Australia / Israel Review

“Start-Up Nation” innovation in the fight against the virus

The worldwide mobilisation to address the coronavirus pandemic has been compared to a war, and nowhere has this been more true than in Israel, where government, defence and academia have pulled together as in wartime to provide innovative solutions to the crisis both domestically and as part of the global community. 

Israel, the world’s leader in start-up companies per capita, has directed that innovative mindset towards some trendsetting efforts to harness technologies and resources to mitigate the coronavirus crisis on four fronts: improving testing methods for determining if people have contracted the virus; creating better treatments to lower mortality rates for those already infected; developing a vaccine to protect those who haven’t been stricken; and improving patient care to deliver the best outcomes for coronavirus patients while minimising risk to the people caring for them.

TESTING IMPROVEMENTS

Testing for coronavirus has been a highly fraught aspect of the current outbreak given the global shortage of testing kits, and the slow pace and labour intensiveness of traditional lab testing methods.

Israeli researchers have been taking a multi-faceted approach to improving testing methods through technology.

At least three different Israeli companies are developing coronavirus screening and monitoring platforms, based on artificial intelligence, that analyse the sound of a patient’s voice and breathing, observing patterns in order to detect the illness, as well as allowing doctors to evaluate the severity of the symptoms among those infected.

Cordio Medical has modified its HearO app, which had previously been used to remotely monitor fluid accumulation in the lungs of outpatients suffering from heart failure. HearO, already in use in 10 Israeli hospitals and medical institutions, is now undergoing clinical trials for coronavirus cases.

Tel Aviv start-up Vocalis Health, working under the guidance of Israel’s Defence Ministry, is developing a similar product, while Herzliya-based Voca – whose core business focuses on automated call centre technology – has partnered with Carnegie Mellon University in Pittsburgh, USA, to develop what it calls the Corona Voice Detect app.

Coronavirus can also potentially be detected not only through sound but through smell. Israel’s Ministry of Defence is teaching dogs from the IDF canine unit to help identify coronavirus patients by smelling saliva samples – a technique that is also being explored in other parts of the world.

On the patient side, Israeli health funds working together with civilian and military partners have unveiled innovative walk-up kiosks in two Israeli cities offering contactless testing for coronavirus. Health care workers conduct the tests from inside pressurised booths using rubber gloves that extend outwards from the enclosure. Between patients, the gloves are carefully washed with disinfectant, providing a secure environment for patient and clinician alike.

A further 30 booths are slated to be deployed in the coming days.

“We would be happy to share the design plans with any health organisation worldwide in order to support our shared mission of fighting the COVID-19 virus,” Maccabi health fund CEO Ran Sa’ar told the UK’s Daily Mail.

Meanwhile, on the laboratory side, researchers at the Technion-Israel Institute of Technology, collaborating with experts at Rambam Medical Centre in Haifa, have come up with a new method of processing test results that could vastly speed up the rate at which tests for the virus can be completed. The technique, known as “pooling”, involves protocols which make it possible for a lab to test samples from up to 64 people at the same time, rather than one at a time, as is the usual practice.

Also, the British-Israeli company “diagnostics.ai”, whose R&D centre is based in Herzliya, is using artificial intelligence to vastly shorten the time it takes for labs in the US and UK to process coronavirus test results, effectively doubling the rate of testing without the need for more technicians.

Tel Aviv University (TAU) has opened a dedicated coronavirus research lab, which will also be able to perform 1,000 tests for coronavirus a day, adding to Israel’s ability to slow the spread of the virus.

Israel has also recruited more than 600 doctoral students from across the country’s top universities and medical centres to help with testing.

“The level of collaboration between faculty, physicians, health professionals and medical and graduate students at the universities, hospitals, health maintenance organisations, Magen David Adom, and Ministry of Health, is unprecedented in Israel,” Professor Karen Avraham, Vice Dean of TAU’s Sackler Faculty of Medicine, reflected.

