Homage, a Singapore-based caregiving and telehealth company, has taken a major step in its global expansion plan. The startup announced today that it has received strategic investment from Infocom, the Japanese information and communications technology company that runs one of the largest healthcare IT businesses in the country. Infocom’s solutions are used by more than 13,000 healthcare facilities in Japan.
During an interview with TechCrunch that will air as part of Disrupt tomorrow, Homage co-founder and chief executive Gillian Tee said “Japan has one of the most ageing populations in the world, and the problem is that we need to start building infrastructure to enable people to be able to access the kind of care services that they need.” She added that Homage and Infocom’s missions align because the latter is also building a platform for caregivers in Japan, in a bid to help solve the shortage of carers in the country.
Homage raised a Series B earlier this year with the goal of entering new Asian markets. The company, which currently operates in Singapore and Malaysia, focuses on patients who need long-term rehabilitation or care services, especially elderly people. This makes it a good match for Japan, where more than one in five of its population is currently aged 65 or over. In the next decade, that number is expected to increase to about one in three, making the need for caregiving services especially acute.
The deal includes a regional partnership that will enable Homage to launch its services into Japan, and Infocom to expand its reach in Southeast Asia. Homage’s services include a caregiver-client matching platform and a home medical service that includes online consultations and house calls, while Infocom’s technology covers a wide range of verticals, including digital healthcare, radiology, pharmaceuticals, medical imaging and hospital information management.
In a statement about the strategic investment, Mototaka Kuboi, Infocom’s managing executive officer and head of its healthcare business division, said, “We see Homage as an ideal partner given the company’s unique cutting-edge technology and market leadership in the long-term care segment, and we aim to drive business growth not only in Homage’s core and rapidly growing market in Southeast Asia, but also regionally.”
Biofourmis, which combines AI-based data analytics and biosensors to monitor the progress of medical treatments, has raised funding from one of the world’s most high-profile investors. The digital therapeutics company, which launched in Singapore and is now headquartered in Boston, announced today it closed a $100 million Series C led by SoftBank Vision Fund 2, with participation from returning investors Openspace Ventures, MassMutual Ventures, Sequoia Capital and EDBI.
The company’s last funding announcement was in May 2019 for a $35 million Series B led by Sequoia India and MassMutual, the venture capital arm of Massachusetts Mutual Life Insurance Company.
Biofourmis’ platform combines AI-based health analytics and wearable sensors to help healthcare providers gauge patient progress and the effectiveness of drugs and other treatments. The company, founded in 2015 by chief executive Kuldeep Singh Rajput and managing director Wendou Niu, said this is the largest funding for a healthtech startup in Southeast Asia to date. In addition to Boston and Singapore, Biofourmis also has offices in Switzerland and India.
Since its Series B funding, Biofourmis has grown through a series of partnerships with seven pharmaceutical companies and 10 health systems, including Novartis, AstraZeneca, and Mayo Clinic. Biofourmis also made several acquisitions, including wearable biosensor startup Biovotion and Gaido Health, a digital therapeutics company for cancer patients.
The funding will be used to validate and bring new digital therapeutic solutions for cardiology, respiratory, oncology and pain treatments to the market. Biofourmis also plans to expand in the United States and Asia-Pacific markets including China and Japan.
Biofourmis also said today that it is realigning its internal operations into two verticals: Biofourmis Therapeutics, which partners with companies like AstraZeneca and Chugai to created software that can help increased the efficacy of drug treatments, and Biofourmis Health, a “home hospital” platform that allows health providers to monitor patients remotely as they transition out of acute care. Biofourmis Health focuses on heart failure, coronary artery disease, respiratory illnesses and cancer.
EDBI is an investment firm linked to Singapore’s government, and looks for startups that can help advance the country’s industries, including healthcare. Biofourmis’ funding from EDBI is a strategic investment, and its technology is being used in Singapore as it copes with repeated outbreaks of COVID-19.
In a press statement, SoftBank Investment Advisers partner Greg Moon said, “We believe predictive health is the future of medicine and Biofourmis is a leader in using AI and machine learning-based models to advance digital therapeutics.”
Jimmy Qian and Lucia Huang, the co-founders of a new clinical practice management and data analysis platform for mental health providers focusing on cutting edge psychedelic treatments, met at Stanford University.
