In a sign of digital health’s rise, Livongo and Teladoc Health agree to $18.5 billion merger

In a sign of the growing importance and value of digital healthcare in the world of medicine, two of the industry’s publicly traded companies have agreed to a whopping $18.5 billion merger.

The union of Teladoc Health, a provider of virtual care services, and Livongo, which has made a name for itself by integrating hardware and software to monitor and manage chronic conditions like diabetes, will create a giant in the emerging field of telemedicine and virtual care.

“By expanding the reach of Livongo’s pioneering Applied Health Signals platform and building on Teladoc Health’s end-to-end virtual care platform, we’ll empower more people to live better and healthier lives,” said Glen Tullman, Livongo Founder and Executive Chairman. “This transaction recognizes Livongo’s significant progress and will enable Livongo shareholders to benefit from long-term upside as the combined company is positioned to serve an even larger addressable market with a truly unmatched offering.”

Under the terms of the agreement, each share of Livongo will be exchanged for 0.5920 shares of Teladoc health plus a cash payment of $11.33 for each share. The deal, based on Teladoc’s closing price on August 4, 2020, is roughly $18.5 billion. It’s an eye-popping figure for a company that was, at one point, trading below $16 per-share.

But the new reality of healthcare delivery in the era of COVID-19 rapidly accelerated the adoption of digital and remote care services like those Livongo was selling to its customers — and investor came calling as a result.

The combined company is expected to have pro forma revenue of $1.3 billion representing 85 percent year on year growth, on a pro forma basis. For 2020, the combined company expects adjusted EBITDA to reach $120 million.

“This merger firmly establishes Teladoc Health at the forefront of the next-generation of healthcare,” said Jason Gorevic, the chief executive officer of Teladoc Health, in a statement. “Livongo is a world-class innovator we deeply admire and has demonstrated success improving the lives of people living with chronic conditions. Together, we will further transform the healthcare experience from preventive care to the most complex cases, bringing ‘whole person’ health to consumers and greater value to our clients and shareholders as a result.”

The companies emphasized their combined ability to engage with patients and monitor and manage their conditions using technology. Teladoc Health’s flywheel approach to continued member engagement combined with Livongo’s proven track record of using data science to build consumer trust will accelerate the combined company’s development of longitudinal consumer and provider relationships, the companies said in a statement.

Teladoc currently counts 70 million customers in the United States with an access to Medicare and Medicaid patients that Livongo’s services could reach. The combined company also pitched the operational efficiencies that could be created through the merger. Teladoc estimated that there would be “revenue synergies” of $100 million two years from the close of the deal, reaching $500 million on a run rate basis by 2025, according to a statement. 

Gorevic will run the combined company and David Snow will serve as the chair of the new board — which will be comprised of eight current Teladoc board members and five members of the Livongo board.

The company expects the deal to close by the end of the fourth quarter, subject to regulatory approvals. Lazard advised Teladoc on the transaction while Morgan Stanley served as the financial advisor to Livongo. 

Stix, offering D2C pregnancy and ovulation tests, raises $1.3 million in seed funding

Stix, a direct-to-consumer women’s health brand, today announced the close of a $1.3 million seed round. Investors such as BDMI, Rogue Women’s Fund, Vamos Ventures, Founders Factory New York, as well as angels like Heidi Zak (ThirdLove) Laurence Franklin (Coach) and Steve Gutentag and Demetri Karagas (30 Madison) participated in the round.

There is no shortage of men’s health startups out there to ease the awkwardness and stress of getting products for hair loss or erectile disfunction. But when it comes to something as common and straightforward as purchasing a pregnancy test, women must still make a run to the drug store.

Until Stix.

Stix offers competitively priced pregnancy tests and ovulation tests that customers can purchase online. As a diagnostics product, Stix is FDA-approved and everything from the instructions to the promotional language has to go through the approval process, according to Plotch. The cofounder and CEO says that both the pregnancy tests and ovulation tests are more than 99 percent accurate.

The Stix pregnancy test costs $13, and includes two tests, free shipping and instructional materials. The ovulation test, which includes seven tests, costs $17.

