NEB Podcast #45 -
Interview with Anu Rebbapragada: Building a Diagnostics Company During the Pandemic

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Transcript

Interviewers: Lydia Morrison, Marketing Communications Writer & Podcast Host, New England Biolabs, Inc.
Interviewees: Anu Rebbapragada, VP of Diagnostics Services, FH Health, Canada


Lydia Morrison:
Thanks for joining us for this episode of the Lessons From Lab and Life podcast, brought to you by New England Biolabs. I'm your host, Lydia Morrison, and I hope this podcast offers you some new perspective. Today, I'm joined by Dr. Anu Rebbapragada of FH Health, which is based in Toronto, Canada. FH Health is a health tech company that was created early in the COVID-19 pandemic to address public diagnostic testing needs.

Lydia Morrison:
Hi Anu, thank you so much for joining me today.

Dr. Anu Rebbapragada:
Hi Lydia. Thank you for inviting me.

Lydia Morrison:
So by way of an introduction, I was hoping that you could tell the listeners about the focus of your work over the last several years.

Dr. Anu Rebbapragada:
Sure. I'm a clinical microbiologist by training. I'm certified by the American Board of Medical Microbiology, and really, infectious diseases have been my passion. I started my career in a very academic setting doing research on signal transduction and bacteria, but then pivoted into the clinical diagnostic space. I've worked with the Gates Foundation doing HIV STI research in Kenya. Then I was a senior scientist at Public Health Ontario, which is the largest reference lab here in Ontario, Canada. I pivoted, once again, into the private sector. I was the lab director at Dynacare, which is a large private lab with high volume testing labs in three provinces of Canada, and it's owned by LabCorp USA, which I'm sure you all know is a big lab in the US. I've also worked in the medical device space at Hologic, national director of scientific affairs. So as you can see, I've had a breadth of experiences in the diagnostic space. And currently, I'm working at FH Health, which is a startup that was created in the midst of the COVID pandemic to really transform how we deliver diagnostic services.

Lydia Morrison:
Yeah, it sounds like you have a lot of experience across a wide range of diagnostic services. Could you explain a little bit more about your role at FH Health?

Dr. Anu Rebbapragada:
Yeah. At FH Health, my title is VP of Diagnostic Services, but I'm also the laboratory director for our fully licensed and accredited lab where we perform COVID diagnostic testing. And now in the process of building other diagnostic services.

Lydia Morrison:
Interesting. So has the COVID-19 pandemic shifted the focus of FH Health?

Dr. Anu Rebbapragada:
That's an interesting questions. A as I mentioned before, FH Health was created in response to the COVID pandemic. So it didn't exist before October 2020. And so we've worked incredibly fast and furiously to stand up a lab and get it licensed and accredited in a very short period of time, and very functional as well. We have turned around 500,000 COVID results in the span of a year. And we are primarily servicing the community, the private pay population here in Ontario, which is a radical thing in and of itself because, in Canada, we are under a socialized healthcare system where you receive services through the government, through publicly funded labs and hospitals. But given the dire necessity during the pandemic, there was a need for additional testing services for travel, for reassurance, workplaces, film industry. And so that was the impetus to create FH Health.

Dr. Anu Rebbapragada:
And the question for our organization is not about, did COVID change our focus, but as a result of COVID, we've realized how broken the diagnostic system is. And I think it's really brought to the forefront a lot of things that can be done differently. What's unique about FH Health is it was born by technology entrepreneurs who have created apps and digital solutions in the financial commercial space. And they have really radically reinvented how we do diagnostics. And for someone like me, who's worked in many different diagnostic settings, for me, it was really thrilling to build something new and responsive from the ground up that provides results in a digitized fashion, that really takes into account that patient journey from the time they experience symptoms to how they book an appointment, how they receive their results, how they track where their sample is. So that was really the draw to bring me into the startup space, to create something truly novel and responsive to the diagnostic experience.

