Watch: 'The End of the Antibiotic Era': How COVID-19 Has Changed the Landscape for Health Tech

Tami Abdollah

Tami Abdollah was dot.LA's senior technology reporter. She was previously a national security and cybersecurity reporter for The Associated Press in Washington, D.C. She's been a reporter for the AP in Los Angeles, the Los Angeles Times and for L.A.'s NPR affiliate KPCC. Abdollah spent nearly a year in Iraq as a U.S. government contractor. A native Angeleno, she's traveled the world on $5 a day, taught trad climbing safety classes and is an avid mountaineer. Follow her on Twitter.

Watch: 'The End of the Antibiotic Era': How COVID-19 Has Changed the Landscape for Health Tech

The spread of the novel coronavirus has sped the adoption of telemedicine in the United States, eliminating barriers like insurance reimbursements. It's also shone a light on the need for faster vaccines and a need for greater investment in public health, experts said on a dot.LA virtual panel Tuesday that looked at how investors are responding to COVID-19.

A move to telemedicine "was a long time coming," said Dr. Jeffrey Klausner, a professor of medicine in the division of infectious diseases in the David Geffen School of Medicine at UCLA. "A lot of doctors and institutions weren't comfortable with that" but now those concerns have been "blown out of the water." Since the pandemic erupted, two-thirds of UCLA medical visits have been done using telehealth.


Klauser is also a medical director at San Dimas, Calif-based Korva Labs, which has worked with Curative Inc. over the last 18 days to test Los Angeles County first responders and support drive-thrus. He said the partnership has resulted in testing capacity moving from zero to 5,000 daily since the start.

That partnership was helped along by Llewellyn Cox, a general partner at MarsBio, a biotech and deep-tech venture capital firm that invests in pre-seed and seed stage companies. Cox introduced the folks at Curative to Korva. Cox, who has cystic fibrosis, has kept an eye on the novel coronavirus from its earlier days. He convened a task force in the first week of March to try to address COVID-19 response issues like supply chain and access to testing kits.

Cox has since pivoted to looking at companies to help address the second and third wave of issues and technology to prevent another COVID-19 from happening.

Strategy Session: Venture on the Front Line of COVID-19www.youtube.com

The novel coronavirus has led to a boom in business for companies in the healthcare world. At Wavemaker Three-Sixty Health, a seed-stage healthcare-focused venture capital fund, 27 of its 29 companies in the portfolio are actually "better off" financially due to COVID-19, said Jay Goss, a general partner at the firm.

"We're being pulled to move faster even to the point of accelerating the timeline in the next fund, instead of slowing down," Goss said. "The world is more aware of the need for healthcare, it's always been there, but now more people are paying attention to it and less attention to the need for electric scooters, or other things."

Of the remaining two portfolio companies that have been impacted, one is a clinical trials-related company that has had to hit the pause button on their work to focus on COVID-19.

Prior to COVID-19, vaccines were not a business-savvy area of investment and were very hard to fund, but "that value metric has been turned upside down," Cox said. He said the long production cycles for something like the development of a vaccine — the flu vaccine takes nine months — is an area that could use improvement even now.

"This is a preview of the end of the antibiotic era, what a world without rapidly cheap, accessible (drugs) to fight off infection looks like," Cox said.

Other areas that have become of greater interest are food, agriculture and manufacturing, Cox said.

COVID-19 has also brought to light the lack of investment in public health — already evident from medical staffing shortages, the lack of affordable education, and the need for more on-the-ground community health efforts, the experts said.

Klausner noted that Italy didn't have a strong primary or middle healthcare system, so anybody with COVID-19 was hospitalized because they had built up the end-of-the-road investment in health services.

States have graduated medical students months early to get them to hospitals that need them. In the past few years, there has been some donors who have helped make medical education for doctors free, but those are stopgaps, Klausner said.

"We need to invest and understand that medical, nursing lab technicians, schools are not just training for those individuals (to) benefit by having a job, but also as part of our societal investment to have the type of people we need at a large enough level and large enough skillset to take care of us," Klausner said. "Our population is only aging and our needs are only increasing. We need investment in things like a public health corps."

Klausner served early in his career as an Epidemic Intelligence Service officer at the Centers for Disease Prevention and Control, a sort of CIA for public health. The program, he said, has been funded at 50 people since 1951 and no one knows it exists.

"As a society, we've allowed public health training and infrastructure to erode," Klausner said.

Goss said that the ability to address a surge in need should be fluid and those who are trained should somehow be able to be moved when that need is apparent, perhaps using a technological advancement similar to the system apps like Uber use to move needed rides from one area to another in real time.

Klausner added a few more predictions, the home is going to be "ascendant" and people will want to improve their homes and make them more comfortable for daily living, working, learning and exercise.

In terms of home health, "people generally prefer to be taken care of in their home, from physical therapy to your last days on Earth," Goss said. "Telemedicine has been helped and advanced more in the last six weeks than in the 144 years (since) we got the thing called a telephone."