The company has also taken measures to ensure that the delivery of these products is discreet for customers who don’t want their roommates, whether it’s a live-in partner or parent or just a regular roommate, to know they’re purchasing a pregnancy test.

Stix uses PayPal to stay discreet on the credit card bill, and doesn’t include ‘Stix’ on the return address of the shipped products.

“The entire experience is really based on learning and education,” said Plotch. “We believe that all women deserve access to these products and peace of mind throughout the experience. So, unlike other brands, we don’t focus on the outcome of the test. We don’t care whether or not you’re trying to get pregnant. We just want to make sure that you have accurate results and the information that you need to understand them.”

Beyond the physical products, Stix also offers the Stix Library, an educational resource online that includes content around Stix products (of course), pregnancy, ovulation, birth control, and more general health information.

“What we’ve found is that there is a huge problem around the lack of proper sex education in this country,” said Plotch, adding that it provides an opportunity for Stix to fill in the gaps.

When asked if Stix would ever get into the birth control space, Plotch said that Stix has “high goals” and that “nothing is out of the question in the near future.”

Stix is currently a team of three women, and plans to use the funding to continue growing the team, which is currently 100 percent white. Plotch added that the company has a commitment to diversity and that the team will “definitely look different” on the heels of this round.

Sight Diagnostics raises $71M Series D for its blood analyzer

Sight Diagnostics, the Israel-based health-tech company behind the FDA-cleared OLO blood analyzer, today announced that it has raised a $71 million Series D round with participation from Koch Disruptive Technologies, Longliv Ventures (which led its Series C round)and crowd-funding platform OurCrowd. With this, the company has now raised a total of $124 million, though the company declined to share its current valuation.

With a founding team that used to work at Mobileye, among other companies, Sight made an early bet on using machine vision to analyze blood samples and provide a full blood count comparable to existing lab tests within minutes. The company received FDA clearance late last year, something that surely helped clear the way for this additional round of funding.

Image Credits: Sight Diagnostics

“Historically, blood tests were done by humans observing blood under a microscope. That was the case for maybe 200 years,” Sight CEO and co-founder Yossi Pollak told me. “About 60 years ago, a new technology called FCM — or flow cytometry — started to be used on large volume of blood from venous samples to do it automatically. In a sense, we are going back to the first approach, we just replaced the human eye behind the microscope with machine vision.”

Pollak noted that the tests generate about 60 gigabytes of information (a lot of that is the images, of course) and that he believes that the complete blood count is only a first step. One of the diseases it is looking to diagnose is COVID-19. To do so, the company has placed devices in hospitals around the world to see if it can gather the data to detect anomalies that may indicate the severity of some of the aspects of the disease.

“We just kind of scratched the surface of the ability of AI to help with with a wish with blood diagnostics,” said Pollak. “Specifically now, there’s so much value around COVID in decentralizing diagnostics and blood tests. Think keeping people — COVID-negative or -positive —  outside of hospitals to reduce the busyness of hospitals and reduce the risk for contamination for cancer patients and a lot of other populations that require constant complete blood counts. I think there’s a lot of potential and a lot of a value that we can bring specifically now to different markets and we are definitely looking into additional applications beyond [complate blood count] and also perfecting our product.”

So far, Sight Diagnostics has applied for 20 patents and eight have been issued so far. And while machine learning is obviously at the core of what the company does — with the models running on the OLO machine and not in the cloud — Pollak also stressed that the team has made breakthroughs around the sample preparation to allow it to automatically prepare the sample for analysis.

Image Credits: Sight Diagnostics

Pollok stressed that the company focused on the U.S. market with this funding round, which makes sense, given that it was still looking for its FDA clearance. He also noted that this marks Koch Disrupt Technologies’ third investment in Israel, with the other two also being healthcare startups.

“KDT’s investment in Sight is a testament to the company’s disruptive technology that we believe will fundamentally change the way blood diagnostic work is done,’ said Chase Koch, President of Koch Disruptive Technologies . “We’re proud to partner with the Sight team, which has done incredible work innovating this technology to transform modern healthcare and provide greater efficiency and safety for patients, healthcare workers, and hospitals worldwide.”