Lydia Morrison:
Yeah, it's a pretty incredible feat to have launched a company so quickly in such a new space to deal with the COVID pandemic. Do you feel like there were major contributing factors to that success?

Dr. Anu Rebbapragada:
Certainly. I think the secret sauce, if you call it, of our organization is our passion and our drive. I've worked in so many different environments. And in this startup environment, really, the energy and the pace at which we did things was phenomenal. We didn't have the bureaucracy of government. We don't have the hierarchy of some of these larger private organizations. What I really love about FH Health is we work very cohesively and collaboratively, and we make decisions quickly, and we execute on them quickly as well. And for me, what was important is that we weren't compromising any diagnostic quality or accuracy. We are now ISO 15189 accredited, and that is a very significant achievement. It has a lot of requirements to demonstrate, not only quality control, training, competency assessment, validations for us to do things very quickly, but also methodically and with a high level of quality. I think that is something unique and phenomenal about FH.

Lydia Morrison:
That's pretty amazing to hear. I think certainly the COVID pandemic has created a scenario where lots of science is moving forward really quickly. Could you tell us specifically about what diagnostics FH Health is offering?

Dr. Anu Rebbapragada:
Sure. We offer RT-PCR testing for COVID. So this is the most sensitive way to detect an infection. We have three different assays that we use. We've also validated a pooling-based detection system. In addition to PCR-based testing, we do antigen testing, and that's offered in a variety of formats, which makes it interesting. One is a person walks into our clinics, we have 20 clinics across Ontario, they walk in, and they receive a rapid antigen result. But the other is a virtual appointment where a person has a kit delivered to their home, and the nurse monitors their self testing process over a screen. And this has worked incredibly well, especially during the busy travel season. We've done a lot of virtual appointments. And it really goes to show how digital and tech-enabled we are in providing these diagnostic solutions.

Dr. Anu Rebbapragada:
We also offer antibody testing, three different types of antibody testing to look at our immune response after vaccination, after natural infection. And the newest antibody test is this innovative one that specifically detects functional neutralizing antibodies that are able to prevent infection. And as we enter the sixth wave, or actually we're in the midst of the sixth wave, people are wondering if they should get their third or fourth booster. And knowing their functional antibody levels is a great way to get that individualized profile of their risk and whether they should get vaccinated now or wait until their immune system really needs another booster.

Lydia Morrison:
Yeah. What a helpful diagnostic tool. That's really interesting. I'm curious how you feel COVID-19, how the pandemic has impacted infectious disease research in general.

Dr. Anu Rebbapragada:
Great question. It's funny. I look at all the publications that have come out on COVID in the last two years, and it's hard to believe it's only been two years, but already all of the publications on COVID have eclipsed anything that's been done in HIV research. And there's a vast body of literature on HIV. So a lot of focus has shifted away from the other infectious diseases to COVID because it's just captured all of our lives. But on the other hand, what's great about COVID is it's catalyze so many changes, changes in how we access diagnostic services, how we access care, but also the emphasis on having rapid testing technologies, the emphasis on having rapid knowledge translations. So we know how to use this research in real time. We're not waiting for publications to sit and then slowly get disseminated and put into guidelines and practice. The rapid pace with which research is being assimilated and then implemented is amazing. And I hope that we do the same for other neglected infectious diseases once we start pivoting away from COVID and shift our focus to all the other things that still require attention.

Lydia Morrison:
Yeah, absolutely. I think you raise a really interesting point, which is the speed at which government organizations are able to take into account scientific research and implement that, as you said, into policy, and procedure, and guidelines. And I think that has been a major shift. And I think it was certainly slow to start, at least in the United States. And so I think it's been nice to see that prevalence of scientific thought being translated into policies that help protect the community.

