Project Doda for Covid-19 Rehab

Brazil has been severely hit by the Covid-19 pandemics, as of June 13, almost half a million people have lost their lives and an estimated 17,4 millions people have contracted the virus so far. 

Parallel to this catastrophic scenario, another crisis is looming: the post-covid-19 syndrome, sometimes referred to as "Long Covid", a condition affecting 10+ millions Brazilians today, 70% of them without proper access to medical care.

Project Doda is a free tool to help self-diagnosing and monitoring Long Covid clinical evolution through a Natural Language Processing (NLP) chatbot, Doda. The bot also acts as a rehabilitation tutor by analyzing the self-diagnosis and conversation data to suggest free video classes on science-backed DIY rehabilitation protocols.

Doda can be an accessible, cheap, simple and pervasive tool to help and educate whole populations on how to deal with, and recover from Long Covid.

"Long Covid”, according to various studies, might affect from 50% to 80% of all people infected by the new virus, with different severity levels. A study published in April in the journal Nature found that coronavirus survivors were 59% more likely to die within six months compared with people who escaped the illness, adding about eight extra deaths per 1,000 Covid patients.

The majority of Long Covid cases are not directly life-threatening, but the persistent symptoms impact not only people’s social and individual wellbeing, but spur a plethora of long-term problems such as the worsening of chronic diseases (diabetes, blood pressure, obesity), mental health issues, and might even threat economic recovery due to reduced work hours reported in 69% of patients, according to a 2020 research.

On top of that, most patients, specially in underdeveloped nations, don’t have access to proper medical assistance, and local health workers are rarely up to date on science-backed protocols for rehabilitation, since this is an ongoing field of research.

The sum of all these problems create a dangerous scenario that might outlast the pandemic for years or even decades.

Doda is the avatar name of a Natural Language Processing (NLP) chatbot integrated with Whatsapp’s API that is programmed to identify wich group of sequelae from Long Covid is more active on patients, teach them about basic medical information on the condition, and tutor about science-backed protocols for do-it-yourself rehabilitation.

We’ve chosen Whatsapp as Doda’s medium due to its immense popularity in Latin America. In Brazil alone, in Brazil, 93 percent of mobile phone internet users actively use the app. 

Doda uses Covid 19 Yorkshire Rehab Screen (C19-YRS) tool to first assess what group of symptoms are more debilitating to the patient, to then guide them through a series of 1 to 3 minutes-long videos, recorded with doctors and specialists, explaining the “whys" and “whats" of theirs specific condition, suggesting rehabilitation protocols and informing when and how to look for offline medical help. Doda also provides self-monitoring tools such as online forms regularly sent by mail or Whatsapp that can be easily used to help local health workers to assess the person’s syndromic evolution. 

Doda targets people who are suffering from Long Covid symptoms for more than 4 weeks after the end of the illness and have none or very limited and low quality medical assistance to help on their recovery.

In Brazil, almost 70% of the population relies on the public health system (SUS), wich is frequently overcrowded, understaffed and lacks proper capillarity within a continental-sized nation. 

Though lacking access to basic healthcare assistance, 82,7% of Brazilians have access to the internet, and the pandemic accelerated the digitization of everyday life in different strata of the social pyramid. Digital Health services are slowly, but progressively consolidating  its appeal to the average population.

Doda taps on the ubiquitous presence of Whatsapp among Brazilians to deliver a private and friendly experience on health literacy and medical assistance for Long Covid, promoting universal access to basic care, specialized information, and avoiding unnecessary and inefficient visits to health institutions already overcrowded with the pandemic. 

All members of Doda’s founding team come from digital health companies in Brazil and we are directly in touch with the population we are hoping to serve.

Doda is a pervasive and easy to use tool to combat a myriad of health impacts from the Covid-19 pandemic, including, but no restricted to, loneliness, stress, depression, and other mental health impacts, many of them directly related to Long Covid.

The stigma and fear of the infection often discourage “Covid long haulers" to seek for professional help, and when they do, it is often hard to find specialized care, specially if you are an underrepresented minority. This despairing scenario spurs anxiety, depression, high levels of toxic stress and might isolate individuals even more within their communities. 

Doda's service and business model taps on the previous experiences and the skills from the founder on the field of digital health. The first months of development were entirely dedicated to partnerships with research institutes, medical universities and local communities to validate the chatbot interface and produce the video classes, online questionnaires and overall team building.

As of June 2021, we are about to launch the alpha version of the chatbot within a 5.000 people cohort in São Paulo, Rio de Janeiro, Fortaleza and Manaus, 4 of the most affected capital cities in Brazil, in partnership with local hospitals both private and public.

The use of chatbots in healthcare is already well explored, however, Doda uses as its methodological axis a new integrative healthcare method called 4T4P, which uses 4 major interfaces to provide access to basic care: teleconsultation, remote monitoring, self-diagnosis tools and health literacy.

We are now able to remotely generate an initial diagnosis of the person's prevalent Long Covid symptoms (both psychological and physical) and understand their level of severity, then offering a broader portfolio of care that is not limited to a consultation with a general practitioner who, given the current situation, could take weeks and even months to happen.

We believe that this broader view of health interfaces partially reduces the burden on health systems and is able to give more autonomy, information while maintaining  privacy to patients suffering from the syndrome.

The chatbot interface also allows for more empathic interaction and is able to communicate with different social realities, only needing a minimally stable internet connection.

Solutions such as Doda can show a doable path towards democratization and de-bureaucratization of access to the universal right to health through the empathetic and emancipatory use of technologies such as AI, bots and Big Data.

We are about to start a 5.000 people pilot in Brazil. By the end of year one of operations, we will be capable of serving more than a million people through Doda's chatbot and, if Long Covid persists as an urgent condition in 5 years, we virtually don't have much operational limitations for the number of people served, since it is an automated interface. We could talk about tens of millions of people helped by Doda in different countries.

Our main indicators are:

 a) number of people served by the platform, 

b) percentage of clinical improvement from the suggested rehabilitation protocols (at least 51% of recovery perceived through subjective scales and, in a lesser extent due to technical challenges, clinical and lab results when available through local partnerships); 

c) capillarity in regions with the lowest medical density in Brazil, especially small and medium-sized cities and northern and northeastern regions of Brazil (at least 40% of the total number of people served by Doda must come from these demographic realities).

3 full-time staff:

Rom Justa, CEO

Leonardo Gross - Institutional Relations

Luiza Albuquerque - CMO

2 part-time staff

Rodrigo Rodrigues - Community partnerships

Nathalia Nunes - Communications advisor

Contractor

Botmaker team

Two of Doda's founding executives, Rom Justa and Leonardo Gross, lost family members to the pandemic and make this project a life mission.

The team is made up of experienced people both in the offline and online health areas as well as in the integration with new impact technologies.

The ethnic and regional diversity of the group allows us to have a broader view of the different needs and cultures involved in Long Covid rehabilitation processes and this is well worked in the programming of the Doda chatbot itself.

As mentioned before, Doda's founding team is a balanced mix of ethnicities, gender and Brazil's regional representation. 

It is one of our fundamental beliefs that we must have as many diverse and different points of view as possible about what is considered well-being, suffering and health within an event as massive as the pandemic.