Simplified Monitoring of Patients in Situations of Mass Hospitalization (MoSimPa) - Fighting COVID-19

I have been quite absent from Debian stuff lately, but this increased since COVID-19 hits us. In this blog post I'll try to sketch what I have been doing to help fight COVID-19 this last few months.

In the beginning

When the pandemic reached Argentina the government started a quarantine. We engineers (like engineers around the world) started to think on how to put our abilities in order to help with the situation. Some worked toward providing more protection elements to medical staff, some towards increasing the number of ventilation machines at disposal. Another group of people started thinking on another ways of helping. In Bahía Blanca arised the idea of monitoring some variables remotely and in masse.

Simplified Monitoring of Patients in Situations of Mass Hospitalization (MoSimPa)

This is where the idea of remotely monitored devices came in, and MoSimPa (from the spanish of "monitoreo simplificado de pacientes en situación de internación masiva") started to get form. The idea is simple: oximetry (SpO2), heart rate and body temperature will be recorded and, instead of being shown in a display in the device itself, they will be transmitted and monitored in one or more places. In this way medical staff doesn't has to reach a patient constantly and monitoring could be done by medical staff for more patients at the same time. In place monitoring can also happen using a cellphone or tablet.

The devices do not have a screen of their own and almost no buttons, making them more cheap to build and thus more in line with the current economic reality of Argentina.

This is where the project Para Ayudar was created. The project aims to produce the aforementioned non-invasive device to be used in health institutions, hospitals, intra hospital transports and homes.

It is worth to note that the system is designed as a complementary measure for continuous monitoring of a pacient. Care should be taken to check that symptomps and overall patient status don't mean an inmediate life threat. In other words, it is NOT designed for ICUs.

All the above done with Free/Libre/Open Source software and hardware designs. Any manufacturing company can then use them for mass production.

The importance of early pneumonia detection

We were already working in MoSimPa when an NYTimes article caught or attention: "The Infection That’s Silently Killing Coronavirus Patients". From the article:

A vast majority of Covid pneumonia patients I met had remarkably low oxygen saturations at triage — seemingly incompatible with life — but they were using their cellphones as we put them on monitors. Although breathing fast, they had relatively minimal apparent distress, despite dangerously low oxygen levels and terrible pneumonia on chest X-rays.

This greatly reinforced the idea we were on the right track.

The project from a technical standpoint

As the project is primarily designed for and by Argentinians the current system design and software documentation is written in spanish, but the source code (or at least most of it) is written in english. Should anyone need it in english please do not hesitate in asking me.

General system description

The system is comprised of the devices, a main machine acting as a server (in our case for small setups a Raspberry Pi) and the possibility of accessing data trough cell phones, tablets or other PCs in the network.

The hardware

As of today this is the only part in which I still can't provide schematics, but I'll update this blog post and technical doc with them as soon as I get my hands into them.

Again the design is due to be built in Argentina where getting our hands on hardware is not easy. Moreover it needs to be as cheap as possible, specially now that the Argentinian currency, the peso, is every day more depreciated. So we decided on using an ESP32 as the main microprocessor and a set of Maxim sensors devices. Again, more info when I have them at hand.

The software

Here we have many more components to describe. Firstly the ESP32 code is done with the Arduino SDK. This part of the stack will receive many updates soon, as soon as the first hardware prototypes are out.

For the rest of the stack I decided to go ahead with whatever is available in Debian stable. Why? Well, Raspbian provides a Debian stable-based image and I'm a Debian Developer, so things should go just natural for me in that front. Of course each component has its own packaging. I'm one of Debian's Qt maintainers then using Qt will also be quite natural for me. Plots? Qwt, of course. And with that I have most of my necessities fulfilled. I choose PostgreSql as database server and Mosquitto as MQTT broker.

Between the database and MQTT is mosimpa-datakeeper. The piece of software from which medical staff monitor patients is unsurprisingly called mosimpa-monitor.

MoSimPa's monitor main screen

Plots of a patient's data

Alarm thresholds setup

And for managing patients, devices, locations and internments (CRUD anyone?) there is currently a Qt-based application called mosimpa-abm.

ABM main screen

ABM internments view

The idea is to replace it with a web service so it doesn't needs to be confined to the RPi or require installations in other machines. I considered using webassembly but I would have to also build PostgreSql in order to compile Qt's plugin.

Translations? Of course! As I have already mentioned the code is written in English. Qt allows to easily translate applications, so I keep a Spanish one as the code changes (and we are primarily targeting spanish-speaking people). But of course this also means it can be easily translated to whichever language is necessary.

Even if I am a packager I still have some stuff to fix from the packaging itself, like letting datakeeper run with its own user. I just haven't got to it yet.

A video showing the software in action

Certifications

We are working towards getting the system certified by ANMAT, which is the Argentinian equivalent for EEUU's FDA.

Funding

While all the people involved are working ad-honorem funding is still required in order to buy materials, create the prototypes, etc. The project created payments links with Mercado Pago (in spanish and argentinian pesos) and other bank methods (PDF, also in spanish).

I repeat the links here with an aproximation to US$.

- 500 AR$ (less than 8 US$)

- 1000 AR$ (less than 15 US$)

- 2000 AR$ (less than 30 US$)

- 3000 AR$ (less than 45 US$)

- 5000 AR$ (less than 75 US$)

You can check the actual convertion rate in https://www.google.com/search?q=argentine+peso+to+us+dollars

The project was also presented at a funding call of argentinian Agencia de Promoción de la Investigación, el Desarrollo Tecnológico y la Innovación (Agencia I+D+i). 900+ projects where presented and 64 funded, MoSimPa between them.