    About the Participants:

    Dr. Jeffrey Klausner, MD, MPH, is a Professor of Medicine in the Division of Infectious Diseases in the David Geffen School of Medicine.

    Jeffrey Klausner, MD, MPH, is a Professor of Medicine in the Division of Infectious Diseases in the David Geffen School of Medicine and Adjunct Professor of Epidemiology in the Fielding School of Public Health. 

    Dr. Klausner earned his Medical Degree from Cornell University Medical College with Honors in Research. He completed his Residency in Internal Medicine at the New York University—Bellevue Hospital Center. Dr. Klausner earned his Master's in Public Health with a focus on International Health and Epidemiology at the Harvard School of Public Health. After that training, Dr. Klausner was an Epidemic Intelligence Service Officer at the Centers for Disease Prevention and Control. Dr. Klausner completed his Fellowship in Infectious Diseases at the University of Washington, Seattle.

    Jay Goss is General Partner at Wavemaker Three-Sixty Health

    Jay Goss, General Partner @ Wavemaker Three-Sixty Health

    Jay is a General Partner at Wavemaker Three-Sixty Health. Wavemaker Three-Sixty Health is Southern California's leading Seed-stage healthcare-focused venture capital fund. The fund's investment thesis is that after 40+ years, healthcare is transitioning away from fee-for-service to value-based payments, and with that comes a massive amount of disruption. There will be no shortage of clinical operations and business challenges to solve in the coming decade, and entrepreneurs are already coming out of the woodwork to solve these problems. Moreover, countless business models are now for the first time commercially viable because the healthcare industry is embracing value-based payments. The fund counts among its investors 50+ healthcare senior executives, eager and extremely able to add value to the early stage companies in which the fund invests. Prior to launching Wavemaker Three-Sixty Health, Jay operated dozens of early stage companies all over Southern California, and advised dozens more.

    Llewellyn Cox is a general partner at MarsBio

    Llewellyn Cox, General Partner at MarsBio 

    Llewellyn is an entrepreneur from Gillingham, Kent, England. He founded LabLaunch, the leading biotechnology incubator network in Southern California, and BioBuilt, a firm that assists early-stage companies in building lab space.Llewellyn received a Ph.D. in Molecular and Cell Biology at Cardiff University, before moving to New York City to perform postdoc research in neuroscience at Weill Cornell Medical College. Llewellyn is an adjunct professor at Keck Medicine of USC where he teaches translational biology and science communications.

    Rachel Uranga, is a reporter at dot.LA.

    Rachel Uranga, Reporter @dot.LA

    Rachel covers the intersection of business, technology and culture. She is a former Mexico-based market correspondent at Reuters and has worked for several Southern California news outlets, including the Los Angeles Business Journal and the Los Angeles Daily News. She has covered everything from IPOs to immigration. Uranga is a graduate of the Columbia School of Journalism and California State University Northridge. A Los Angeles native, she lives with her husband, son and their felines.

    tami@dot.la

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    How Dot.LA Readers Use AI in a Professional Setting

    Decerry Donato

    Decerry Donato is a reporter at dot.LA. Prior to that, she was an editorial fellow at the company. Decerry received her bachelor's degree in literary journalism from the University of California, Irvine. She continues to write stories to inform the community about issues or events that take place in the L.A. area. On the weekends, she can be found hiking in the Angeles National forest or sifting through racks at your local thrift store.

    How Dot.LA Readers Use AI in a Professional Setting
    Evan Xie

    According to Pew Research data, 27% of Americans interact with AI on a daily basis. With the launch of Open AI’s latest language model GPT-4, we asked our readers how they use AI in a professional capacity. Here’s what they told us:

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    The Near Miss Apocalypse: Predictions for Post SVB Collapse

    Spencer Rascoff

    Spencer Rascoff serves as executive chairman of dot.LA. He is an entrepreneur and company leader who co-founded Zillow, Hotwire, dot.LA, Pacaso and Supernova, and who served as Zillow's CEO for a decade. During Spencer's time as CEO, Zillow won dozens of "best places to work" awards as it grew to over 4,500 employees, $3 billion in revenue, and $10 billion in market capitalization. Prior to Zillow, Spencer co-founded and was VP Corporate Development of Hotwire, which was sold to Expedia for $685 million in 2003. Through his startup studio and venture capital firm, 75 & Sunny, Spencer is an active angel investor in over 100 companies and is incubating several more.

    The Near Miss Apocalypse: Predictions for Post SVB Collapse
    Evan Xie

    The historic Silicon Valley Bank collapse dominated headlines recently, and the tech and financial communities have only just started processing the aftermath. The 48-hour breakdown was both historic and a few inches away from economically catastrophic, and thanks to the swift moves of the FDIC, complete disaster was avoided.