Dr. Anu Rebbapragada:
Right. And I think beyond the policies and guidelines, we've seen a lot of test development. We've seen a lot of new medical device companies pop up new ways to detect infection, whether it be at the point of care, whether they use virtual technology. So to me, I feel like a kid in a candy store I've been waiting for this diagnostic transformation. I've done a lot of research in this space, but pre COVID, it was such a slow journey to first conceptualize something, then do the research, then you validate it, and then you wait for FDA or health Canada approval. And it's such a slow process. And to see the acceleration of that review, and responsible review, I might add, and responsible implementation, that's inspiring to me. And I only hope we can transfer some of that energy and enthusiasm to other diagnostic conditions.

Lydia Morrison:
Yeah, absolutely. How do you think this experience has impacted preparedness for the next virus of concern?

Dr. Anu Rebbapragada:
Well, there's two ways my mind works. Sometimes I can be very cynical and sometimes I'm very optimistic, and they both exist in me. The optimistic view that I take is we've learned a lot, and certainly there's some pitfalls that we can certainly avoid for the next big pandemic, whether it is another coronavirus, or an avian flu, or whatever else. I think we've learned that communication, and really knowledge translation is so critical in galvanizing people, and having the public respond to public health measures. I think often scientists and public health officials, epidemiologists were seen as being in an ivory tower. We're consuming a lot of information and trying to present it to the public, but we don't do a very good job in effectively communicating it to that audience. So I think that's one big lesson that I hope the whole space has learned. And the other is preparedness comes in all different ways. We've learned about supply chain shortages. We've learned about technology shortages, and then there's system shortages. So the optimistic view is that we've learned about these challenges, and we will start addressing it.

Dr. Anu Rebbapragada:
My cynical view is human behavior is hard to change. And as much as we've learned, we also tend to forget, and it's been 100 years since we've had the last pandemic. And here we are in 2020 and now 2022, and it feels like the public really doesn't have an appreciation for taking a collective responsibility, or understanding what vaccines do at a basic level, how testing can really support risk mitigation so that not everybody has to live in a bubble. So I think there's a lot of behavioral changes that need to accompany all the technology changes. And I'm in the technology space, so I get excited about that, but technology without proper implementation is really ineffective. So I hope the behavioral change also follows.

Lydia Morrison:
Yeah, I think you raised some really interesting points. I, myself, am obviously a huge fan of scientific communication, and I've always felt like there is a major disconnect between scientists performing the research and the general public. And I think that something that the field could really benefit from in general is more science communication training earlier on in scientific careers, just around the best way to present ideas. And I think, at that point, during scientific training, a lot of people are really focused on the granular detail and presenting their thesis and defending their thesis to other scientists to establish PIs. But I think there's definitely something to be said for an individual who can play an in between role and would be able to communicate that complex science to a layman, to someone who's not in the field, and make that communication impactful, and meaningful, and something that the person can understand and walk away with an understanding of even if it's not a finely tuned, detailed understanding.

Dr. Anu Rebbapragada:
Right. You're, you're absolutely right. We need knowledge translators who can be that conduit. And I look at myself and I fall into the trap of going into the details and in nitty gritty, granular fashion, because that was my training, and everything feels like a dissertation. And I wish I had sales and marketing training because there is a marketing aspect to how the core elements of that scientific finding are communicated to a wider audience. And perhaps that's something that will become a part of curriculums going forward.

Lydia Morrison:
Yeah. I'd love to see that as someone with a master's in biochemistry and biophysics who eventually made my way into marketing and has learned the marketing over the last few years, I can imagine that that's something that would've been really helpful to me when I was in graduate school. So where do you hope to see your work in the next five years, Anu?

Dr. Anu Rebbapragada:
Well, certainly, what we have built at FH Health is a reinvention of how diagnostic services are delivered. And there's a lot of need in the diagnostic space for infectious diseases, but also chronic diseases and genetic conditions. And a lot of the principles that we have built with molecular testing, but also in that patient journey, the digitization of that journey that I talked about, I would like to see that applied to chronic diseases, genetic screening, so that patients are not in the dark waiting for their results, so that when they receive their results, they also receive the proper interpretation, the physician consultation, and it's delivered in a way that is empathetic, and responsive, and convenient at the end of the day. Lining up at a collection center to provide a sample, that's a barrier. Can we have home-based collections? Is there something else that we can do to alleviate that bottleneck? And virtual consultations I think are here to stay, and they're very convenient without jeopardizing quality.

