Approaching Omicron with cautious optimism

Even if Omicron does emerge as the final variant of Covid-19, it is unlikely that it would mean endgame for the virus entirely. Rather, it will remain present in society at an endemic level.

The strongest steel is forged by the fires of hell. The Indian healthcare industry too went through the corridors of hell as the pandemic posed newer and newer challenges as it progressed. As the Omicron variant now blazes through India, the country seems to be experiencing a third wave of Covid infections, albeit the overall impact is expected to be less disruptive than previous waves.

Having said that, there are rising concerns about vaccine inequality and its role in the threat of new variants evolving down the line in different parts of the world.

Will this wave be milder and shorter, and will the Indian economy continue to show the growth momentum it has shown over the past few months? Will the various players in the Indian healthcare space bounce back stronger than before? And will Omicron be a true test of their progress? These are some of the questions that are plaguing the powers that be.

There is no denying that crisis gives birth to innovation. The battle against Covid-19 has led to new weapons to fight the virus with. Let us take a look at some of the most exciting trends that are now shaping the healthcare market.

The immunology sector has witnessed a string boost, with rapid and lateral-flow testing to molecular assays. The most popular is the RT-PCR and other nucleic acid amplification tests. With the surge in demand for testing, either for diagnosis, screening, or public health surveillance, it is imperative to have affordable, accessible, and easy-to-use testing methods.

The diagnostics industry stepped up with home-grown testing kits to meet this need. During the height of the Covid-19 pandemic, University Hospitals Harrington Discovery Institute put out a call to scientists around the world – Send us your ideas to battle the coronavirus and we may fund your research.

They received three hundred applications; twelve that had the most promise were selected. These included a once-a-day nasal spray, that promised a 100-percent protection; and a monoclonal antibody therapy that offers an improved antibody combination that has longer protection, a more powerful protection against variants, normally given to people who get Covid-19 but are at a much higher risk of getting very sick because of an underlying condition.

While Jen Nwankwo and colleagues at 1910 Genetic, Boston, turned a pair of artificial intelligence (AI) tools against SARS-CoV-2, one newly developed AI program, SUEDE, digitally screened all known druglike compounds for likely activity against biomolecules thought to be involved in disease. Another, BAGEL, predicted how to build inhibitors to known targets. The two programs searched for compounds able to block human enzymes that play essential roles in enabling the virus to infect our cells.

Closer home, OmiSure, a testing kit developed by the Tata Medical and Diagnostics, has recently been approved by the ICMR for commercial use. It combines the use of two S-gene viral targets to identify Omicron and other SARS-CoV-2 variants.

Introducing a hand-held, personalized, portable device that uses faster, miniaturized isothermal amplification tests, able to detect the virus within a few minutes with sensitivity at par with RT-PCR assays into the diagnostic world is a welcome addition to the investigative arsenal. The application of biosensing formats in RT-PCR and the integration of CRISPR/Cas technology, with amplification assays toward developing these POCT devices, promises to be path-breaking. The potential of this technology to ramp up testing, covering large populations of people, will prove to be extremely helpful in early, specific, and accurate diagnosis within a short turnaround time.

And beyond Covid-19, it can look forward to providing rapid diagnosis of many other infectious diseases, with its portable and accessible PCR technology, which will make a big difference in healthcare delivered, especially in rural areas, where accessibility to accurate diagnosis and treatments is a concern.

Emerging medical education. The industry saw the need for specialist care in smaller cities and rural areas. It called for a revamp of the existing medical education system, both in terms of the quantity and quality of physicians and paramedical staff.

There has been a push to markedly expand the number of medical colleges in the country to increase the number of graduating doctors ready to serve the community. NITI Aayog is also drafting ways to attach these medical colleges to existing district hospitals in a public-private-partnership model. By 2022, the traditional NEET entrance exams will be replaced by the NEXT model, which tests a medical student’s basic skills and concepts while serving as a licentiate exam, which means students need it to practice medicine post MBBS.