    But it’s still been disruptive. SVB was the banking partner for nearly half of U.S. venture-backed technology and healthcare companies that listed on stock markets in 2022, making it one of the biggest lenders for early-stage startups. The aftershocks of SVB’s breakdown spread just as far and fast as the main event: the close of Signature Bank just two days later, major market volatility, other banking crises at Credit Suisse, tech industry troubles, and much more.

    In the days since, things have settled slightly, and the world’s fingers are crossed that depositors are comforted enough and confident enough to avoid another bank run. It’s good news, but we aren’t out of the woods yet. Now that we know the second-largest bank failure in U.S. history could be looming around any corner, how does that change the ways startups do business?

    Level, Set, Go

    Before we get into what could happen, it’s smart to level-set about how we got here. (And for an introductory primer, this short podcast can help.)

    • The government 100% did the right thing by assuring depositors that they will be made whole. The FDIC swooped in, steadied the ship, and made sure people had the money they needed when they needed it.
    • Some have called this a ‘bailout', but it’s not for two reasons. 1) SVB shareholders and creditors will be wiped out and 2) taxpayer money is not being used to do any bailing.
    • Remember: depositors are not creditors. When companies and people put money into their accounts at SVB, they had every reason to expect that it would be there when they needed to withdraw it. They weren’t loaning the money to SVB (as a creditor would), they were depositing money into their own account at SVB for safekeeping.
    • People who say “depositors took a risk by having more than the FDIC insured $250K limit” are, ahem, a bit misguided. (I’m being polite). The truth is that $250K is not that much money for a company, especially of the size and scale of some of SVB's major customers.

    Here’s where I think we should go from here.

    The Short Term

    While SVB’s failure didn’t launch us over the precipice, many people are rightfully feeling very nervous being this close to the edge.

    Looking out to the next few weeks, I predict we’ll see venture funding slow way down. It’s been chilly out there recently, but it’s going to be ice cold, piggybacking on the already struggling tech landscape. Writing new checks will take a backseat to checking in on existing investments. VCs will need to assess where their cash is and where their portfolio companies stand, and likewise startups are going to have to start thinking hard about what it means to be lean and extend runway. Hopefully this only lasts a few weeks and the wheels of the machine start turning again before summer.

    If there is a positive take on the SVB wreckage, it’s that the Fed will likely slow down the rate of increases. I’d predict a 25, maybe even 0, basis-point increase next week, and I wouldn’t be surprised if there was a rate cut later this year.

    Whither venture debt?

    Prior to SVB’s failure, it was very common for a startup to have enough cash at SVB for one year of runway, plus a venture debt line for an additional another year. SVB profited from this by charging interest plus warrants and requiring banking exclusivity. It was part and parcel of how they did business, and since they’ve transitioned from success story to cautionary tale, expect to see new regulations prohibiting banks from requiring customer exclusivity in exchange for additional services.

    In the immediate term, companies who had venture debt lines with SVB are trying to decide whether to put their cash back in SVB in order to access that venture debt. The whole situation is surreal, since just a few days ago these same companies were scrambling to pull their money out of SVB, and now they are considering returning. There are conflicting reports, but it appears that SVB is allowing these companies to keep a second banking relationship with another bank (so no more exclusivity), but at least half of their cash must be with SVB.

    For startups choosing not to access that venture debt line, now trying to figure out how to operate without venture debt (aka less hiring, less spending, less growth), they’re in for challenging times ahead. To fill that funding gap, maybe we’ll see more private lenders step in and provide venture debt as a product. If that is the case, I suspect terms will be tougher and many VCs will recommend against it for their companies.

    Another prediction: audit committees of boards will come into play much earlier than they often do now. Given the ever larger seed and Series A/B rounds, it wasn’t uncommon to see startups that had raised $100M+ and had 200+ employees before an audit committee was formed. I suspect these will now be formed upfront and have a much bigger role to play in early stages.

    Silver Lining

    The good news: the world isn’t ending and won’t in the near future (at least, not because of this). Yes, things will be different and it will take some time to settle into a post-SVB startup environment, but with change comes adaptation. And with adaptation comes innovation, which is what startups are all about.

    https://twitter.com/spencerrascoff
    https://www.linkedin.com/in/spencerrascoff/
    admin@dot.la

    This Week in ‘Raises’: SpectrumAI Lands $20M, Fount Grabs $12M

    Decerry Donato

    Decerry Donato is a reporter at dot.LA. Prior to that, she was an editorial fellow at the company. Decerry received her bachelor's degree in literary journalism from the University of California, Irvine. She continues to write stories to inform the community about issues or events that take place in the L.A. area. On the weekends, she can be found hiking in the Angeles National forest or sifting through racks at your local thrift store.

    This Week in ‘Raises’: SpectrumAI Lands $20M, Fount Grabs $12M
    This Week in ‘Raises’:

    Local digital health company SpectrumAI raises fresh funding to accelerate the company’s applied behavior analysis (ABA) electronic health record, Twyll, and Patterns, while health and performance advisor Fount will use its new funding to advance its mission to make tailored health and performance programs more accessible.

    ***

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