How India’s Healthcare Startups Have Innovated During Covid-19
(Photographer: Samyukta Lakshmi/Bloomberg)

How India’s Healthcare Startups Have Innovated During Covid-19

The sudden lockdown imposed in the wake of the Covid-19 posed both a challenge and opportunity for India’s healthcare startups. Restricted access to diagnostic centres meant more patients embraced online consults and solutions. But limited imports meant broken supply chains that led to prices of raw materials in the domestic market to skyrocket.

BloombergQuint spoke with three healthcare startups to better understand how they made the most of the opportunities, while dealing with the lockdown challenges.

More Users, Scaling Up

People with pre-existing medical conditions like diabetes appear to be more vulnerable to becoming severely ill with the Covid-19 virus. When they develop a viral infection, it can be harder to treat due to fluctuations in blood glucose levels and, possibly, the presence of diabetes complications, according to the International Diabetes Federation.

What’s made matter worse is disruption in health services for non-communicable diseases. A recent survey of 155 countries by the World Health Organization revealed that Covid-19 significantly impacted health services for non-communicable diseases. In 49% of the countries surveyed, treatment for diabetes and diabetes-related complications was disrupted.

That’s why five-year-old BeatO—a platform for diabetic patients to monitor their blood-glucose levels—saw engagement level increase by as much as 30-40%, said founder Gautam Chopra. Due to the Covid-19, growth for the company has come “much sooner and faster”, he said.

But the stress of the lockdown, limited access to diagnostics, more patients going out of normal range also meant scaling up.

First four weeks into the lockdown, Chopra said, 10% of users—who otherwise had perfect glycemic control—went out of range by 30-40%, which was very abnormal.

People could not go to doctors and specialists. Medicine supplies, sugar test strips were difficult to obtain. During the last couple of weeks, we developed a Virtual Endocrine Clinic platform assisting doctors—GPs, diabetologist, endocrinologist — to video/tele call patients on BeatO App. We also doubled down on interventions through our Intelligent Nudging System to educate users on lifestyle changes, diet, etc. based on the data they were inputting.
Gautam Chopra, Co-founder, BeatO

But any technology, more so in the healthcare space, has to deal with trust issues. BeatO is experiencing it as well. For instance, one of the users in a review on AppStore says: “For a non-diabetic, the app is showing a fasting sugar value as 150 mg/dL whereas the clinical reading is only 85 mg/dL.”

At a time when users can’t access diagnostic centres and are only relying on the application to measure blood sugar levels, aren’t such inconsistencies worrisome?

Chopra says while the constant aim is to make the data more accurate, users should treat platforms like his as pre-boards.

All of us have given board exams and your HbA1c test—which one would get after three months or six months—is like a board exam. So, it is fair to say that if your pre-boards are not moving in the right direction, unfortunately it’ll be difficult to score well in your board exams as well.
Gautam Chopra, Co-founder, BeatO

There is a level of awareness and education that an individual needs because this is self-monitoring, he said. “You can’t compare the readings that come out of a monitor to a venous blood sample taken and diagnosed by a lab- typically, there is a variance of around +/-15 percent compared to a lab reading,” Chopra said.

Safer Transportation, Pricey Raw Materials

Incubated by Society for Innovation and Development, Indian Institute of Science in 2016, Azooka Life Sciences is trying to solve two problems—manufacturing RT-PCR test kits and providing hospitals and diagnostic centres with a safe medium to transport Covid-19 samples.

RT-PCR has been recognised by the Health Ministry as the ‘gold standard’ frontline test for Covid-19. India imports most of these kits from companies like Thermo Fisher Scientific, Altona, etc., said co-founder Alex Paul. With imports becoming limited, expensive and demand for test kits increasing exponentially, the company decided to manufacture RT-PCR kits and its proposal is pending approval from the Indian Council For Medical Research.

“Our dye—Tinto Rung—that goes into making these kits is far safer to use and dispose of compared to imported kits,” Paul claimed. What makes it so, he said, is the company’s patented first-ever food-grade nucleic acid gel stain—an important component that goes into making testing kits.

The market leader is actually SYBR which is carcinogenic and mutagenic. This means there are a lot of problems in not only in using it, but in storing, and transporting it. To give you a simple example, transporting a toxic substance is 50 times more expensive compared to a food-based substance likes ours. Since the imported nucleic stains are biohazardous, their disposal adversely affects the environment as well.
Alex Paul, Co-Founder & CEO, Azooka Life Sciences

The aim is to provide a safe nucleic acid stain in India to be used for Covid test kits—this will have a direct impact on the cost of molecular diagnostics by eliminating import duties, handling and disposal costs, Paul said.

