Meeting the Ventilator Emergency of India During COVID19

By Shazib Siddique

In a conversation with Siraj Dhanani, Founder and CEO of InnAccel Technologies Pvt. Ltd. which had developed a non-invasive ventilation system that provided respiratory support to moderately severe hypoxemic Covid patients. In this interview Mr. Dhanani spoke about how his company met the challenges of pandemic, answers questions and mis-conceptions around the usage of ventilators and talks about the road ahead.

The unprecedented rise in Covid19 cases has created a severe shortage in ventilators for extremely critical patients and the costs of procuring them also makes them an unaffordable commodity during this health crisis. The Indian government, early in the pandemic, had restricted the export of medtech equipment to meet the existing demands of the country.

InnAccel uses the Stanford Biodesign method to identify and validate critical unmet clinical needs in India. Their systematic approach has led to the development of multiple products in three focus areas — Critical Care, Maternal & Child Care, and ENT.

SAANS Pro: Non-Invasive ventilation system for COVID-19 patients

What have been the recent focus areas of InnAccel?

Today InnAccel has two main divisions. A critical care space and secondly in the maternal and child care space. The critical care division is more focused on the respiratory issues. InnAccel has developed two products in the span of 5 years; VAPCare and CPAP System.

VAPCare (Ventilator-Associated Pneumonia) is a technology to automate manual procedures that nurses do in maintaining oral hygiene of patients who are on a ventilator. Our goal by automating this process was to make it better and reduce the chances of lung infections using VAPCare. We figured that the quality of oral hygiene is directly related to the incidence of lung infection in patients on a ventilator. This has been one of the main reasons why a lot of patients on ventilator support die in India.

We had also developed a new kind of a neonatal breathing support system, called CPAP system (Continuous Positive Airway Pressure). This kind of breathing support is only available in the NICs and these come with a lot of infrastructure requirements as well. Our device, by using completely novel technology makes this CPAP therapy available in any circumstance, be it in the NICs, in a PHC or during transporting a baby in a rickshaw. It is the only CPAP system in the world that can work on manual power which is extremely useful during emergency situations.

How did you discover the problem related to invasive ventilators? What made you develop your own non-invasive ventilation system?

When COVID hit, we felt that the focus on ventilators alone was misplaced for two essential reasons, one was that there is a lot of infrastructure and skilled people required to operate a ventilator and secondly was the data observed in the initial days which said that patients in the Western countries treated using an invasive ventilator had very poor outcomes. More than half of them were eventually succumbing to the disease.

When the lockdown started, we decided to build a non-invasive ventilation system because we saw that as a big gap in India. Hence, we leveraged our neonatal CPAP system and used that as a platform to develop SAANS Pro, a non-invasive ventilation system. This product was built and tested in about 4 months. The first commercial lot we rolled out was at the end of July and we started shipping it from August.

Training the health staff for using the SAANS Pro non-invasive ventilation system

Training the health staff for using the SAANS Pro non-invasive ventilation system

Can you briefly explain the applications of your products which you have developed during COVID?

This product provides both CPAP therapy and HFNC (High-Flow Nasal Cannula) therapy which are the two main modes of non-invasive ventilation to a patient both adult and paediatrics. It is a robust portable system which is relatively easy to use as it is non-electronic and mechanical in nature. We also developed something called a CPAP helmet or a CPAP hood. This has been used a lot in COVID because the helmet prevents the spread of infection from the patient’s exhalation, cough or any other similar communicable source. This product is only made by two-three parties in the world.

Novel CPAP helmet/hood used for COVID-19 patient

What kind of support did you receive for making these devices? How many hospitals have you currently helped with your products?

We did an engineering partnership with Thermax global and in 3 months we were able to develop our own CPAP helmet. Both CPAP Helmets and SAANS Pro were supported by ACT Grants. For the SAANS platform (the neonatal CPAP system), we received several grants and support from the department of biotechnology. They have been instrumental in supporting the innovative medtech ecosystem.

With the SAANS Pro system and the helmets we have shipped around 105 devices to about 20 odd hospitals across the country, mainly government or academic health centers. We anticipate that each device when used where there is a capacity largely filled can treat about 30 to 40 patients in a year. By the end of this year, we think it will have a positive effect in saving the lives of approximately 2000 odd patients. And we aim to deploy about 400 to 500 systems this year.

Can you highlight some of the challenges you had to face due to COVID?

Mobility wasn’t really as much of an issue for us. The structural challenge was only to make sure we could operate. We got lucky on that front, as we quickly got passes to move, work from our labs and go to the hospital whenever required. The big issue we faced was with supplies and with components coming from outside of India. During the lockdown, things didn’t move and also from the last two months, there have been tensions with China. In general, a lot of component supplies coming from overseas have slowed down due to prolonged processing.

Besides, our entire portfolio that we had developed until the end of 2019 was not COVID specific. We had just launched our product portfolio in the middle of 2019 and one product at the end of 2019. Both took a big hit because not only hospitals got curtailed but the ability of hospitals to focus on anything other than COVID was minimal at that point. Overall, from a business perspective, it has been a lost year for our other products.

What are some of the key learnings and takeaways you have picked from this unprecedented period?

One key learning is to be nimble and be able to spot an opportunity. I am frankly amazed that our team came together and built an entire system in 4 months. We all are hoping that things come back to as close to normal as is feasible. For us working with this product, we see this as an opportunity for this year. Currently, we are trying our best to set up relationships, partnerships and are doing the work on the ground for sales effort for our portfolio.

This year, we are going to survive and meet this COVID requirement for non-invasive ventilation as much as we can.

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