Dr. Uli K. Chettipally, Emergency Physician, Author, Founder InnovatorMD. Dr.Uli gives insights into Corona Virus, scale of the problem, testing and possible responses. The ‘Home Shelter Policy’ by Bay Area Authorities and its significance is covered in his talk. More about Dr.Uli (www.linkedin.com/in/ulichettipally)

This discussion is moderated by David Cao, F50 Ventures & Hunniwell Lake Ventures and Amit Saha, Ph.D, Research Engineer, School of Medicine, Stanford University.

F50 Global Insights is a series of webinars on ‘Elevating HealthTech Innovation’ and brought to you by Silicon Valley based F50 & F50 Elevate. F50 serves is a community of VCs, Investors, angel investors, Corporates, startup founders, entrepreneurs and thought leaders. F50 Global Capital Summit(GCS) is among the leading investor events of Silicon Valley. F50 Elevate is a pre-Series A HealthTech startup accelerator based out of Silicon Valley. For details: F50 : http://www.F50.io F50 Global Capital Summit(GCS) : http://f50.io/summit/ F50 Elevate: http://f50.io/elevate/

David Cao: Good afternoon. Welcome to F50 Global Insights. I am David Cao, Managing Partner of F50 and Partner of Hunniwell Ventures. I will be your host today. Let me introduce my co-host Amit.

Amit Saha: Good afternoon. My name is Amit Saha. I am a research engineer at Stanford University School of Medicine. I’m a bio-engineer by training and my current research focus is on ‘Chronic Fatigue Syndrome’. Thank you everyone for being here. 

David Cao: Today, we have a very distinguished speaker. He has been working in the hospital system for a very long time and also he leads a physician innovation program, company name is called innovator MD. Please give him a big welcome.

Dr.Uli : Thank you, David and thank you Amit. Thank you for having me on this program. I’m really, it’s a great privilege. My name is Uli Chettipally and I’m an emergency physician by training. I also was a researcher did that job for about 26 years at a large healthcare Company. So I have both of firsthand and frontline experience and also understand the data that comes in. It is first frontline experiences and we have been analyzing the data that comes through the emergence to look at different conditions. Currently I President and what InnovatorMD does is, we work with startups and we also work with healthcare companies and how to bridge that gap. That’s what we’re working on, bringing healthcare companies the knowledge and the domain expertise from healthcare, and also for healthcare companies bringing the technology and the current new innovations that are happening in the startup world. And so we host monthly meetings and also an annual meeting in January. It’s called the InnovatorMD Global Summit. The other hats I wear are you know, I’m active in the San Mateo County Medical Association and I’m the president elect currently. I also help run the Society of Physician Entrepreneurs, which is a non-profit that is again focused on how to get physicians to become entrepreneurs, or at least work with entrepreneurs. So that’s my background and I have been watching COVIT-19 very closely and some interesting things are popping up. So I’m happy to be here to share my thoughts and my instincts from what I have seen so far.

David Cao: Great, thank you Dr.Uli. I want to start with the question with where we are right now. You know, last 10 days, since there are significant developments and it changes in North American, particularly in Bay Area and Bay Area announced Home Shelter program in the last few days. So now everybody is in a panic mode. Can you tell us especially from the hospital care, hospital care stand point, where we are in terms of responding to this virus?

Dr. Uli: Sure, that’s a great question. So, initially, you know, we were thinking that we can control this, right, you know, we can catch people when they are symptomatic, and we can test them and then we can control you know, have them quarantined or have them stay at home. But I think we may have moved out of that stage. The reason being that this is a much bigger problem than we originally thought was. One of the big reasons is that you know, this condition has been brewing around for the last couple of months, at least in the community. Number two, there are a lot of cases where, you know, people may be asymptomatic, which means that, you know, they may not have any symptoms, but, you know, when you test them, you know, they test positive for this disease. And the second, the third thing is that, this is spreading pretty fast. What we have seen in other Countries, especially in Italy and China and South Korea, you know, it, it spreads really fast. And so, we are now at a very high level of alert where we are, we want to restrict people from exposing, you know, if they are a carrier, you know, we want to cut down the exposure. So the best way is to stay where you are and not go to places where you may be infecting others or catching infection. So we are in a very strict place where we want everybody to stay home basically.