With the shift to telemedicine, the rapid adoption of online modules for training led to the development of massive open online course platforms, which could revolutionize the way healthcare professionals train and upgrade their skills. For example, the government-run IGOT initiative (integrated government online training) for Covid-19 has training content for numerous stakeholders – district administration, medical officers, nurses, paramedics, ANMs, hygiene workers, technicians, and volunteers from various ministries, departments, and organizations.

The aim is to be better prepared and organized with readily available skilled staff to prepare communities for future emergencies, like the incoming Omicron wave. In a bid to develop medical infrastructure that is emergency-proof, hospitals and specialty centers have also expanded to increase the number of beds-per-100-population, to close the accessibility gap in suburban or rural areas.

The home healthcare sector in India that for many years accounted for about 3.6 percent of the overall industry earning is now expected to expand at a CAGR of 18.9 percent by 2025. With social distancing norms and the apprehension of going in person to doctors’ appointments or hospitals, the ability to avail healthcare services in the comfort of home is appealing to many. What will potentially kickstart this revolution is a recent move by the Insurance Regulatory and Development Authority of India (IRDAI) to extend coverage for homestay and care.

The potential range for home healthcare services is also increasing rapidly. With its beginning in at-home nursing services and medical consultations, screening and monitoring using self-diagnostic devices like pulse-oximeters and POCT tests, there is now ICU care at home facilities that help reduce the length of stays at hospitals to mitigate the Covid transmission rates.

In a move that may prove to be a win-win for all, especially in the light of a new Omicron wave, intelligently designed home ICU services can benefit public and private operationally, enabling them to care for patients requiring intensive care outside the confines of the hospital, where beds may be in short supply. This move could potentially decompress the existing infrastructure and shift to remote-based patient monitoring.

Speedy supply chains. Evidence shows that the resilience to face new waves like the Omicron variant will be the ability of the healthcare industry to use strong business models, supported by a robust digital backbone and processes that can pivot rapidly. With the previous waves, supply chain operations had to change at breakneck speeds to keep up with the ever-increasing demand for healthcare consumables, PPEs, and test kits. It was undoubtedly a push toward the path of self-reliance in the Indian market. To prepare for future pandemics or variants, there was a concerted effort to source locally available materials while pivoting, and scaling the production of indigenous supplies through rapid digitization and automation to assist and augment intelligent supply chains. As we deal with Omicron, the proposed integration of robotics, IoT, sensor-based software, drones, big data, blockchain technology, and predictive analytics can make all the difference.

Digital health technology has seen an unprecedented push that will be a turning point in how the Indian healthcare industry deals with the new Omicron variant. Telepathology and teleradiology had their moments in the spotlight through efficient diagnosis that overcame the challenges of reduced skilled workforce and social-distancing mandates. However, what helped lessen the burden on local hospitals and clinics, while still delivering care, was undoubtedly the rapid adoption of telemedicine. With the rapid adoption of chatbots, smartphone applications, video conferencing, and e-prescriptions, the industry laid the foundation for a digital health technology revolution. And it is not limited to the private sector. Perhaps the most prominent example of the collective vision of public and private healthcare sectors has been the creation of the government’s e-Sanjeevani portal, which provides affordable telehealth consultations to a large population.

The Ministry of Health and Family Welfare and NITI Aayog have introduced new guidelines for registered medical practitioners (RMPs), providing healthcare services using telemedicine. With the launch of the NDHM (National Digital Health Mission), there is an aim to introduce integrated health IDs, electronic health records, and e-pharmacy and Digi-doctor services.

The push toward preventive care has resulted in the astronomical rise of SaaS or Software-as-a-service in healthcare, using digital health applications. These med-tech unicorns will transform how we gather and utilize patient data, especially when dealing with ominous new variants like Omicron.

While it is advisable to be mindful of the Third Wave, as reports and data on the Omicron variant continue to roll in, with all the advances made over the last two years, the Indian healthcare industry has reason to be cautiously optimistic in 2022!