The two both come from healthcare backgrounds. Huang, whose mother was a biomedical engineer, worked as an associate at Warburg Pincus focused on healthcare and worked at the startup Verge Genomics before heading to Stanford’s business school while Qian was in medical school at Stanford.
Both also went to high school in the Bay Area and were intimately familiar with the mental health crisis affecting the communities around Silicon Valley.
Qian worked on a few non-profits in the mental health space through his undergraduate years at Penn and then again in the Bay Area while he was at Stanford.
Osmind’s founders say the goal for their young startup is to help patients access innovative treatments to mental health by providing clinicians and pharmaceutical companies with software and services that will make the provision of care, and proof of the efficacy of treatment, more readily available.
There are 11 million Americans that are resistant to most mental health therapies, according to Huang and Qian. Those patients can cost the healthcare as much as $250 billion, they said. “Nobody has been able to help this patient population,” said Huang in an interview. “Pharma doesn’t develop drugs for them.”
Now graduating with Y Combinator’s latest cohort of companies, Osmind’s public benefit corporation intends to aggregate data from the sickest patient population and provide that data to drug developers for clinical trials and to help insurers route patients to the treatment providers that can benefit them the most, according to Qian.
The company, which launched its services two months ago, already has 30 practices using its software covering 3,000 patients.
“The beauty of all of this is that it’s a win-win for everyone,” said Huang. Providers get a software platform that streamlines administrative tasks and provides patient outreach and remote monitoring services. They also have a web portal that allows them to view patient progress.
Qian said its a service designed for physicians that are not necessarily technically savvy. It also provides a dataset that can be used to clinically validate some of these more experimental forms of therapy including psychedelics and ketamine treatment.
“We improve the care journey,” said Qian. “These are clinics that don’t have the manpower to do that.. You can’t call your patients every single day.”
Amit Garg and Sanjay Rao have spent the bulk of their professional lives developing technology, founding startups and investing in startups at places like Google and Microsoft, HealthIQ, and Norwest Venture Partners.
Over their decade-long friendship the two men discussed working together on a venture fund, but the time was never right — until now. Since last August, the two men have been raising capital for their inaugural fund, Tau Ventures.
The name, like the two partners, is a bit wonky. Tau is two times pi and Garg and Rao chose it as the name for the partnership because it symbolizes their analytical approach to very early stage investing.
It’s a strange thing to launch a venture fund in a pandemic, but for Garg and Rao, the opportunity to provide very early stage investment capital into startups working on machine learning applications in healthcare, automation and business was too good to pass up.
Meanwhile, Rao, a Palo Alto, Calif. native, MIT alum, Microsoft product manager and founder of the Accelerate Labs accelerator in Palo Alto, Calif., said that it was important to give back to entrepreneurs after decades in the Valley honing skills as an operator.
Both Rao and Garg acknowledge that there are a number of funds that have emerged focused on machine learning including Basis Set Ventures, SignalFire, Two Sigma Ventures, but these investors lack the direct company building experience that the two new investors have.
Garg, for instance, has actually built a hospital in India and has a deep background in healthcare. As an investor, he’s already seen an exit through his investment in Nutonomy, and both men have a deep understanding of the enterprise market — especially around security.
So far, the company has made three investments automation, another three in enterprise software, and five in healthcare.
The firm currently has $17 million in capital under management raised from institutional investors like the law firm Wilson Sonsini and a number of undisclosed family offices and individuals, according to Garg.
Much of that capital was committed after the pandemic hit, Garg said. “We started August 29th… and did the final close May 29th.”
The idea was to close the fund and start putting capital to work — especially in an environment where other investors were burdened with sorting out their existing portfolios, and not able to put capital to work as quickly.
“Our last investment was done entirely over Zoom and Google Meet,” said Rao.
That virtual environment extends to the firm’s shareholder meetings and conferences, some of which have attracted over 1,000 attendees, according to the partners.
The firm expects the massive changes in e-commerce, healthcare, logistics, and urban infrastructure to remain in place for an extended period of time and is urging investors to rethink their approaches to each as a result.
“It really ties into the mandate that we have in thematic investing,” said Leon Pedersen, the head of Thematic Investments at CPPIB.
There was a realization at the firm that structural changes were happening and that there was value for the fund manager in ensuring that the changes were being addressed across its broad investment portfolio. “We have a long term mandate and we have a long term investment horizon so we can afford to think long term in our investment outlook,” Pedersen said.
