beta rollout, thousands of people used the tool and hundreds of readings are now recorded every day.

So, how does MFine Pulse work? The company has built a proprietary algorithm that measures oxygen saturation in a hassle-free manner. To do so, a photoplethysmogram (PPG) signal is obtained from the user’s fingertip using the smartphone camera (and its flash). The PPG is used to detect blood volume changes in the microvascular bed of tissue. In this case, the LED (camera flash) illuminates the skin, and the smartphone camera measures the changes in light absorption.

The signal is then broken down into red, blue and green parts, and using the difference in light absorption levels across these wavelengths, SPO2 is calculated by a machine-learning algorithm. Currently, the MFine Pulse SPO2 measuring tool features 80% medical-grade accuracy. The tool is in public beta for Android users and will soon be launched for iOS users. The company is now preparing to get algorithm certification as hundreds of SPO2 readings have provided medical-grade accuracy and reliability to the algorithm.

Home Care Solutions For Covid

In the previous article of this series, we saw several startups such as 1mg, PharmEasy, MFine, Practo, Healthians and Portea offering at-home Covid-19 sample collection services in selected cities. These mostly include antibody, antigen and RT-PCR tests. Besides, many startups are also offering comprehensive home-care solutions for Covid patients.

Portea’s Tewari points out that more than 90% of the patients need not visit hospitals. “Anybody who is mildly symptomatic or asymptomatic can be treated through our home isolation programme that includes nursing and attendant services based on the plan chosen by a patient. We have worked with governments, and we are now working with lots of individuals and hospitals and companies. In fact, businesses are supporting their employees in a big way if they are put in home isolation.”

As part of its Covid care services, Portea also extends Oxygen support and supplies cylinders and concentrators for patients who are recommended to have oxygen.  Portea has so far served 400,000 Covid patients and provided home nursing to 10,000 people.

Besides Portea, Navia, MFine and several other startups are offering similar suites of services.

MFine has recently launched its Covid-19 Homecare Plan and users get the following benefits:

• Unlimited consultations with (Covid-19) physicians, pulmonologists and dietitians
• 15-day care plan for infection consultation and recovery tracking
• Follow-up with Covid specialists on symptom progression
• Covers up to four members of the family for extended care

Delhi-NCR-based Navia Life Care offers video consultation, and the service is currently used by thousands of doctors across the country. The company has curated a panel of Covid-19 specialists for patients trying to find specialist doctors for treatment.

Gaurav Gupta, cofounder of Navia Life Care, says, “We have seen an 80% week-on-week growth since the second surge, about 5x growth in the number of daily video consultations on the platform. We now have more than 8,000 doctors on the platform using it for healthcare delivery services.”

Constant Covid Monitoring At Workplaces

Apart from Covid-19 patients, essential workers and others still operating from their respective workplaces also need constant monitoring. That is why Hyderabad-based BlueSemi has developed an AIoT-powered (artificial intelligence of things) thermal scanner that records each employee’s temperature and also keeps a track of the person’s health statistics. This will help track the medical condition of employees/visitors based on their symptoms. Micro-lockdowns can also be implemented after analysing data/records from the sensors, says Sunil Kumar Maddikatla, CEO of BlueSemi.

“We have SENS —  a contactless and wireless thermal scanner — installed at 250+ locations and we have scanned 2 Cr people for safety. With SENS, both in India and abroad, we are getting 70,000+ scans a day,” says Maddikatla.

BlueSemi is backed by companies like Google, Samsung Ventures and Microsoft.

US and Bengaluru-based startup HealthCube, a point-of-care diagnostics solution provider, has come up with an offering called COVIDSAFE. It is a holistic Covid-19 risk management solution that can help workplaces, healthcare providers and governments prevent transmission through regular and repeated screening. It can assess the severity of infection and thus identify individuals who may need early hospitalisation and also prioritises them for RT-PCR tests. It is a diagnostic solution that allows for common tests such as D-dimer, CRP (C-Reactive Protein blood level) and antibody tests.

HealthCube’s primary product is a portable diagnosis system, similar to a set-top box, that can be easily used anywhere and by anyone with minimal training. “The system is a combination of smart diagnostics and artificial intelligence to facilitate rapid screening of patients. HealthCube provides results in 1-15 minutes for 30+ tests,” says Dr Runam Mehta, the company’s chief growth officer.

More Solutions For Covid Relief 

As India’s healthcare needs are escalating and getting more complicated at multiple levels, startups are working on several products that are currently under clinical trials or in the development phase.

For instance, Hyderabad-based Docturnal has come up with CoVawe, a screening tool for Covid-19 that emits the sound of a cough. “We are actively involved in Covid-19 clinical trial for which we obtained an ethics committee clearance only last week. This will help us focus on home-based screening subject to validation numbers,” founder and CEO Rahul Pathri tells Inc42.

BlueSemi is also planning to launch a major healthtech product that will be under clinical trials for the next two months. The company has not provided any information regarding the same, but it will be a pocket-friendly product, says CEO Maddikatla.

Nocca Robotics, a Pune-based company that launched ICU-grade ventilators earlier last year, has also introduced a high flow oxygen therapy (HFOT) device. This non-invasive oxygen support unit can be used on patients who do not need a full-fledged ventilator.

While startups like Dozee and MFine are currently working on expanding their existing suite of Covid products and services, Portea’s Tewari tells Inc42 that the company plans to launch a vaccination drive in the first week of May.

Dozee sold 3,000 devices last year when the pandemic first hit India. But with the second surge overwhelming the country, it has already sold as many devices in the past two weeks and doubled down on production.

“We have learnt from the challenges we faced last time and upgraded our product and operations. Currently, there aren’t many low-cost, easy-to-deploy solutions that will help hospitals monitor their patients in wards. Even today, nurses manually visit patients every couple of hours to check their vital signs. Without constant monitoring, any deterioration in a patient’s health can go unnoticed and lead to complications. Although RPM (Remote Patient Monitoring) has been in use in other countries, it is still at a nascent stage in India,” says Dozee’s Dandwate.

Mounting Challenges Require Desperate Measures

Experts think India should have been better prepared to contain the second surge of the pandemic, given the 2020 scenario. Instead, the country seems to have let down its guard too early, ignoring that there could be consecutive waves as witnessed in other countries like the UK, Belgium, and Germany. Pointing out that it is the right opportunity to fix India’s crippled healthcare system, Maddikatla of BlueSemi says that governments, private organisations and individuals must adopt a secure way to monitor and track health status. There must be proactive actions like door-to-door testing in place and adequate measures to react to emergency situations we are facing right now.

Portea’s Tewari and MFine CEO Prasad Kompalli see home care as an alternative to reduce the rush of patients to overburdened hospitals. “The load on hospitals and doctors and labs is huge, and telemedicine and vital sign monitoring can make the job easier and more efficient for healthcare providers. Moreover, non-Covid patients need to be taken care of as well. So, the digital means of reaching out and ensuring care continuity will be super important, without necessarily requiring them to come to hospitals,” says Kompalli.

Tewari brings the attention back to basics. “One of the biggest reasons behind the rise of the second wave is that people got relaxed. Knowing that vaccines would be available, people stopped wearing masks and did not maintain social distancing at all.”

In such a scenario, is it fair to say that those who will wear the mask and maintain social distancing will live?

“Perhaps,” concur most of the founders.