The company now has about 100 employees, mostly in R&D, with offices in London and New York.

Amid pandemic, returning to offices remains an open question for tech leaders

As COVID-19 infections surge in parts of the U.S., many workplaces remain empty or are operating with skeleton crews.

Most agree that the decision to return to the office should involve a combination of business, government and medical officials and scientists who have a deep understanding of COVID-19 and infectious disease in general. The exact timing will depend on many factors, including the government’s willingness to open up, the experts’ view of current conditions, business leadership’s tolerance for risk (or how reasonable it is to run the business remotely), where your business happens to be and the current conditions there.

That doesn’t mean every business that can open will, but if and when they get a green light, they can at least begin bringing some percentage of employees back. But what that could look like is clouded in great uncertainty around commutes, office population density and distancing, the use of elevators, how much you can reasonably deep clean, what it could mean to have a mask on for eight hours a day, and many other factors.

To get a sense of how tech companies are looking at this, we spoke to a number of executives to get their perspective. Most couldn’t see returning to the office beyond a small percentage of employees this year. But to get a more complete picture, we also spoke to a physician specializing in infectious diseases and a government official to get their perspectives on the matter.

Taking it slowly

While there are some guidelines out there to help companies, most of the executives we spoke to found that while they missed in-person interactions, they were happy to take things slow and were more worried about putting staff at risk than being in a hurry to return to normal operations.

Iman Abuzeid, CEO and co-founder at Incredible Health, a startup that helps hospitals find and hire nurses, said her company was half-remote even before COVID-19 hit, but since then, the team is now completely remote. Whenever San Francisco’s mayor gives the go-ahead, she says she will reopen the office, but the company’s 30 employees will have the option to keep working remotely.

She points out that for some employees, working at home has proven very challenging. “I do want to highlight two groups that are pretty important that need to be highlighted in this narrative. First, we have employees with very young kids, and the schools are closed so working at home forever or even for the rest of this year is not really an option, and then the second group is employees who are in smaller apartments, and they’ve got roommates and it’s not comfortable to work at home,” Abuzeid explained.

Those folks will need to go to the office whenever that’s allowed, she said. For Lindsay Grenawalt, chief people officer at Cockroach Labs, an 80-person database startup in NYC, said there has to be a highly compelling reason to bring people back to the office at this point.

First US apps based on Google and Apple Exposure Notification System expected in ‘coming weeks’

Google Vice President of Engineering Dave Burke provided an update about the Exposure Notifications System (ENS) that Google developed in partnership with Apple as a way to help public health authorities supplement contact-tracing efforts with a connected solution that preserves privacy while alerting people of potential exposure to confirmed cases of COVID-19. In the update, Burke notes that the company expects “to see the first set of these apps roll out in the coming weeks” in the U.S., which may be a tacit response to some critics who have pointed out that we haven’t seen much in the way of actual products being built on the technology that was launched in May.

Burke writes that 20 states and territories across the U.S. are currently “exploring” apps that make use of the ENS system, and that together those represent nearly half (45%) of the overall American populace. He also shared recent updates and improvements made to both the Exposure Notification API, as well as to its surrounding documentation and information that the companies have shared in order to answer questions state health agencies have had, and hopefully make its use and privacy implications more transparent.

The ENS API now supports exposure notifications between countries, which Burke says is a feature added based on nations that have already launched apps based on the tech (that includes Canada, as of today, as well as some European nations). It’s also now better at using Bluetooth values specific to a wider range of devices to improve nearby device detection accuracy. He also says that they’ve improved the reliability for both apps and debugging tools for those working on development, which should help public health authorities and their developer partners more easily build apps that actually use ENS.

Burke continues that there’s been feedback from developers that they’d like more detail about how ENS works under the covers, and so they’ve published public-facing guides that direct health authorities about test verification server creation, code revealing its underlying workings, and information about what data is actually collected (in a de-identified manner) to allow for much more transparent debugging and verification of proper app functioning.