The Thematic Investments group within CPPIB will make mid-cap, small-cap and private investments in companies that reflect the firm’s long term theses, according to Pedersen. So not only does this survey indicate where the firm sees certain industries going, but it’s also a sign of where CPPIB might commit some investment capital.
The research, culled from international surveys with over 3,500 respondents as well as intensive conversations with the firm’s investment professionals and portfolio companies, indicates that there’s likely a new baseline in e-commerce usage that will continue to drive growth among companies that offer blended retail offerings and that offices are likely never going to return to full-time occupancy by every corporate employee.
Already CPPIB has made investments in companies like Fabric, a warehouse management and automation company.
The e-commerce wave has crested, but the tide may turn
Amid the good news for e-commerce companies is a word of warning for companies in the online grocery space. While usage surged to 31 percent of U.S. households, up from 13 percent in August, consumers gave the service poor marks and many grocers are actually losing money on online orders. The move online also favored bigger omni-channel vendors like Amazon and Walmart, the study found.
The CPPIB also found that there may be opportunities for brick and mortar vendors in the aftermath of the epidemic. As younger consumers return to shopping center they’re going to find fewer retailers available, since bankruptcies are coming in both the US and Europe. That could open the door for new brands to emerge. Meanwhile, in China, more consumers are moving offline with malls growing and customers returning to shopping centers.
Some of the biggest winners will actually be online entertainment and cashless payments — since fewer stores are accepting cash and music and video streaming represent low-risk, easier options than live events or movie theaters.
LOS ANGELES, CA – MAY 30: General views of tourists and shoppers returning to the Hollywood & Highland shopping mall for the first weekend of in-store retail business being open since COVID-19 closures began in mid-March on May 30, 2020 in Los Angeles, California. (Photo by AaronP/Bauer-Griffin/GC Images)
Healthcare goes digital and privacy matters more than ever
Consumers in the West, already reluctant to hand over personal information, have become even more sensitive to government handling of their information despite the public health benefits of tracking and tracing, according to the CPPIB. In Germany and the U.S. half of consumers said they had concerns about sharing their data with government or corporations, compared with less than 20 percent of Chinese survey respondents.
However, even as people are more reluctant to share personal information with governments or corporations, they’re becoming more willing to share personal information over technology platforms. One-third of the patients who used tele-medical services in the U.S. during the pandemic did so for the first time. And roughly twenty percent of the nation had a telemedicine consultation over the course of the year, according to CPPIB data.
Technologies that improve the experience are likely to do well, because of the people who did try telemedicine, satisfaction levels in the service went down.
DENVER, CO – MARCH 12: Healthcare workers from the Colorado Department of Public Health and Environment check in with people waiting to be tested for COVID-19 at the state’s first drive-up testing center on March 12, 2020 in Denver, Colorado. The testing center is free and available to anyone who has a note from a doctor confirming they meet the criteria to be tested for the virus. (Photo by Michael Ciaglo/Getty Images)
Cities and infrastructure will change
“From mass transit to public gatherings, few areas of urban life will be left unmarked by COVID-19,” write the CPPIB report authors.
Remote work will accelerate dramatically changing the complexion of downtown environments as the breadth of amenities on offer will spread to suburban communities where residents flock. According to CPPIB’s data roughly half of workers in China, the UK and the US worked from home during the pandemic, up from 5 percent or less in 2019. In Canada, four-in-ten Canadian were telecommuting.
To that end, the CPPIB sees opportunities for companies enabling remote work (including security, collaboration and productivity technologies) and automating business practices. On the flip side, for those workers who remain wedded to the office by necessity or natural inclination, there’s going to need to be cleaning and sanitation services and someone’s going to have to provide some COVID-19 specific tools.
With personal space at a premium, public transit and ride hailing is expected to take a hit as well, according to the CPPIB report.
New York City, NY is shown in the above Maxar satellite image. Image Credit: Maxar
Supply chains become the ties that bind in a distributed, virtual world
As more aspects of daily life become socially distanced and digital, supply chains will assume an even more central position in the economy.
“Amid rising labor costs and heightened geopolitical risk, companies today are focused on resilience,” write the CPPIB authors.
