D-Rev’s rapidly launched two COVID-19 programs in response to the needs of healthworkers and patients: tele-training for pediatricians and neonatologists in high-need regions, and the development and distribution of non-aerosolizing interfaces for non-invasive respiratory support for COVID-19 patients. Our approach has been informed by our global network of medical experts, healthcare workers, and decision-makers who are on the front lines of saving lives and planning for—or already managing—a surge of COVID-19 patients. We also recognize that in the coming months and years, resources will be shifted from already urgent areas of healthcare such as newborn, child, and maternal health. We are doubling down on our efforts to meet these needs as well in our shifting landscape.
D-Rev’s COVID-19 ECHO Clinic
for Pediatricians and Neonatologists
Preparing pediatricians and neonatologists to meet the demand of their health systems and for intensive respiratory care during the COVID-19 pandemic
As novel coronavirus COVID-19 continues to spread, clinicians are experiencing challenges with meeting patient demand to provide continuous care in the face of hospital closures, additional risks, and disrupted supply chains for essential clinical tools. Mothers and babies who require emergency hospitalization, including respiratory support, but are unable to travel to referral centers are increasingly relying on closer-to-home facilities, which are ill-equipped to manage sharp increases in patient volume. Governments worldwide have started to recognize the need for significantly strengthened capacity throughout their systems. These physicians require fast, community-specific training on critical newborn management, and how to effectively manage new mothers with COVID to meet the call of this pandemic.
D-Rev focuses on geographies with high infant mortality rates. We currently run the world’s only newborn health-focused ECHO teletraining program to increase the capacity of clinicians and improve the quality of care provided to newborn patients in India. At the request of past participants, D-Rev is already using the proven ECHO model to conduct collaborative region-specific teletraining clinics for pediatricians and neonatologists who are managing higher loads. Our goal is to foster a knowledge-sharing network to support them through this pandemic. D-Rev’s network of local medical experts, such as respirologists and pulmonologists, lead sessions, and participating physicians will be grouped by region to ensure that ECHO clinic content is contextually relevant. Topics covered include:
- Breast-feeding guidance for COVID-19 positive mothers
- Neonatal ventilator principles and patient management
- Patient management principles to limit the spread of COVID-19
- Prevention of infection and viral spread (e.g. ventilator associated pneumonia)
- Prevention and management of negative outcomes that may present during treatment
D-Rev is seeking to significantly scale the COVID-19 ECHO training to respond to this growing need. ECHO clinics are held entirely online via Zoom, making them easy and quick to implement while complying with local lockdown orders. In early April, D-Rev ran a pilot COVID-19 Clinic in the Indian states of Uttar Pradesh, Madhya Pradesh, and Chhattisgarh. In partnership with the state chapters of the India Association of Pediatrics (IAP), D-Rev then held additional ECHO clinics in Gujarat and West Bengal.
The seven-session teleclinic in Gujarat was implemented in 18 days—from conception to the last session completion—and trained 305 doctors. Nearly 500 healthcare workers took part in our April clinics alone. This is a 10-fold increase since the start of the COVID outbreak.
We are also in discussions with the national IAP office and other states, such as Bihar and Assam, to scale throughout India as well as with other organizations across the world. ECHO sessions are led by local subject matter experts, physicians who have different specialties and locally-relevant training. With proper funding and support, D-Rev will expand the COVID-19 Response ECHO model to East Africa and Southeast Asia, where the virus is expected to surge in the coming months.
|Impact||India||East Africa||Southeast Asia||Total|
|Neonatologists and pediatricians trained3||2,000||300||1,400||4,700|
|Resulting patients treated4||280,000||42,000||196,000||428,000|
|Total impact (people)||952,000||147,000||607,600||1,706,600|
Outside of the tele-clinics, participating physicians continue to share knowledge and recommendations with their virtual community through WhatsApp. With increased knowledge and confidence, doctors are more willing and able to treat patients in respiratory distress, leading to better outcomes for patients, hospitals, and communities. The benefit to clinicians also extend far beyond COVID response:
For the first time in my career as a pediatrician in the past 10 years do I understand the concepts of ventilator management. The faculty has helped me a lot in understanding this difficult topic. Thanks for organising such a wonderful workshop. It was a great experience to be a part of it. — Dr. Pooja Parikh, Gujarat
It was a wonderful experience to have such a well organized workshop on a difficult topic. Thanks to D-Rev and the excellent faculty. I wish to have such initiatives in future. — Dr. Gajanand Agarwal, West Bengal
I must say that you guys are really doing great … All sessions went so smoothly, were well coordinated, and your ability to sense the things and ability to adapt to it is just WOW! — Dr. Hiren Patel, Gujarat Indian Academy of Paediatrics State President
If you are interested in supporting this project or you know an individual or foundation that is aligned with our work, please contact:
D-Rev India Country Manager
Snr. Manager, Development and Partnerships
12 ECHO teleclinics x 3 countries (Kenya, Uganda, India)
22 ECHO teleclinics x7 Southeast Asian countries
3India: 100 physicians per ECHO session x 20 ECHO sessions, East Africa: 50 physicians per ECHO session x 6 ECHO sessions, Southeast Asia: 100 physicians per ECHO session x 14 ECHO sessions
4# of physicians participating x 10 unique patients treated per day x 14 days of reassignment
D-Rev’s Design and Distribution of
Non-invasive Ventilation Interfaces
Safe and Adaptable Non-Invasive Respiratory Support for COVID Patients
Many patients suffering from COVID-19 cannot get enough oxygen which can lead to rapid deterioration (acute respiratory distress syndrome, or ARDS) resulting in the body being deprived of oxygen and organs shutting down (i.e. kidney failure, brain death). Standard non-COVID treatment for ARDS would have patients advancing from supplemental oxygen to non-invasive oxygen support and ventilation to invasive mechanical ventilation. Invasive ventilation requires the patient to be completely sedated and paralysed to tolerate intubation. Intubation also requires a skilled clinician who carefully inserts a tube through the patient’s mouth, down the throat, through the vocal cords, and into the airway.)