Google also explains why it requires that an Android device’s location setting be turned on to use Exposure Notifications – even though apps built using the API are explicitly forbidden from also collecting location data. Basically, it’s a legacy requirement that Google is removing in Android 11, which is set to be released soon. In the meantime, however, Burke says that even with location services turned off, no app that uses the ENS will actually be able to see or receive any location data.

Mammoth Biosciences’s CRISPR-based COVID-19 test receives NIH fundings through RADx program

CRISPR tech startup Mammoth Biosciences is among the companies that revealed backing from the National Institutes of Health (NIH) Rapid Accleration of Diagnostics (RADx) program on Friday. Mammoth received a contract to scale up its CRISPR-based SARS-CoV-3 diagnostic test in order to help address the testing shortages across the U.S.

Mammoth’s CRISPR-based approach could potentially offer a significant solution to current testing bottlenecks, because it’s a very different kind of test when compared to existing methods based on PCR technology. The startup has also enlisted the help of pharma giant GSK to develop and produce a new COVID-19 testing solution, which will be a handheld, disposable test that can offer results in as little as 20 minutes, on site.

While that test is still ind development, the RADx funding received through this funding will be used to scale manufacturing of the company’s DETECTR platform for distribution and use in commercial laboratory settings. This will still offer a “multi-fold increase in testing capacity,” the company says, even though it’s a lab-based solution instead of a point-of-care test like the one it’s seeking to create with GSK.

Already, UCSF has received an Emergency Use Authorization (EUA) from the FDA to use the DETECTR reagent set to test for the presence of SARS-CoV-2, and the startup hopes to be able to extend similar testing capacity to other labs across the U.S.

Genomics startup Helix receives $33 million in NIH funding to scale COVID-19 testing

The U.S. National Institutes of Health (NIH) is revealing the first beneficiaries of its Rapid Acceleration of Diagnostics (RADx) program, and San Mateo-based Helix is on the receiving end of $33 million in federal funding as a result. Helix is a health tech startup founded in 2015 that focuses on insights derived from personal genomics, but the company has also developed a COVID-19 test that detects the presence of SARS-CoV-2 using RT-PCR methods.

The funding will be used to support Helix’s efforts to scale its COVID-19 testing efforts, with the aim of achieving a rate of 100,000 tests per day by this fall, and then extending the throughput capacity even further after that. Helix’s test got FDA Emergency Use Approval (EUA) earlier this month, and has since been available nationally across the U.S., promising “next day” results.

Helix was also filed for an EUA for a second type of test, an NGS test that offers higher throughput for more testing volume, as well as increased sensitivity towards actually detecting the presence of the virus to avoid false negatives. This test, if approved, will be key to helping Helix achieve that much greater scale of testing capability that is the ultimate aim of the RADx program.

That second test system currently seeking approval would be able to process as many as 25,000 tests per day, and it uses a different method that would also help reduce the strain on the supply chain.

The road to recurring revenue for hardware startups

If you look at the most successful startups today, you’ll find plenty of proof that the hardware-enabled service (Haas) model works: Peloton, Particle, Latch and Igloohome all rely on subscriptions along with product sales. Even tech giants like Apple are rapidly reinventing themselves as service companies.

Yet, if you currently rely on device sales, the prospect of changing your entire business model might seem daunting.

At Minut, we are building smart home monitors (privacy-safe noise, motion and temperature monitoring) and recently made the transition despite the lack of resources on the process. Here are the seven lessons we learned:

  1. It is a question of when  —  not if.
  2. The transition will have company-wide impact.
  3. Your current and future target audience may differ.
  4. Price should reflect the value for the customer. Your revenue should grow with theirs.
  5. Avoid your free offer competing with your premium ones.
  6. Be transparent (internally and externally) about the changes. Over-communicate.
  7. Start the process early, check regularly with your team and set measurable targets.

Why subscriptions are the future of industry (and your startup)

Hardware has one advantage over software: customers understand there is a cost to your product. Now, this allows hardware startups to generate revenue with their first iteration, but it’s unsustainable as the company grows and needs to innovate: the software and user experience need continuous improvement and excellent support, just like in a software-only startup.

