The pictures in Northern Italy resembled a war zone. The hospitals were over-run. The body count was stacking up. People could not say goodbye to their loved ones and the panic and fear that set in Northern Italy was about to hit the whole world, and the world knew it was coming. It was time to strike back.
The European Space Agency (ESA) was in the eye of the storm, and as the virus started killing thousands, the organization was working how it could use its formidable assets to help healthcare systems in Europe. Donatella Ponziani, downstream oateway Officer at ESA told Via Satellite that she believes space is an enabler of solutions, and while it is not in the driver’s seat, she sees it as a part of the engine driving solutions.
The organization works with different parts of overall health systems. On a global level, ESA is involved in telemedicine strategies and at the European Union level, helping to provide health services for remote areas, playing a role in the study of epidemics and monitoring and medical research. At the local level, ESA supports activities to ensure patient and staff remote surveillance, continuing medical education, and emergency management. Drilling down further, on an individual level, ESA has activities on healthcare education and supporting people in remote communities. In the future it could be different. “In the future, ESA can place contracts with industries that develop healthcare solutions using space assets. There are several calls for proposals that have been issued in the last months addressing the COVID-19 outbreak. ESA can establish partnerships with other institutions, deliver ground support in the mapping of epidemics, for example,” says Ponziani.
Ponziani believes the role of ESA has changed over the last two years and that its role as a broker between the space and healthcare industries has been reinforced by the creation of an ESA downstream gateway which, among others, has the objective to create links among new non-space and space actors, she says.
So, what exactly has ESA been doing in this area? It is actually developing downstream solutions using space assets to respond to the outbreak and prepare for the post-COVID phase. Several actions have been taken so far, according to Ponziani. She says, “ESA has invited the submission of industrial proposals which address rapid development and demonstration of innovative analysis methods to characterize the impacts of COVID-19. There is now a permanently open call for proposals through ESA’s [Earth Observation] EO Science for Society program.”
There are some concrete examples in Italy and the United Kingdom. The Italian Ministry for Technological Innovation and Digitization, the Italian Space Agency (Agenzia Spaziale Italiana or ASI) and ESA have issued a call for proposal focused on Space in response to COVID-19 outbreak targeting health and education with a focus on Italy. There has been a similar cooperation with the United Kingdom Space Agency (UKSA), where there has a call for proposals for space helping COVID and other pandemics with a focus on the United Kingdom. There has also been another open call to address the health and education issues following COVID-19 outbreak in Europe, Ponziani adds.
Tele-Ultrasounds and COVID Care
Satellite technologies have been on the frontline in Europe, where technologies and downstream services and applications developed in ESA programs have been used. During the pandemic, tele-ultrasound technology initially developed and sold by French company AdEchoTech to support scientific experiments and medical operations at the International Space Station (ISS), has been used to ensure care provision continuity to non-COVID patients while keeping medical professionals safer.
The first robotic tele-ultrasound prototypes were produced in the early 2000s as part of projects led by ESA and CNES. The primary objective was to provide astronauts with a diagnostic medical imaging tool during their missions in which the human body undergoes major changes due to the absence of gravity and extreme speeds.
AdEchoTech has industrialized the first remote ultrasound solution based on more than 10 years of space medicine research on tele-ultrasound. MELODY, a medical device certified in several countries (Europe, United States, and Canada), is an example of how space technology has made its way into mainstream healthcare. In Europe, the company has several facilities within hospitals that no longer have a radiologist in their imaging department — the entire activity is carried out in tele-radiology.
“Most of the time, MELODY is used in remote or medically isolated areas. It is necessary to move patients to perform a proper ultrasound. This is often impossible or quite costly. This is for example the case of the Belle Ile en Mer hospital or the Lannemezan hospital in France where MELODY is used for abdominal ultrasound. We can also cite Norway with Hammerfest and Alta, which use MELODY in obstetrics for monitoring pregnancies. More than 30 solutions have been deployed to date around the world. Finally, we are currently working on a major project in the Paris region for the care of children with COVID-19,” says Eric Lefebvre, CEO of AdEchoTech.
Lefebvre believes the MELODY system makes sense to help combat the spread of COVID-19. “It stops the spread of the virus by allowing equipped medical facilities to establish additional barriers. It can help protect isolated patients (care homes for the elderly, prisons, isolated centers, etc.) by avoiding moving them, thus keeping people away from possible contamination. Secondly, by allowing the medical expert to intervene and bring their expertise to remote locations to people who are both infected, and not infected, it will protect the medical expert from possible infection also. You have to remember a conventional ultrasound requires a significant proximity to the patient, making it more difficult to protect the medical professional from possible infection,” says Lefebvre.