Dr. Anu Rebbapragada:
And I look forward to seeing how else we can make that result faster, more accurate, and more immediate so that patients can take action for what they need to do.

Lydia Morrison:
Yeah. And I think that's really powerful. I think that we're living in a time right now where it's really important for individuals to take ownership of their own healthcare. And I think that there's a lot more information available allowing people to do that. And I think you mentioned convenience. And to me, it stands out as efficiency too. I think everybody feels like time pressured, oftentimes in life, and just in the general run of the day. And I think that being able to meet with a physician, take a test at home, have that assurance in hand, and to be able to do that in the comfort of your own home, especially with the instruction of a qualified nurse or a qualified practitioner, I think that's a really powerful way to reimagine the healthcare and diagnostic processes.

Lydia Morrison:
And as a patient, I know what it's like to have a blood sample taken or something like that, and be waiting on the results of your test for a long time, and have to wait for a physician to interpret those results for you. And I think that putting that access in a patient's hand could be a really amazing way to help bring healthcare forward, and help bring patient responsibility and patient control over their care to a next level.

Dr. Anu Rebbapragada:
Yeah. You said it so beautifully. It is that patient responsibility, but also empowerment at the same time, doing this accessibility in convenience. But on the other hand, there's also a lot of health system benefits in removing these bottlenecks so we're not transporting specimens to a centralized lab. There's a lot of logistical delays. There's bottlenecks because of that, errors because of that. And also, alleviating the burdens on the hospital and urgent care system. If people can get virtual consults from home, then they're not lining up in the hospitals for people who actually need to access those critical care services. There's a lot of new technology, even for remote oxygen measurements, oximetry, and that's a game changer because people who are afraid of COVID, for example, and afraid that their oxygen levels are low, are going to rush to the ER. Meanwhile, there's a lot of other people who need that urgent support. And having some of these remote tools, virtual tools, I think can only improve the entire health system while bringing convenience to individuals.

Lydia Morrison:
I think you're absolutely right. So as a final question here, I just wanted to know which virus you find the most interesting, and why?

Dr. Anu Rebbapragada:
This was actually my favorite question. And I love to ruminate on this. I was like, my favorite virus. Well, that's like asking me my favorite food. I can't just pick one. There's so many tasty foods. And same with viruses, I'm thinking of, well, there's influenza, it mutates so much. And there's avian influenza. Well, what about HIV? And certainly COVID is captured all of our lives. So I made a list of what are the things that make a virus stand out in my mind? And I'm thinking population level impact, people feel the presence of this virus, the transmissibility, the severity of the virus, and the complications it causes, and then any unusual effects on the immune system, something unique in how it operates.

Dr. Anu Rebbapragada:
And certainly, there's many viruses that are severe and lethal. I'm thinking Ebola. It's horrific. And HIV certainly fits the billing with it has a population impact, it's transmissible, it's severe, it does weird things to the immune system. But then I thought of a virus that people don't think of very often, and hopefully, it can bring it to the forefront. It's dengue virus. And this is a virus. This is a single stranded RNA virus. It's transmitted by a mosquito, Aedes mosquito. And it affects four billion people who live in endemic areas where these mosquitoes also thrive. And what's happening with global warming is that we're seeing more and more regions that are affected by dengue virus. So in the past, we would think, "Dengue, that's African countries, maybe Caribbean countries," but it's creeping up north as our planet's temperature rises. So we're seeing mosquitoes migrating to newer areas.

