With COVID-19, companies are putting employees at unecessary risk. There is a better way.

In order to be sure of the safety and efficacy of a COVID-19-screening technology that he was considering for his employees, Tech Mahindra's C.E.O., C.P. Gurnani, suggested testing it on himself and his household members. That decision may have saved him and his family from having to be admitted to hospital. As it turned out, everyone in the house received a clean bill of health except the two sons of his cook, Rishi. They tested positive for IgM antibodies — indicating recent exposure to SARS CoV-2, the virus that causes COVID-19.

As most of us do, Gurnani had had his domestic staff members take all necessary precautions, remaining distant and wearing masks. All seemed okay, with Rishi’s children showing no signs of illness.  Even the COVID-19 RT-PCR tests they subsequently received came back negative indicating that the children were no longer in an active phase of the infection. RT-PCR tests have “false negative” rates of 20% to 67%, depending on the time at which the test is performed, and the techniques that businesses are using, such as temperature screening and contact tracing, don’t identify the presymptomatic spreaders who mathematical modelling suggests could be responsible for half of the infections.  

The technology and techniques I had persuaded Gurnani and Tech Mahindra to pilot, and that I had a hand in developing, are based on understanding an individual’s risk and monthly testing. The reality is that even though COVID-19 can be devastating for a few, not everyone who gets infected will have serious symptoms.  We can identify the people at high risk with reasonable accuracy based on studies from around the world and data from India.

For example, it is well established that men above the age of 65 whose health is chronically compromised by diabetes, cardiovascular disease, or obesity are at higher risk of severe outcomes.  Further, severity can be predicted by a number of tests, including those for hypertension, diabetes, and obesity, and measures of lactate dehydrogenase (LDH) and D-dimer.

Businesses in America have considered offering these types of tests, but the costs and logistics of doing so are usually prohibitive, with the most basic tests costing more than $100 apiece and requiring the shipment of samples to labs. A single comprehensive screening for an individual could cost over a thousand dollars and is usually not covered by insurance plans.

This is where India has an advantage over the West: it has developed screening devices such as the HealthCube that can conduct a range of biochemical and physiological tests for a tiny fraction of the U.S. cost. These include 12-lead EKGs, tests for blood pressure, oxygen saturation, blood glucose, hemoglobin and cholesterol, and rapid diagnostic tests for infectious diseases. With the HealthCube, an entire regimen of tests, including a test for COVID-19 antibodies and severity markers, can be performed for less than 1000 Rupees. The technology meets western standards and has received Europe’s CE certification. (See the video below for how this technology is benefiting the poor).

The COVID-19 risk screening program underway at Tech Mahindra on the HealthCube platform, uses patient risk factors — including age, gender, medical conditions such as hypertension, obesity, diabetes, potential exposure such as contact with a COVID-19 confirmed patient, recent travel or being in a crowded place, public-health data, aggregations from previous screenings, patient symptoms such as cough, headache, and fever and antibody test results— to compute a risk score for patients. Those who are at high risk are checked for markers such as D-dimer and Troponin, which are elevated in those who develop severe disease (which indicate heart ailments). These tests are followed up by teleconsultations and further testing, as appropriate.

The best part is that, with more data and testing, the artificial-intelligence algorithms become increasingly accurate and people are given an individualized screening and testing protocol based on their risk factors, rather than being treated like machines that need temperature checks.

Antibody tests have created much controversy largely because the first generations of tests that were performed worldwide were mostly from China and, like much of its medical equipment, were low quality and defective. There have also been doubts about whether all coronavirus patients develop antibodies and, even if they do, how long the immunity lasts.

The newer generations of tests, made outside China, are highly accurate. Roche, for example, claims that 14 days after infection, its test can detect antibodies with 99.8% specificity and 100% sensitivity; HealthCubed claims that its India-made tests have 98% specificity and 96% sensitivity. These are both a huge leap from the 5.4% accuracy of the tests that China first sold to India.

There is substantial evidence that within 19 days after symptom onset, 100% of patients test positive for COVID-19 antibodies. And as Harvard epidemiologist Marc Lipsitch explained in The New York Times, “After being infected with SARS-CoV-2, most individuals will have an immune response, some better than others. That response, it may be assumed, will offer some protection over the medium term — at least a year — and then its effectiveness might decline”.

And even a year will buy us time to understand and develop better approaches to prevention and treatment—and administer vaccines to those at high risk. 

C.P. Gurnani’s personal experience and the testing his staff had done with a few hundred employees has convinced him to offer the full health screening to his entire India employee base including third-party employees, who typically can’t afford the test and are the most vulnerable because stay in crowded places. 

To date, Tech Mahindra has completed more than 10,000 screenings. An analysis of 3358 individuals screened in July showed that 190 were at high risk of infection. Interestingly, 77.4% of these individuals were asymptomatic. No doubt, preemptively isolating them averted potential clusters of infection. An additional benefit of these screenings is that individuals sometime learn of a potential hypertensive or diabetic condition based on tests performed. For example, of 804 third party contractor workers who had high systolic blood pressures, 92.3% had no previous diagnosis of a hypertensive condition. Similarly, of 216 individuals with blood glucose levels (random) in the diabetic range, only 20.6% reported being diabetic.

To help its customers and the Indian economy, Tech Mahindra has started offering a solution, branded as MHealthy, to other companies in India. And is notable that Economic Times just awarded MHealthy its Intelligent Health & Tech Award for being the best technology solution for COVID in India.

It is more than India, I believe their solution is actually the best solution in the world. Other countries need to urgently learn from this and provide comprehensive and holistic healthcare to their employees. 

For more, please visit my website: www.wadhwa.com and follow me on Twitter: @wadhwa.