Lefebvre says on an operational level, MELODY makes it possible to solve the problems of unequal access to healthcare in medical imaging while allowing savings in transport costs. “It is in addition to the benchmark imaging examination for so-called fragile populations such as pregnant women and children because ultrasound is harmless to health,” he says.
ESA itself owns physiological monitoring units, like temperature or blood pressure; imaging, like ultrasound; and defibrillators, with telemedicine capability that traditionally have been used for astronauts landing operations and space analog experiments. “These units have been loaned to medical centers in Spain to fight COVID-19. ESA has also been working on a mission to support the Piemonte region in Italy for COVID-19 rapid screening and epidemiological mapping towards its B-LiFE application. ESA and the University of Louvain joined forces to create B-LiFE (Biological Light Fieldable Laboratory for Emergencies) in a bid to boost biolab capabilities using space assets. The result is an autonomous, rapidly deployable communications bubble,” Ponziani says.
According to ESA, B-LiFE first came to prominence during the Ebola epidemic in 2015 in Guinea. Blood samples from infected patients were analyzed in the B-LiFE laboratory and results were sent via satellite link to secure B-LiFE databases. Doctors in Belgium were able to monitor the status of the epidemic remotely as well as the effects of new drugs developed to treat Ebola, helping them to tailor treatment to individual patients.
A Smarter Future
The main role of space is monitoring and enabling, according to Ponziani but it goes beyond that is way to transform to a smarter way of living, as we enter the era of smart cities and smart communities. She sees a future in not only technology-based healthcare, but technology-based cities in the future if we address challenges on a large scale.
“The need for digitalization and decentralization of certain functions is not an exclusive need of healthcare systems. You have to look at the combined impact of enhanced smart healthcare, smart working, smart education, smart mobility on the quality of life and on the environment,” Ponziani says. “The importance of prevention instead reacting to emergencies. The digital technology is there and it is an exponential technology. We will experience the same kind of disruption we saw in the ’90s when we first saw the internet. I do not see issues related to space-based healthcare, it will be there at the rendezvous. It is already here. Society’s challenge is establishing the right balance between digitalization and potential human social isolation, as a result of this disruption.”
Supply Chain
Satellite technology also plays a huge role in stopping the spread of pandemics in rural communities. Kyle Whitehill, the CEO of Avanti Communications is already seeing the impact that satellite is having in Africa, and the pandemic has only heightened this. Avanti has been has worked with the government in Niger on healthcare initiatives, and it has been involved in rural maternity clinics in the Democratic Republic of Congo. “We have done e-health and telemedicine in DRC in the summer of 2019. That is three rural maternity clinics connected to a central hospital in the capital of DRC. It is amazing when you see it in real life. They don’t have doctors in rural communities. They have nurses, that quite often they do not necessarily have a full nurse education. In Kenya, we are working with Red Cross on disaster, risk and reduction. They are the big ones we have done. The application isn’t hugely sophisticated. What you require is an expert to see what is happening somewhere else,” says Whitehill.
As for the possibility of more partnerships between satellite companies and major healthcare companies going forward, Whitehill gives an interesting response. “When I was CEO of Vodafone in Ghana, Accenture had a program where effectively if you wanted to become an Accenture partner, you had to spend a year in their CSR division. I really liked this program. I met an Accenture person who was working for the government to help overcome supply chain issues that came from the fact if 100 medical bottles arrived in the port of Thema, which is the major port in Ghana, only three got to the rural communities that needed it. So, they lost 97% of the medicines they needed from going from the port to the rural communities,” he says. “So, his job was to work with the Ghanaian government on how to improve the supply chain and get a higher percentage. How are you going to solve the problem of telemedicine? You are going to have to work with government bureaucracy. If you think about, you could go to Glaxo or Bayer, and say ‘Let’s do this together.’ You could run a world class pilot. You have to embed yourself into the government’s process and the people who are responsible for delivering it.”
Whitehill believes the satellite industry could work together more and provide an over-arching solution for global healthcare. He says, “The satellite industry could collaborate with each other to deliver significantly more results together, rather than doing it independently. We don’t all have ubiquitous coverage, or the same resources in each country. I would want to say could the space industry could collaborate with each other and go to the WHO or another significant organization (Save the Children), and do something significant together that really tackles this specific issue.”