Non-invasive respiratory support, such as HFNC, CPAP, and BiPAP, could significantly improve outcomes for many COVID patients, but these treatments carry a high risk of spreading the virus through aerosolization of the virus. As the patient exhales, their expiratory (out) air generates tiny, highly viral droplets that are released into the air and contaminate the surrounding environment. To avoid transmission of the viral droplets, each patient would need to be contained in a negative pressure isolation room, with all medical personnel in full personal protective equipment (PPE). High-resource hospitals (in high-income countries) typically only have a few of these rooms and not enough to meet the demands of a coronavirus pandemic. As a result, COVID patients in these facilities are escalated directly to invasive, potentially damaging intubation, and critical ventilator supplies are strained.1 It is virtually impossible for lower resource hospitals to treat COVID patients and prevent contamination.
With the early panic of the pandemic, government agencies and medical device manufacturers understandably focused on increasing ventilator supplies, but this is an incomplete solution. While ventilator production has increased by 30-50%, a 500-1,000% increase is needed to meet the anticipated global demand.2 Low- and middle-income countries (LMICs) are having growing access to CPAP, but they do not have broad access to ventilators—and most critically they lack trained clinicians to safely intubate patients and operate ventilators.3
More concerning, sedating and intubating a patient with COVID-19 reduces the body’s ability to fight the virus and increases the risk of permanent lung damage. Emerging data from China, New York, and the United Kingdom indicates very poor outcomes (66-88% mortality4,5,6) for mechanically ventilated COVID patients.
D-Rev has two approaches to design and distribute affordable non-invasive respiratory support for COVID patients. Both involve improving the interface for breathing (oxygen) therapy:
- Design, with partners, a user-centered non-invasive interface that provides safe and affordable breathing assistance that is appropriate for all geographies, including LMICs that would be ready in the next year; and
- Support partners with available interface solutions to distribute at scale for immediate use, especially in LMICs.
The first project ensures non-invasive breathing treatments can be administered to patients without the danger of releasing the COVID-19 virus into the air and putting healthcare workers at risk. We are confident that a robust, universal, and highly-effective interface can be developed working with partners in less than a year.
The benefits of this solution include:
- Greater flexibility for clinicians, especially in LMICs, to treat COVID patients with the most appropriate forms of respiratory support.
- Significantly improved health outcomes for COVID-19 patients who need oxygen and can be treated with less invasive measures, and in most cases preventing escalation to ventilation.
- Improved safety for healthcare workers who manage patients with COVID-19 and other infections that can be spread through aerosolized droplets.
- Reduced strain on ventilator supply, particularly in settings where demand is high or resources are low.
- Reduced reliance on specialized medical professionals who are intubating a patient and managing their ventilator. This is a particularly acute problem in rural and LMIC regions with few specialists.
Our second project involves D-Rev leveraging our expertise in bringing medical solutions to LMICs to accelerate the scale of existing solutions. In parallel to developing a more user-centered interface, D-Rev is in conversations with viable interface manufacturers to support their immediate needs to reach greater scale. A three-year randomized control trial of ARDS patients at the University of Chicago found that despite issues, non-invasive ventilation via a helmet resulted in lower patient mortality, faster recovery time, and shortened ICU stay compared to mechanical ventilation.
If you are interested in supporting this project or you know an individual or foundation that is aligned with our work, please contact Shelly Helgeson, Senior Manager of Development & Partnerships, (+1)937-441-5471
1For a user perspective, escalating patients to ventilators relies on scarce resources: trained clinicians. Ventilators require ICU physicians who are able to manage them, and more nurses are required per patient for intubated patients compared to patients on non-invasive ventilation.
2Netland, Torbjørn. A better answer to the ventilator shortage as the pandemic rages on. World Economic Forum Global Agenda. 2020; (Published online April 3, 2020. Accessed April 20, 2020)
3The need for skilled clinicians is global. See Business Insider: A NYC coronavirus patient died after her ventilator was set too high under the care of inexperienced medical residents 30 April 2020
4Yang X, Yu Y, Xu J et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020; (published online Feb 21, 2020. Accessed April 20, 2020) https://doi.org/10.1016/S2213-2600(20)30079-5
5Vaudya, Anuja. 66% of COVID-19 patients needing mechanical ventilation die, new study shows. Becker’s Hospital Review; (Published online April 3, 2020. Accessed April 20, 2020)
6Note this is for critically ill patients. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. Published online April 22, 2020. doi:10.1001/jama.2020.6775
7 Patel BK, Wolfe KS, Pohlman AS, Hall JB, Kress JP. Effect of Noninvasive Ventilation Delivered by Helmet vs Face Mask on the Rate of Endotracheal Intubation in Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. JAMA. 2016;315(22):2435–2441. doi:10.1001/jama.2016.6338
We welcome collaborators and partners to speed product development and scale. Please contact us if you work in these areas or are able to support our work: Shelly Helgeson, Senior Manager of Development & Partnerships.