Companies are reassessing their reliance on Chinese manufacturing since political pressure is coming from more regions on Chinese suppliers thanks to the internment of the Uighur population in Xinjiang and the crackdown on Hong Kong’s democratic and open society. According to CPPIB, India, Southeast Asia, and regional players like Mexico and Poland are best positioned to benefit from this supply chain diversification. Supply chain management software providers, and robotics and automation services stand to benefit.
“Confined to their homes for months and subjected to a rapid reordering of their perceived health risks and economic prospects, consumers are emerging from a shared trauma that will change their priorities and concerns for years to come,” the CPPIB study’s authors write.
In the two years since Jeff Semenchuk took the reins in the newly created position of chief innovation officer for Blue Shield of California, the nonprofit health insurer with $20 billion in revenues has stepped up its investments in startup companies.
As one of California’s largest insurance providers with more than four million members, Blue Shield plays an outsized role in technology adoption among physicians, hospital networks and patients. With that in mind, and with the acceleration of entrepreneurial activity around the multitrillion health care market, Semenchuk was brought on board after serving as chief executive of Yaro (now Virgin Plus) and CIO of Hyatt Hotels and Citi Ventures.
Semenchuk said he sees Blue Shield as working to create a new health care system: “It’s not to perpetuate the health care system we have today.” Increasingly, startups have a role to play in that revisioning of health care services in America, according to Semenchuk.
“What I would say has happened over the last two years is that we have really focused on transformational innovation,” he added.
Investing in those transformational technologies involves taking cash directly from Blue Shield’s balance sheet for investments. The company doesn’t operate a corporate venture capital fund in the traditional sense, instead making strategic investments under the auspices of Semenchuk or Chief Financial Officer Robert Kolodgy.
Unless you’re an expert, there’s little difference between the Internet of Things (IoT) and the Internet of Everything (IoE). However, the latter term is broader, semantically. In this post, we’ll go into the details to explain why IoT software development companies use the term IoE comparatively rarely.
The term IoT was coined in 1999 to refer to machine-to-machine, or M2M, communication. IoE appeared a few years later, to describe interrelated elements of a whole system, including people. IoE entails not only M2M communication but also P2M (people-to-machine) and even P2P (people-to-people) communication.
To understand the differences between the three types of communication, let’s consider several examples. Say it got dark outside and you turned on a light in the office, then you sat and typed on a keyboard. This scenario provides P2M examples of IoE.
We are so used to these things that we don’t even realize they are part of a system. Another example: You make a Skype call to your colleague. That’s a simple human-to-human, or P2P, communication. An example of M2M communication, on the other hand, is the process of data exchange between your office temperature sensing devices and the HVAC mainframe.
You might think M2M communication, being technological, is the most progressive means of interaction. but IoE focuses on P2M and P2P interactions as the most valuable. According to aCisco analysis, as of 2022, 55% of connections will be of these two types.
IoE is now considered the next stage of IoT development. Maybe this is why there are so few IoT development companies offering IoE development services at the moment.Internet of Things solutions are now more common and widespread.
4 Main Elements of the IoE Concept
By thing, we mean an element of the system that participates in communication. A thing is an object capable of gathering information and sharing it with other elements of the system. The number of such connected devices, according to Cisco, will exceed 50 billion by 2020.
What are things? In the IoT, a thing could be any object, from a smart gadget to a building rig. In the IoE, that expands to include, say, a nurse, as well as an MRI machine and a “smart” eyedropper. Any element that has a built-in sensing system and is connected on a network can be a part of the IoE.
People play a central role in the IoE concept, as without them there would be no linking bridge, no intelligent connection. It is people who connect the Internet of Things, analyze the received data and make data-driven decisions based on the statistics. People are at the center of M2M, P2M, P2P communications. People can also become connected themselves, for example, nurses working together in a healthcare center.
In 2020, it’s projected that everyone using the internet will be receiving up to 1.7 MB of data per second.
As the amount of data available to us grows, management of all that information becomes more complicated. But it’s a crucial task because, without proper analysis, data is useless. Data is a constituent of both IoT and IoE. But it turns into beneficial insights only in the Internet of Everything. Otherwise, it’s just filling up memory storage.
Process is the component innate to IoE. This is how all the other elements — people, things, data — work together to provide a smart, viable system. When all the elements are properly interconnected, each element receives the needed data and transfers it on to the next receiver. The magic takes place through wired or wireless connections.