Welfare of Remote Communities
Inmarsat is another satellite operator that has been working in remote healthcare in Africa for many years. For example, it has worked with SOS Children’s Villages Benin and Safe Triage to bring health monitoring to remote communities in Benin in West Africa. This linked onsite medical teams to urban hospitals for real-time access to diagnostic expertise and enabled the early identification and treatment prioritization of potentially life-threatening diseases.
According to Mike Carter, president of Inmarsat Enterprise, this trend towards satellite-based healthcare will only accelerate as a result of COVID-19. He says, “The current pandemic will only serve to accelerate this trend towards satellite-based healthcare, as it becomes clear that telemedicine does not need to be considered a stop-gap approach, but can become the basis for ongoing healthcare provision in remote areas. And what will underpin this is the appreciation that satellite connectivity is not merely about disease prevention but is about managing the overall health and welfare of remote communities.”
So, what could the future of space-based healthcare look like? Carter says one trend he can see is the growth in wearable technology, which is especially pertinent in the healthcare context. “I am hopeful that over the coming decade, we will see doctors regularly examining patients via video, whilst supporting medical devices are providing real-time data on the condition of the patient,” he adds. “And going forward, we are already seeing the use of medical robots and other [Artificial Intelligence] AI-type technologies being pioneered. It is exciting to think that, in the future, a specialist surgeon could perform a medical procedure from hundreds if not thousands of miles away.”
However, satellite’s role in healthcare is multi-faceted as Carter points out. He says, “We saw this in the work of BBC Media Action during the Ebola crisis in Sierra Leone. They used the broadcast capabilities of satellite communications to deliver vital guidance on best practice sanitary behaviors to communities that had no other way of accessing this information. By doing so, they certainly helped many in remote communities, unable to access reliable terrestrial connectivity, to stay safe and avoid the risk of infection. And this is where satellite communications is so valuable. It can provide both one-to-one and one-to-many connectivity, using the same infrastructure and the same, on-the-ground technology.”
After the COVID crisis, Carter believes remote consultations will become the norm. Carter believes this sort of revaluation and reinvention of traditional operating models is something we have seen across industries during the crisis, with many approaches yielding effective results that will certainly alter. But, with governments’ cash constraints, there are other factors.
“Many countries are going to face a severe squeeze on their financial resources over the coming years and this will lead to some tough choices. This will be especially an issue for emerging economies and here satellite-enabled healthcare may be the only option to extend and strengthen the provision of medical services in regions outside the major urban centers,” Carter says. “If we look beyond the immediate impact of COVID-19, we are seeing – in effect – the widescale implementation of new ways of working for the medical community. And what it is showing is that for remote communities, telemedicine is not just a stop-gap measure but may be both more effective and require fewer human and financial resources than the traditional ways of working. For these reasons, we expect to see the adoption of telemedicine solutions increase significantly once the immediate crisis has been addressed. And satellite connectivity will be at the heart of this transformation.”
A Satellite-Based Social Distancing App
Lanterne is a U.K.-based startup whose free app Crowdless uses satellite data to help people socially distance. CEO Alex Barnes says the the company was originally started to help people navigate safety in conflict zones, but recalibrated in response to the COVID-19 pandemic. The company came up with Crowdless, which helps users avoid queues and crowds. "We want people to be able to plan ahead — 30 seconds on the app should hopefully save you 30 minutes in a queue," he says.
It is an intriguing concept and showcases innovative use of satellite technology. Barnes says the company is exploring a number of ways to further develop the app, like adding more venues such as pubs, doctors' offices, or public libraries. Crowdless has spoken to government bodies, both at the national and city council level, about how to tackle the current social distancing situation.
Barnes believes COVID-19 has given people a renewed appreciation for public spaces and communal gatherings, and challenged our assumptions about flexible working. “Through Crowdless, Lanterne is focusing on giving people useful information to help them manage their time and exposure risks when they decide to visit communal spaces. We're also thinking about how to support the economic recovery, including strengthening local business, retail and tourism, by giving people more confidence that they understand how busy places are before they leave to visit,” he says.
Barnes believes there are a range of impressive ways that organizations are monitoring the disease using satellite technology. He cites the example of ESA's Rapid Action Coronavirus Earth observation. He also believes Lanterne and other organizations can also be creative about supporting local communities during this time. He cites another example where AstroSat has repurposed their ThermCERT technology to support local authorities identify and support vulnerable populations. “I think satellite technology is a helpful tool for tracking, monitoring and planning, which has to be deployed alongside a range of other measures,” he says. VS