How Amal Health is helping patients with chronic conditions
Earlier this year Nadia Smati and Zaha Masri founded Amal Health, a UK-based digital healthcare platform that aims to help doctors and patients manage chronic conditions. Here Smati tells Healthcare Global about how they're aiming to help people with long term illnesses during the pandemic.
Smati and Masri met at Stanford University before moving to London to further their studies. They founded Amal Health earlier this year, after spotting inefficiencies in healthcare delivery during the pandemic. "While working at a GP practice I saw many patients attend with stress and mental health issues related to their conditions, such as social anxiety about going to work or feelings of guilt for being a burden to their loved ones" explains Smati.
"Inflammatory chronic diseases like psoriasis have a syndemic relationship with stress and mental health disorders, in which they can cause a worsening of physical symptoms and generally make it more difficult for patients to cope with their conditions. Another issue is accurate clinical histories from patients - for a doctor the key aspect of a consultation is understanding the full history of a patient’s symptoms."
Smati says that it can be challenging for patients to recall their entire history, so along with Masri she set about creating a digital healthcare company that would streamline inflammatory chronic disease care, including digital psychology interventions for patients which would all be recorded and fed back to the patient's doctor.
"The Covid-19 pandemic influenced this greatly" Smati says. "GP and outpatient appointments were converted to telephone consultations, and during the transition fewer appointments were available. This meant patients were left more responsible for self-management of their conditions. The pandemic greatly increased the urgent need for holistic, patient-centred care for primary management of chronic diseases that could be delivered easily and effectively."
Amal Health's platform allows patients to record both physical and psychological symptoms through text-based, daily health questionnaires. "The questions are framed in a way so that the patient is having a familiar, medical-jargon free conversation with the symptom tracking platform, which then records their responses" Smati says.
Their responses are converted into assessments reflecting how they are coping with their condition, based on their behaviours and psychological wellbeing. If they need psychological treatment, the platform provides them with personalised, text-based therapy.
The symptom tracking also allows patients to document their health goals, or other lifestyle changes like changing their diet to see if it impacts on pain symptoms. Through machine learning (ML) the questions become more individualised over time.
A summary of this information is provided to the individual's doctor, which Smati says helps to get the most out of consultations ny reducing the burden of re-explaining and remembering every detail of their symptoms.
Smati says the pandemic has highlighted several structural issues with the way healthcare systems manage chronic diseases, which can be addressed with increased outpatient symptom monitoring, a greater focus on prevention, and greater
access to mental health services to cope with anxieties and stress related to medical conditions. The latter has become particularly important during the pandemic, as anxiety, isolation and fear amongst the general population has increased.
"Digital health in particular has incredible potential to address all these challenges" Smati says. "Checking in with patients, monitoring symptoms at home, offering different mediums of mental health therapy, and giving patients the tools to be able to keep track of their own medical conditions are all ways in which digital health can offer virtual care without increasing the demand for healthcare professionals or physical appointments.
"AI and machine learning will enable us to better understand people’s physical and mental health problems and forward cases to medical professionals in a timely manner" she says.
Technology can also help to increase people's role in their own care through self-monitoring, increasing health education, and encouraging lifestyle changes, medication compliance, and mental health awareness.
Looking ahead, Smati says they aim to make Amal Health faster and more accurate in the way it develops tracking and therapies for each patient. They also have plans to expand their services. "We want to have Amal Health’s services offered for more chronic diseases including hypertension and diabetes control, and also expand to help with post-surgical rehabilitation services as well. We plan to offer our services in multiple languages to cater to the diverse population in the UK, and expand to more primary care clinics globally."
Long haul Covid, the brain and digital therapies
It is estimated that around 10% of people who get Covid-19 develop long haul Covid, a debilitating condition that can last many months and cause breathlessness, exhaustion and pain.
Research is underway to find out who is more likely to get it and how to treat it. Here neuroplasticity expert and owner of Harley Street Solutions in London Ashok Gupta tells us how the condition affects the brain.
