carbon health
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Primary care health tech startup Carbon Health has added a new element to its “omnichannel” healthcare approach with the launch of a new pop-up clinic model that is already live in San Francisco, LA, Seattle, Brooklyn and Manhattan, with Detroit to follow soon – and that will be rolling out over the next weeks and months across a variety of major markets in the U.S., ultimately resulting in 100 new COVID-19 testing sites that will add testing capacity on the order of around an additional 100,000 patients per month across the country.
So far, Carbon Health has focused its COVID-19 efforts around its existing facilities in the Bay Area, and also around pop-up testing sites set up in and around San Francisco through collaboration with genomics startup Color, and municipal authorities. Now, Carbon Health CEO and co-founder Even Bali tells me in an interview that the company believes the time is right for it to take what it has learned and apply that on a more national scale, with a model that allows for flexible and rapid deployment. In fact, Bali says the they realized and began working towards this goal as early as March.
“We started working on COVID response as early as February, because we were seeing patients who are literally coming from Wuhan, China to our clinics,” Bali said. “We expected the pandemic to hit any time. And partially because of the failure of federal government control, we decided to do everything we can to be able to help out with certain things.”
That began with things that Carbon could do locally, more close to home in its existing footprint. But it was obvious early on to Bali and his team that there would be a need to scale efforts more broadly. To do that, Carbon was able to draw on its early experience.
“We have been doing on-site, we have been going to nursing homes, we have been working with companies to help them reopen,” he told me. “At this point, I think we’ve done more than 200,000 COVID tests by ourselves. And I think I do more than half of all the Bay Area, if you include that the San Francisco City initiative is also partly powered by Carbon Health, so we’re already trying to scale as much as possible, but at some point we were hitting some physical space limits, and had the idea back in March to scale with more pop-up, more mobile clinics that you can actually put up like faster than a physical location.”
Interior of one of Carbon Health’s COVID-19 testing pop-up clinics in Brooklyn.
To this end, Carbon Health also began using a mobile trailer that would travel from town to town in order to provide testing to communities that weren’t typically well-served. That ended up being a kind of prototype of this model, which employs construction trailers like you’d see at a new condo under development acting as a foreman’s office, but refurbished and equipped with everything needed for on-site COVID testing run by medical professionals. These, too, are a more temporary solution, as Carbon Health is working with a manufacturing company to create a more fit-for-purpose custom design that can be manufactured at scale to help them ramp deployment of these even faster.
Carbon Health is partnering with Reef Technologies, a SoftBank -backed startup that turns parking garage spots into locations for businesses, including foodservice, fulfilment, and now Carbon’s medical clinics. This has helped immensely with the complications of local permitting and real estate regulations, Bali says. That means that Carbon Health’s pop-up clinics can bypass a lot of the red tape that slows the process of opening more traditional, permanent locations.
While cost is one advantage of using this model, Bali says that actually it’s not nearly as inexpensive as you might think relative to opening a more traditional clinic – at least until their custom manufacturing and economies of scale kick in. But speed is the big advantage, and that’s what is helping Carbon Health look ahead from this particular moment, to how these might be used either post-pandemic, or during the eventual vaccine distribution phase of the COVID crisis. Bali points out that any approved vaccine will need administration to patients, which will require as much, if not more infrastructure than testing.
Exterior of one of Carbon Health’s COVID-19 testing pop-up clinics in Brooklyn.
Meanwhile, Carbon Health’s pop-up model could bridge the gap between traditional primary care and telehealth, for ongoing care needs unrelated to COVID.
“A lot of the problems that telemedicine is not a good solution for, are the things where a video check-in with a doctor is nearly enough, but you do need some diagnostic tests – maybe you might you may need some administration, or you may need like a really simple physical examination that nursing staff can do with the instructions of the doctor. So if you think about those cases, pretty much 90% of all visits can actually be done with a doctor on video, and nursing staff in person.”
COVID testing is an imminent, important need nationwide – and COVID vaccine administration will hopefully soon replace it, with just as much urgency. But even after the pandemic has passed, healthcare in general will change dramatically, and Carbon Health’s model could be a more permanent and scalable way to address the needs of distributed care everywhere.
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Efforts to get at-home test kits for the COVID-19 coronavirus are ramping up quickly, and two more health industry startups are bringing their own products to market, with both Carbon Health and Nurx starting to ship their own in-home sample collection kits.
Both of these new offerings are the same in terms of approach to testing: They deliver swab-based sample collection hardware that people can use at home to collect a mucus sample, which they then ship back using included, safety approved, projective packaging to be tested by one of the existing FDA-approved commercial labs across the country.
These tests follow the PCR-based method, which tests for the genetic presence of the COVID-19 virus in a patient. These have a high degree of accuracy, at least when performed in a controlled setting and administered by a medical professional, and are the same tests that are available via drive-through testing stations being set up by state agencies.
At-home use is relatively new to market, and could introduce some potential for error in the collection part of the process, but both Carbon Health and Nurx are offering consultation with medical professionals to help ensure that samples are collected properly, and that results, when available, are correctly interpreted and provided with guidance on next steps for those taking the tests.
None of these tests are free — the Carbon Health test costs $167.50, and the Nurx test costs $181, including shipping and assessment. These are in line with other offerings, including the one from Everlywell we covered earlier this week, which retails for $135. These are described as essentially at-cost prices, and all parties say they are subject to coverage by FSA or HSA money, or potentially by insurers depending on a person’s plan.
One big question around these types of tests is how much supply will be available. Nasopharyngeal swabs used for the in-person type of testing are already reportedly in short supply in some regions, and testing needs are only growing. Carbon is using different swabs to collect a simple saliva sample, which it notes are not in as short supply as the nasopharyngeal version. Other types of tests, including a “serological” one being developed by startup Scanwell, instead work by analyzing a patient’s blood, and could provide some relief for the swab-based tests, especially now that the FDA has expanded its emergency guidance to include their use.
Nurx, which also offers at-home HPV screening, says that it will have 10,000 kits available to patients “over the coming weeks,” and hopes to expand to cover “over 100,000 patients” in the “near future.” Carbon Health CEO and co-founder Eren Bali tells me that it should ramp to around “10,000 per day capacity in about two weeks,” through its medical device partner Curative Inc., and that it can do 50 per day today, with an estimated increase to 150 per day by Monday and 1,000 per day by end of week.
All of these tests are gated by a screening and assessment questionnaire, and the round-trip time is likely to take a few days even with round-trip shipping due to testing times. It may seem like a lot of these are popping up, but these startups at least have proven track records in healthcare services, and there will be a need for very widespread testing in order for any broad attempt to flatten the curve of the virus to prove successful, so expect more of these providers to come on line.
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