Dr. Anu Rebbapragada:
And what this means is there are more people who are getting infected. So currently there's about 400 million people who are infected every year. And there's about 40,000 deaths every year, which doesn't seem like a lot, but 400 million people infected still has a lot of burden on healthcare systems. Sometimes the infections are mild. You have some aches and pains, and it goes away. But what's very interesting about dengue is if a person is infected with dengue, and there's four different stereotypes of dengue before I proceed, there's four different stereotypes. So let's say I get infected with one stereotype. I build some immunity against that particular stereotype, but when I get a second infection with a different stereotype, the antibodies produced by the first infection actually enhance the secondary infection. And this is phenomenon called antibody dependent enhancement, which it's mind boggling because we think the immune system is here to protect us.

Dr. Anu Rebbapragada:
But low and behold, the antibodies is generated from the first infection when they bind this new stereotype of virus that's trying to infect you, it actually enhances the ability of this virus to infect you, but also cause severe complications. So that secondary infection leads to hemorrhagic fever, plasma leakage, all kinds of very severe effects, and eventually death. And there's some scary stories, even with vaccine trials, with the dengue vaccine, very sad, actually, in zero negative children who got vaccinated, there were actually 14 deaths, and it's because the vaccine was simulating this primary infection. So when these kids went out after they got their vaccine and they acquired a secondary infection, that secondary infection was more potent, and it actually led to some deaths in these children.

Dr. Anu Rebbapragada:
So it's a very unusual virus in that sense. It's clearly has an impact on our immune system. And given the prevalence globally and only the increase with global warming, I think it's something we should look out for. And I have a soft spot for neglected tropical diseases, being someone who is born in a born in India and lived in those tropical climates. There's no FDA-approved test for dengue, even though it impacts 400 million people who are infected yearly. So it just speaks to the need to think globally and to have some solutions for some of these neglected viruses that may come to the forefront as our environment changes.

Lydia Morrison:
Yeah, that's really interesting. Neglected tropical diseases are a passion of any bees as well. And since our founding, we've actually had a research group dedicated to neglected tropical disease research. And so I'm familiar with dengue a bit, but I was not at all familiar with the antibody, the secondary infection antibody response, which is really quite scary and shocking, I think.

Dr. Anu Rebbapragada:
Scary. And I hesitated to even bring it up because, with all the confusion around vaccines, I didn't want to add fuel to that fire, but it is an unusual phenomenon. Thankfully, not found with the COVID vaccines that we're using, but it just goes to show you that there's still so much to learn about viruses. And they're so unusual. They're not even truly living creatures. They're just pieces of RNA and DNA floating around, and yet they have so much impact. There's cancer causing viruses. There's hemorrhagic fever. There's things that affect our neurological symptoms. So this is why I got into infectious diseases. I continue to be fascinated by them. And they evolve. I say they evolve more than humans do. So I think we should stay on our toes to see what else happens in the next however many years we're around.

Lydia Morrison:
Absolutely. And I think that your passion for infectious disease research and viral diagnostics, as well as for the advancement of technology and patient empowerment in healthcare is really heartening to see. And I think that you can rest assured that you've followed your passion and gone into the right field. It's so nice to hear from someone who's really so passionate about their work, and really helping drive progress forward on a lot of different fronts. So thank you so much for being a guest on the NEB podcast with me today, Anu.

Dr. Anu Rebbapragada:
Thank you so much, Lydia. This is wonderful. I get to nerd out and talk about my passion. So it's been a wonderful experience.

Lydia Morrison:
Well, we love nerds, and we're happy to have you join us. And thanks so much for your time today.

Dr. Anu Rebbapragada:
All right. Have a great day.

Lydia Morrison:
You too. Bye-bye.

Dr. Anu Rebbapragada:
Bye.

Lydia Morrison:
Thanks for joining us today. Please tune in next time. When I interview Susan Aitken, Molecular Laboratory Assistant Manager at the HUCL Lab at Harvard University, which was created to help meet the COVID testing needs of students and staff on the Harvard University campuses.


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