Another way to explain this is that IoT describes a network and things, while IoE describes a network, things, and also people, data, and process.
Where Is IoE Applied?
As to the market, we can say confidently that IoT is a technology of any industry. IoE technology is especially relevant to some of the most important fields, including (1) manufacturing, (2) retail, (3) information, (4) finance & insurance, (5) healthcare.
IoE technology has virtually unlimited possibilities. Here’s one example: More than 800 bicyclists die in traffic crashes around the world annually. What if there was a way to connect bike helmets with traffic lights, ambulances, and the hospital ecosystem in a single IoE. Would that increase the chances of survival for at least some of those cyclists?
Another example: Do you realize how much food goes to waste, say at large supermarkets, because food isn’t purchased by its best-before date? Some perishable products like fruit and vegetables are thrown away due to overstocks even before they get to the market. What happens if you find a way to connect your food stocks with the racks and forklifts of the supermarket in-stock control system using IoE?
There are endless variations on uses of IoE right now, and many of them are already becoming familiar in our “smart” homes.
In our industry, few would deny the value of IoE in improving our standard of living. Luckily, there’s a flourishing market of IoT development services. Who knows, maybe one day soon, you’ll be a “thing” in the IoE environment.
We are living through an unprecedented crisis. During the COVID-19 pandemic, healthcare workers have emerged as frontline heroes, working overtime to protect our communities from the spread of novel coronavirus. But they aren’t immune to the anxious, uncertain atmosphere the pandemic has fostered nor, indeed, the coronavirus itself.
We need to protect the first responders and hospital staff who put their wellbeing on the line to support their communities during a crisis. To my mind, that means using every tool at our disposal to the fullest — with AI chief among those at hand.
There’s little doubt that the current situation demands a creative solution. The United States has become the center of the global pandemic; as of April 16th, the US confirmed 644,188 cases and endured 28,579 deaths. Despite efforts to flatten the curve by ordering regional shut-downs and stay-at-home orders, hospitals across the county have been all but overwhelmed by incoming cases. The impact on provider morale has, according to reporting from NPR, been similarly problematic.
“Nearly a month into the declared pandemic, some health care workers say they’re exhausted and burning out from the stress of treating a stream of critically ill patients in an increasingly overstretched health care system,” NPR reporters Will Stone and Leila Fadel recently wrote. “Many are questioning how long they can risk their own health […] In many hospitals, the pandemic has transformed emergency rooms and upended protocols and precautions that workers previously took for granted.”
Hospitals are doing all they can to keep their caregivers safe and protected, but their resources are stretched far too thin. According to reports, some hospitals in high-infection areas like New York City can only afford to give healthcare workers one N95 mask every five days. Used masks are collected, disinfected, and returned on a cycle between uses. But some frontline workers worry that, given the highly contagious nature of the disease, they may not be adequately protected.
“It can be disheartening to have that feeling of uncertainty that you are not going to be protected,” Sophia Rago, an ER nurse based in St. Louis, told reporters for NPR.
We need to shield our frontline workers as much as possible. The obvious solution would be to increase stores of personal protective equipment (PPE) and N95 masks; however, given that we face a national shortfall and harsh state-to-state bidding wars over the gear, that fix seems unlikely. What we can do to at least lessen the risk of patient-to-provider transmission is to invest in AI-powered solutions that can automate some healthcare protocols and limit the need for close contact.
“Traditional processes — those that rely on people to function in the critical path of signal processing — are constrained by the rate at which we can train, organize, and deploy human labor. Moreover, traditional processes deliver decreasing returns as they scale,” a team of digital health researchers recently wrote in an article for the Harvard Business Review.
“Digital systems can be scaled up without such constraints, at virtually infinite rates. The only theoretical bottlenecks are computing power and storage capacity — and we have plenty of both. Digital systems can keep pace with exponential growth.”
These AI-powered, digitally-facilitated solutions generally fall into two broad categories: disease containment and patient management.
Assessing AI’s Ability to Limit Disease Transmission
When it comes to limiting disease spread, the aim is to use AI tools to allocate human resources better while still protecting patients and staff. Take the screening system that was recently deployed at Tampa General Hospital in Florida, for example. This AI framework was designed by the autonomous care startup Care.ai and intended to facilitate early identification and interception of infected people before they come into contact with others. According to a report from the Wall Street Journal, the Care.ai tool taps into entryway cameras and conducts a facial thermal scan. If the system flags any feverish symptoms such as sweat or discoloration, it can notify healthcare staff and prompt immediate intervention.
