In a multistoried building on north Bengaluru’s Bellary Road, two pulmonary specialists are guiding a doctor, 2,000km away in a district hospital in Muzaffarpur, Bihar, in treating a covid-19 patient.
The Muzaffarpur hospital does not have intensive care unit (ICU) specialists and so a team from Bengaluru-based medtech startup CloudPhysicians is analyzing patient data and helping the doctor make clinical decisions.
India has just 4,500 specialists who can work in ICUs. Even if the country of 1.3 billion ramps up infrastructure and prepares critical care units to treat covid-19 patients, it is woefully short of specialists who can work in these units.
Cloudphysicans, founded in 2017 by critical care specialists Dr Dileep Raman and Dr Dhruv Joshi, is working with hospitals in tier-2 cities in seven states to help them deal with emergencies.
“We remotely provide ICU expertise to hospitals that do not have access to ICU specialists. We help hospitals with capacity building. These gadgets can be used only if there is trained manpower. Our tele-ICU does that," said Dr Raman.
The tele-ICU has an off-site command centre, where a critical care team, comprising intensivists and nurses, are connected with patients in distant ICUs through real-time audio, visual and electronic means, and health information is exchanged. They work with small and medium-sized hospitals in Maharashtra, Bihar, Uttar Pradesh, Andhra Pradesh, West Bengal and Tamil Nadu, as well as Karnataka.
Ideally, the doctor-patient ratio in an ICU is about 1:10. The doctor-nurse ratio is 1:1 for those who are very unwell and 1:3 for other patients.
“Some ICUs do not have any specialists. Most of the 4,500 intensivists India has are in the metros. So, the distribution is skewed," said Dr Raman. With a tele-ICU system, it is possible for one intensivist to cater to the needs of 60 to 80 patients.
The challenge is to train enough doctors and nurses to work in an ICU and this is not possible when the number of covid-19 cases is rising. The Telemedicine Society of India has begun conducting training and webinars for doctors in tier-2 cities to use technology.
“The need of the hour is to leverage technology. Short-term training programmes are conducted for doctors and nurses to deal with this emergency," said Dr Rajani Bhat, a Delhi-based pulmonologist.
The Centre too has accelerated the process and got doctors and nurses to enrol for a three-year specialized course so that more medical professionals are trained over time to use technology in healthcare. “We too have commenced training through webinars to assist as many doctors and nurses as possible," said Dr Raman.
Another Bengaluru-based startup, InnAccel, has built a non-invasive ventilation system, Saans Pro. It can be used to treat those who are not critically ill but need backup ventilation and when trained staff is not available. “Non-invasive ventilation has been crucial in managing moderately severe coronavirus patients in Italy and China, and Saans Pro can play the same role in India," said InnAccel founder and chief executive officer, Siraj Dhanani.