David Cao: So, the second question I want to you to share with our audience as we have a larger number of entrepreneurs and investors in our community, so maybe you can share us with this disease looks like still a lot of infrastructures and innovations are needed, maybe you can tell us where we are, and where are the opportunities?

Dr.Uli: Sure. So I would divide the opportunities into four distinct areas, four big areas. The first one is in preparedness. You know, when you have a pandemic of this size, we, you know, we do get experience. We’ve seen that with the Chinese and in South Korea, where they had experience with other pandemics before and so, they are much more better prepared to tackle this and we have seen that in the in the outcomes. So number one is preparedness in the preparedness, you know, we have to think about the infrastructure, how do we connect these hospitals, how do we connect the public health system would be with the hospitals, which because right now they’re you know, very separate and very distant and not communicating with each other. So how do we develop an infrastructure where, you know, there is a way to track all the diseases, all the disease cases, in different areas from different hospitals and different so those kinds of connections and the network needs to be built, where it is easy to see where the new cases are coming from and, and that will give us some clues on where to implement what kind of strategies to control this disease. So, that’s number one, which is the preparedness. 

The second area that I would direct the innovators to focus on is on prevention. Prevention is where, you know, that this disease is coming and how do you prevent from getting infected. What are the things that you need to do? Are there vaccinations that you need to do or develop? Are there any other barriers that you can build between people? Or how do you figure out what, whether it is a chemical or biological? Is there any way to block the spread of this disease? So that’s the second area, which is the prevention. 

The third area, I would say is the diagnosis, you know, the diagnosis has been very difficult. The tests that have so far, a lot of tests were not performing well. And so there was a lag between detection and treatment. And so how do we test? How do we use novel technologies to be able to do a quick test rather than wait for the test to come back two days later, the test result? Because in the meantime, you know, that person will be spreading, you know, disease, and how do we track those people who have tested positive? Because the tracking system needs to be there where you know where this person is going and how the disease is spreading. 

And the fourth and the last one area is where you are looking at treatment options. You know, what are the medications that help? Do we need to develop new medicines? Do we need to get, a novel treatment options? Can we find new medicines that may not have been used before or new medicines that work for other diseases and test it on these patients? Are those useful? Those are some of the areas. So those are the four areas that I would say definitely need it. 

Amit Saha: Yeah. So it’s, it’s great, the way you divided this opportunity into four parts, right? I kind of focus on the latter two, you know, on the diagnosis and treatment and I have a specific question pertaining to these. As we know already, there are a lot of these symptoms which overlap with a lot of other conditions. Flu for example, right. So, when we are looking at diagnosing or treating, what should be our approach to address these overlaps and especially at a time when we are really hard pressed to test everyone? We cannot, we have to be very careful as to how to use our resources, right. So what should our approach be to tackle this issue?