Other technology companies––Microsoft, for one––have rolled out similar remote diagnostic and alert tools in facilities across the globe. Their unique capabilities vary, but their purposes are the same: to prevent the spread of infection and provide support to overworked personnel.
As representatives for Microsoft shared in a recent press release, “[AI technology] not only improves the efficiency of epidemic prevention, but it also reduces the work burden of frontline personnel so that limited human resources can be used more effectively.”
In these resource-strapped time, the aid is undoubtedly needed.
AI’s Applications for Diagnostics and Patient Management
Fighting a pandemic is a task that requires speed. Now more than ever, providers must be able to accurately and quickly identify infected patients so that they can trace and hopefully contain the viral spread. But doing so isn’t an easy order.
To borrow a quote from Forbes contributor Wendy Singer, “Analyzing test results nowadays requires skilled technicians and a lot of precious time, as much as a few days. But in our current reality, healthcare systems need to analyze thousands of results instantly, and to expose as few lab workers as possible to the virus.”
We don’t have that kind of time––and we can’t put our lab workers at undue risk. Thankfully, cutting-edge AI technologies may provide a solution. With AI, hospitals can automate some steps of the testing process, cutting down on the time and effort needed to process test results. These capabilities aren’t just hypothetical; in the weeks since the start of the pandemic, the health tech startup Diagnostics.ai has provided laboratories in the US and UK with a diagnostic tool that streamlines the testing process by automating DNA analysis.
However, the applications of AI diagnostics aren’t limited to testing alone. Some have also used artificial intelligence to support population management in overstretched hospitals. One Israeli medical-device developer, EarlySense, recently developed an AI-powered sensor that can identify which patients will most likely face complications like sepsis and respiratory failure within six to eight hours. This can give a hospital the information it needs to best allocate limited resources and staff attention.
No AI innovation — no matter how brilliant or helpful — will fix our resources shortfall. There is no question that healthcare providers need more PPE and support, or that they need it immediately. However, the benefits that AI provides to screen and patient management efforts are evident. It seems reasonable that we at least consider the weight the deployment of such tools could remove from our exhausted front-liners’ shoulders.
The COVID-19 pandemic has exposed weaknesses around the US healthcare system and resulted in a large amount of uncertainty around the healthcare and health insurance costs for the pandemic, says GlobalData, a leading data and analytics company.
As the US does not provide universal healthcare to its citizens, and with more than 30,000,000 citizens who have recently become unemployed, many have lost their employer-provided healthcare and are facing tough economic decisions about covering their healthcare costs out-of-pocket. Additionally, health insurers are facing uncertainty about the costs of the pandemic and the rates they will need to charge.
Johanna Swanson, Product Manager at GlobalData, comments: “In the US, most citizens receive health insurance through their employer, but the high levels of unemployment have resulted in significant numbers of people losing their coverage. Those unemployed can continue to receive health insurance by using coverage from the Consolidated Omnibus Budget Reconciliation Act (COBRA) or applying for Medicaid, but COBRA coverage can be costly as employers are often paying an average of nearly 82% of the cost of their employees’ health insurance.”
The US Government is considering helping employers cover the cost of COBRA, so future rounds of financial support measures could include this assistance. Also, states that did not expand Medicaid under the Affordable Care Act may reconsider due to COVID-19 in order to receive more funding for their unemployed population.
Swanson adds: “Healthcare providers and insurers face uncertainty around the costs and rates that will be caused by the pandemic. It remains unclear what the true cost of the pandemic will be for the health insurance industry. It is expected to reach billions of dollars, but estimates vary widely.
“Health insurers need to submit 2021 rates for approval in June 2020. These rates must be based on expected future costs, which has proven challenging due to the current level of uncertainty. Many insurers have indicated that they will not increase rates for 2021, but it remains to be seen how they will mitigate the high costs of COVID-19. Additionally, healthcare companies may be facing uncertainty about the rules and regulations on obtaining federal pandemic relief funds. This leaves a large amount of uncertainty around the costs for the COVID-19 pandemic.”