What is long Covid exactly?
Long Covid is when patients who have experienced Covid-19 go on to have continuing symptoms for weeks and months afterwards. These symptoms can include breathlessness, exhaustion, brain fog, gastric issues, pain, and post-exertional malaise. It is estimated that around 10% of Covid-19 infections may result in developing long haul symptoms, and in the USA, this may be affecting over 3 million people.
How does it affect the brain?
Here at our clinic, we hypothesise that it is due to a malfunction in the unconscious brain, creating a conditioned response that keeps the body in a hyper-aroused state of defensiveness. At the core of this hypothesis is the idea that we are here because our nervous system and immune system have evolved to survive. We are survival machines!
When we encounter something such as Covid-19, the brain perceives it as life threatening, and rightly so. And in the era of the pandemic, with more stress, anxiety and social isolation, our immunity may be compromised, and therefore it may take longer for the immune system to fight off the virus and recover.
If the brain makes the decision that this is potentially life threatening and we get to the stage where we’re overcoming the virus, a legacy is left in the brain; it keeps over-responding to anything that reminds us of the virus. Even if we’ve fought off the virus, the brain will react in a precautionary way to stimuli reminiscent of the virus.
The brain may get stuck in that overprotective response, and keeps stimulating our nervous system and our immune system, just in case the virus may still be present.
What symptoms does this cause?
These signals cause a cascade of symptoms including breathlessness, extreme fatigue, brain fog, loss of taste or smell, headaches, and many others. And these are caused by our own immunes system.
In the case of long-haul Covid, symptoms in the body get detected by a hypersensitive brain which thinks we’re still in danger. The brain then chronically stimulates the immune and nervous systems, and then we have a continuation of a chronic set of symptoms.
This isn’t unique to long-haul Covid. Many patients develop chronic fatigue syndrome, sometimes known as “ME”, for example, after the flu, a stomach bug, or respiratory illness. Covid-19 may be a severe trigger of a form of chronic fatigue syndrome or ME.
How does long-haul Covid affect mental health?
Anxiety is a very common symptom in long haulers. It can be frightening to wonder about what may be happening in your body, and what the prognosis is going to be for one’s long term health. Reaching out for support for mental health is crucial for long-haulers.
How does neuroplasticity treatment work for long-haul COVID patients?
We have been working with patients for two decades with a brain retraining programme using neuroplasticity or “limbic retraining.”
We believe that through neural rewiring, the brain can be “persuaded” that we are no longer in danger and to come back to homeostasis. But to be very clear, we are not saying it is psychological in any way, but we believe there are novel ways of accessing the unconscious brain.
We recently worked successfully with a 56-year-old male with long-haul Covid, who prior to contracting Covid-19 in March of 2020 was running half-marathons and cycling, but afterwards he struggled to get off the sofa for months. Within 3 months he’s now back to 100% and running half marathons again.
At our clinic, we train the patient to be able to recognise those subtle unconscious danger signals on the periphery of consciousness. This, coupled with supportive techniques and the natural hallmarks of good health such as sleep and diet help prepare the patient to respond to perceived threats that might trigger the response.
The natural state of our brain is to default to protection. The brain prioritises survival and passing on our genes to the next generation, over any other impulse. It cares more about that than you feeling healthy and well. Protective responses are evolutionary, and are the right thing for the brain to do – it’s survival.
What digital therapies or apps are proving effective at treating long-haul Covid?
It seems that long haul patients are availing themselves of many online therapies and services, including meditation apps and wellness websites. We have an online neuroplasticity “brain retraining” video course called the “Gupta Program” which hosts 15 interactive videos and many audio exercises. This is proving very popular with long haul patients, and we are currently conducting a trial to test the effectiveness of this therapy.
What is the danger of leaving long-haul Covid untreated?
The longer it goes untreated, we hypothesise that it may become more entrenched in the brain, and become chronic in the longer term. Therefore we advise all patients to get help and advice as soon as possible.