Dr.Uli: Sure, that is a great question. So one of the things that I mean, there are several factors that go into the test. Number one, the test has to be accurate. Number two, the test has to be quick. Number three, you know, you have to pick the right people to test. Otherwise, you will run out of test very soon. So somebody suggested that, oh, we should test the whole population. You know, if you want to test the, you know, 40 million people in California, I was discussing this with another Physician, and I said, it will probably take 20 years or more with the number of tests we have right now, which is about 5000 a day. So, that is a challenge. That’s number one. Number two is that if you do any test, when you do a test, then it has to be followed by an action. Okay? So if you see a patient that is positive, and how do you treat that? How do you differentiate the treatment of a person who tested positive with the person who tested negative? And that’s where you know we will run into problems because there’s no cure for the people who have tested positive. You might say, oh, maybe they should be isolated or quarantined, that is true but it is also true because this disease can be asymptomatic, right. So there are a lot of people who are asymptomatic and who are running around or moving around within the community and they may be spreading the disease. So if you if you quarantine a few people that you have tested, that are symptomatic, it does not make a big difference in a later stage of an of a pandemic like this. In the earlier stage, it might make a difference like it did in China and South Korea, you know? And how, how strictly can you enforce these laws where, you know, you’re keeping people away from each other. So that’s where the biggest problem is. Let’s say you go, you have symptoms and you go and get tested. And if it is positive, you know, the first thing they would say is that, yeah, you have symptoms, but you’re not sick, right? We have to make sure that we preserve the ICU beds for the really sick ones where you cannot breathe. So my recommendation would be to stay home until you know you really, really need to be in the hospital. When you have, let us say a fever or cough or some symptom, you know, it can be any of the other viruses like the flu. So just by going into the hospital, going into an environment you’re not only at a higher chance of contracting something else, God forbid do you want to be in a place where there are other COVID-19 patients. So I would recommend that unless you’re having really severe symptoms where you’re having difficulty breathing, I would not recommend going to the hospital and that’s what you know, CDC has recommended also.

Amit Saha: Right, so the thing also is, you know, so that’s that that really helps right with the diagnosis. Now, let’s focus a little bit on the treatment right. Obviously, we do not have any treatments now. And you a Physician but from what I understand, right now, the only strategy is to be treating the symptoms correct. So one question that I have are concerned rather, especially for the US, is the is the extensively lengthy drug trial processes involved, right. So now even if one was to identify some potential candidate, how are we going to get that medicine to the people? Are there any specific strategies that can bypass the overall lengthy process or how can or how does that work?

Dr. Uli: So, FDA does have a fast track process where you know, in an emergency, you know, you can try different drugs and you can actually study and in fast track the process for approval. So that is not a problem and there are currently many studies are occurring throughout the country and so there are different drugs that people are trying. And so that in a case like this where it is an emergency, you know that will not be a problem, I don’t expect that, that that will be a problem. And the other thing is that we already have experience from other countries, you know, people have tried different drugs and until we can actually import some of those ideas, import some of those trials and see how we can build on top of those. So there’s already on top of what the current drugs that are being tried and so I don’t expect that to be a long process. Of course, it could be a long process when you compare to the current pandemic. Obviously, we want to get something out to the doctors as soon as possible. But in this case, it’s going to be a little, little tricky. It’s going to take some time. 

Amit Saha: Okay, thank you.

David Cao: Okay, great. I think, the testing is one of the challenges. So what are the difficulties for the testing? What are the entrepreneur or startup opportunities in this area?

Dr.Uli: Sure. So number one problem is the availability of tests, right, so there’s not enough tests that can go around where you can test everybody. So that’s a problem. Number two problem is having a simpler and more rapid test. Right. You know, there’s always this question of, you know, if you get a test done, you know, do we have to wait two days, three days for the test results to come back? 

I’m sure, you know the larger lab testing, testing companies are working on that problem. But one of the big, big ideas is that, can we develop a test which can quickly diagnose. Maybe using the breath or maybe using a drop of blood, maybe using a little bit of mucus. So we can do a point of care test, where you’re actually testing and the result comes out, comes back to you within a few minutes. That would be great, I think, in trying to understand the extent of this disease. 

David Cao: You know what, that was my last question. But somebody, my partner suggested a very good question. So the Virus seems to have different versions and has been changing a lot. Will it affect how the testing being done?

Dr.Uli: Well, right now, right now, there’s nothing like that available. Of course, there are some places where healthcare workers were sent to the home of the person and where they drew sample and that was sent back to the lab. But self-testing or home testing is quite possible. But a lot of startups are thinking about it and working on this problem. But that would be great if somebody can come up with a test.

David Cao: Okay, great. I really think that’s our time today. We look forward to invite you to come back for another different topic for discussion. Thank you, Uli.

Dr.Uli: Thank you, David. Thank you for having me. It’s a pleasure.

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