BETTER CORONAVIRUS TREATMENTS

While the public’s focus may be on vaccine development, inoculations are useless to the millions of people worldwide who have already contracted the virus, or those who are expected to in coming months.

For those people, the medical community is more focused on finding off-the-shelf treatments that might weaken the virus’ fatal grip on so many patients, especially the elderly and those with pre-existing health issues.

To that end, scientists at Israel’s Weizmann Institute of Science, together with Diamond Light Source laboratory in the UK, are “pioneering a revolutionary method of scientific research that could see a candidate for an anti-coronavirus drug emerge ‘within weeks’” the UK’s Jewish Chronicle reported.

According to Dr. Nir London, who heads the team at Weizmann, the technique involves using the “crowd-sourcing of global intelligence” to quickly generate an “unprecedented amount of preliminary data” and then using tests conducted on all proposed molecules in parallel, rather than linearly, enabling scientists to follow up on “500 to a 1,000 compounds” in the same period it would normally take to test a “few tens of compounds.”

Potential treatments go beyond pharmaceuticals. Haifa-based Pluristem has used its PLX placenta-based stem cell-therapy product to treat seven ventilated, critically ill coronavirus patients, including one in a US hospital. All of them survived, giving hope for its potential as a treatment in improving coronavirus survival rates.

Like other countries, Israeli hospitals are also experimenting with treating patients with antibodies from people who have recovered from the virus. Results, while encouraging, are still inconclusive.

Coronavirus kills most of its victims by affecting the lungs – typically, in such cases, double pneumonia sets in and the organ loses its ability to oxygenate blood, until the point that the weakened body can no longer breathe on its own and the patient dies.

At that crucial point for so many, the only thing standing in the way of death is a ventilator, which breathes for the patient until the immune system can beat back the virus and healing begins.

The fear in Israel, as in Australia and elsewhere, has been that the number of critical patients in need of ventilation will exceed the number of ventilators available. It has been said that in the war against the coronavirus, ventilators are the tanks on the battlefield, personal protective equipment (PPE) are the bullets.

Perhaps it’s not surprising, then, that Israel’s Ministry of Defence, defence contractors and entire units of the Israel Defence Forces itself have been redeployed as ventilator builders and PPE makers virtually overnight.

The IDF tasked its famous Unit 81, the military intelligence technology unit, with upgrading simple and inexpensive household breathing regulators, commonly known as CPAP machines, into “smart” ICU-grade ventilators. The first prototype reportedly took a month to perfect. Israel’s Health Ministry ordered 1,000 – the first hundred were delivered on April 19.

Meanwhile, according to the Jerusalem Post, Israel’s Defence Ministry, in collaboration with medical company Inovytec and Israel Aerospace Industries (IAI), launched a production line for Ventway Sparrow ventilators on the grounds of a classified IAI missile production site.

Additionally, Unit 108 of the Israeli Air Force has teamed up with Microsoft Israel Research and Development, Ichilov Medical Centre, Magen David Adom (MDA) and others to develop a simple respirator that could be mass-produced in labs at low cost. It is being developed as “open source” so that countries around the world can ramp up manufacturing locally, affordably and in a short period of time.

The IDF has also retooled assembly lines previously used to build seats for tanks in order to produce protective goggles for health care workers.

THE RACE FOR A VACCINE

Early reports that Israel was ready to export a coronavirus vaccine to the world were premature: In reality, even vaccines that appear to work on lab animals need additional testing before they can be considered safe and effective in humans. All such candidates would require extensive clinical trials that take at least a year. However, there are at least four Israeli institutions closing in on such a vaccine.

Israel has recruited its university labs and doctoral students to assist with testing

Israel’s state-run Institute for Biological Research (IIBR) was tasked with the job of creating a vaccine early on by Prime Minister Binyamin Netanyahu. Fifty top scientists at the Institute are working on the vaccine, in three separate teams, alongside a global biotech company with complementary expertise. As of the end of March, according to reports, IIBR had begun testing a COVID-19 vaccine prototype on rodents.