BloombergQuint found that the safety data sheet for SYBR does acknowledge carcinogenicity to be conclusive but not sufficient for classification. For mutagenicity, or ability to cause mutations, it says the available information is not adequate for making a satisfactory assessment.

N Raghuram, former vice-president of the Society for Scientific Values, explained that the volume of these dyes used in RT-PCR kits is very small. “But when you’re doing these tests in lakhs and crores, all these drops add up to generate a significant amount of waste, which needs responsible disposal,” Raghuram said.

Paul said making an efficient RT-PCR kit was an easier challenge for Azooka Lifesciences since the base component was already in place. The bigger issue was to cater to the need for safe storage and transportation of Covid-19 samples.

Once a hospital collects a sample, it needs to be stored and transported in a medium to the testing centre. The composition of this medium, according to Paul, requires it to be stored and transported at 4 degrees Celsius. “We’ve come up with a medium that will work at room temperature,” Paul claimed.

The aqueous solution is called RNAWrapr. So far, it’s been supplied to Sri Shankara Cancer Hospital in Bengaluru which is a collection center. Hospitals like it as samples can be stored and moved at room temperature because cold storage is expensive, he said.

“We’re also in the process of offering a medium that will deactivate the virus while keeping the RNA intact for RT-PCR processing,” Paul said. “If the bottle breaks or is poorly handled, the virus can spread. The new viral transport medium is in the works.”

But one problem Indian companies are facing is increasing raw material costs.

For instance, a throat or nasal swab used to cost Rs 1-2 but now it’s selling anywhere between Rs 25 and 35. Similarly, Ethidium Bromide—a base chemical used in nucleic acid based diagnostics—is selling for three times the pre-Covid price, Paul said, adding that the government needs to reconsider GST levy on these raw materials.

There is a huge goods and services tax component that we pay on all this. If there is a policy level change, we can pass on the value to the hospital or the distributor and that in turn can go to the consumer.
Alex Paul, Co-founder & CEO, Azooka Life Sciences

While there will be input tax credit available, it’ll be some time before these refunds come, but in the meantime “companies like mine are grappling with cash flow issues,” he said.

More Attention, No Institutional Mechanism

For every million people in India, there are just three psychiatrists, and even fewer psychologists, according to a 2015 WHO report. Mental health professionals discontinuing appointments during the lockdown compounded the problem for patients. Add to that the stress and anxiety from job losses, loan defaults, and the general uncertainty.

Covid 19 has exacerbated the environment for mental health patients who were underserved to begin with, Ashwin Naik, founder of Manah Wellness, said. But the lockdown has brought these issues front and centre and people are paying more attention to them, he said.

Naik’s company has tied up with several NGOs to provide a mental health helpline—called ‘Let’s Talk’.

Various agencies have seen that there is a 20-30% increase in the number of calls and cases that have come to them. One of the big challenges we foresee is that this will not end with the lockdown—the impact of this will stick for months and years.
Ashwin Naik, Founder, Manah Wellness

The maximum number of calls, he said, has come from two categories: small business owners and adolescents/young people, particularly those who are entering the job market for the first time.

For the first set, the financial uncertainty is very stressful. And for fresh graduates, the fact that they were looking forward to joining new jobs and those opportunities have been put on hold, will have a “tremendous adverse impact on their mental health and overall worldview,” Naik said.

Efforts of companies like Naik’s was also aided by the government amending the regulations to allow for teleconsultation and e-prescription, which is particularly important for mental health patients. Benzodiazepines, used to treat anxiety, depression, is hard to obtain without a prescription.

Besides making doctors available for consultation, Naik said, “All we can do is create a mechanism for people to call up, share their anxieties, and provide someone to reassure them.” Some of the coping mechanisms that doctors on his platform have advised are building a routine and use traditional methods like meditation, mindfulness.

But what the mental health fraternity needs is an institutional framework. A law for which already exists in the Mental Healthcare Act, 2017 but implementation is missing. The law gives rights like access to affordable, free treatment to mental health patients who are below the poverty line, and provides for an oversight body in Central and State Mental Health Authority.

There’s no better time to focus on implementing this law, especially since we haven’t even seen the full-blown effects of reverse migration play out, Naik said. “There will be a lot of mental distress in far-flung areas.”

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