In addition, Migal Galilee Research Institute, located in Kiryat Shmona in Israel’s far-north, has spent four years working on a vaccine for a coronavirus disease in poultry that has many similarities to the current novel coronavirus which is causing the current pandemic among humans. 

David Zigdon, the CEO of Migal Galilee Research Institute, said his lab was working hard to accelerate the vaccine’s development, and is expecting to be able to go to clinical trials “within a few months”.

“The experiments we have carried out so far show that because the vaccine does not include the virus itself, it will be safe to use in immune-suppressed recipients, and has fewer chances of side effects,” Zigdon said in an April 22 statement announcing a new infusion of venture capital funding in the vaccine’s development.

Meanwhile, Professor Jonathan Gershoni of the School of Molecular Cell Biology and Biotechnology at TAU, announced on April 19 that his lab was “two-thirds of the way to a vaccine” that would tackle not only COVID-19, but the entire family of coronaviruses – past, present and future.

Gershoni was recently granted a US patent for his vaccine model, which would target the coronavirus’ Receptor Binding Motif (RBM) – what he believes is a vulnerable keystone in the virus’ mechanism for invading a cell. According to Gershoni, who has studied the coronavirus family since 2004, a vaccine that would target the virus at this stage would likely be effective against any mutation.

“The idea is to recreate, to reconstitute, to construct an RBM of COVID-19 virus and use it as the vaccine,” he told the Jerusalem Post. “That is to say, you would inject a small 50 amino-acid sequence and it would allow our immune system to focus on it and create antibodies that would directly target the virus at its weak spot.”

Finally, at Haifa’s Technion, Dr. Avi Schroeder, head of the Laboratory for Targeted Drug Delivery and Personalised Medicine Technologies, is aiming to rework an immunity-boosting treatment he has previously developed to fight a virus affecting shrimp into a coronavirus vaccine.

“Viruses infect us by multiplying inside our cells,” Schroeder told Forbes. “To do this the virus produces proteins. [When] we stop the production of these proteins inside the body, this is called RNA interference. The shrimp [treatment] triggers RNA interference, breaking down the messenger RNA that carries the virus that infects the body”, and Schroeder believes he can interfere with coronavirus RNA in the same way.

REFINING PATIENT CARE

Winning the war against coronavirus requires a holistic approach that maximises efficiency in caring for patients, while at the same time minimising exposure to the virus, not only for doctors and nurses, but other patients and staff in the hospital. Israeli tech companies are providing innovative solutions in all aspects of patient care.

For example, CLEW Medical, based in the coastal city of Netanya, has developed an artificial intelligence platform for use in intensive care units (ICU) designed to identify a pattern of respiratory deterioration in patients in real-time and issue pre-emptive warnings to ICU doctors accordingly. While already in use in some Israeli hospitals and not aimed at coronavirus per se, the technology is expected to be especially valuable in coronavirus cases, given the disease’s notoriously fast-moving nature.

The Israeli defence contractor Elbit Systems has developed an automated radar-based system to measure a patient’s heartbeat, respiration rate and body temperature from a distance, without any need for physical contact by a medical worker. It is currently undergoing medical trials at Rabin Medical Centre.

Tel Aviv-based Kryon Systems has developed an automation system to help Israel’s health insurance companies quickly process the mountains of data coming in from the country’s growing number of coronavirus patients – as well as those who have tested negative. Kryon is now offering its automation technology free of charge to assist in the global effort to combat the virus.

In Israel, even secondary school students have made a meaningful technological contribution to the national effort, with students at the Hebrew Reali School in Haifa answering the call of Rambam Hospital for a remote-controlled robot to handle some of the tasks required in coronavirus wards, reducing the exposure of staff to the virus.

Israel has proven itself to be at the cutting edge in helping solve this dangerous pandemic. Time remains of the essence, but Israel’s entrepreneurs, academics, engineers and innovators appear to not be wasting any of it.