That’s why we see most hardware startups eventually launching a subscription model and limit what’s available for free. Even established companies  —  think Strava or Wink  —  often end up having to radically limit free features after years of operations.

Experienced founders and financial markets favor subscription models and recurring revenue. Market valuation multiples are typically much higher for companies that benefit from service revenue in addition to sales.

Humana partners with Heal and invests $100 million in the company’s doctor-on-demand service

“The doctor’s office is dead.”

That’s the way Nick Desai, the co-founder and chief executive of the Los Angeles-based startup Heal describes the future of traditional healthcare delivery.

While Desai’s bluster may be wishful thinking, the doctor’s office is certainly changing, and that’s thanks in part to companies like Heal, which offer in-home and telemedical consultations — and health insurance providers like Humana that are backing them.

The two companies have announced a new partnership that will see Humana pushing Heal’s in-home and virtual care delivery services to the patients it covers and committing $100 million to spur the Los Angeles-based startup’s growth.

“Humana has a more strategic view of home-based care,” said Desai. “We want all payers to be this strategic. Most insurance partners offer Heal now but we want them to view it more strategically.”

For Desai, the home is the best place to get care because doctors can see the environment that may influence (and in some cases complicate or worsen) a patient’s condition. Heal, Desai says, also works with the digital technologies to provide more remote and persistent patient monitoring, so that doctors can have a better sense of a patient’s health over time, rather than at an acute moment of care.

“You want to talk to the doctor and get continuity of care,” said Desai. “We think we are…  an accelerant for the adoption of those services.”

Things like iPhone-based EKG machines, remote diagnostics to determine diabetic retinopathy, digital hubs to provide remote monitoring of body mass and movement are all hardware offerings within Heal’s panoply of care and diagnostic solutions. “We want to be able to gather more and more of those diagnostics remotely,” Desai said. “Anything that makes care more accurate, more data driven, more timely we want to use and ask our patients to utilize so that they can get better care, more quickly and more affordably.”

The new financing from Humana will go to support Heal’s geographic expansion, product development, and sales and marketing, Desai said. Already, the company has expanded into new treatment areas, including teletherapy for mental health.

Discussion between Heal and the Louisville-based Humana began back in December and the two businesses only inked the final terms of their deal last week.

Heal telemedicine, telepsychology (CA only), and digital monitoring services are currently available in New York, New Jersey, Washington, California, Georgia, Virginia, Maryland, and Washington D.C. To date, the company has linked patients with over 200,000 home visits from doctors since its launch in 2015.

Under the terms of the agreement with Humana, will expand to geographies in Chicago, Charlotte and Houston as part of Humana’s “Bold Goal” program focusing on addressing and creating healthcare services that address social determinants and social needs for its population of insured patients.

“The partnership with Heal is part of Humana’s efforts to build a broader set of offerings across the spectrum of home based care, with high quality, value-based primary care being a key foundational element,” said Susan Diamond, Humana’s Segment President, Home Business, who is joining Heal’s Board of Directors as part of the partnership and investment. “We continue to see high levels of customer satisfaction and improved health outcomes when care is delivered in the home. Our goal is to make the healthcare experience easier, more personalized and caring for the people we serve—and is the hallmark of how Humana delivers human care.”

For Desai, the deal is also an indicator of not just his company’s growth, but the growth of the entire Los Angeles technology ecosystem.

“Heal’s funding just proves that LA is  as much an epicenter of venture backed ecosystem as any in the country including Silicon Valley,” he said. 

The hype, haplessness and hope of haptics in the COVID-19 era

In March, Brooklynite Jeremy Cohen achieved minor internet fame when he launched an elaborate scheme to court Tori Cignarella, a cute stranger living in a nearby building.

After spotting Cignarella across an air shaft, Cohen used drones, Venmo, texting and FaceTime to interact with his socially distanced crush. But it was on their second date when Cohen pulled out all the stops. He purchased a gigantic plastic bubble, sealed himself inside and invited his new friend to go on a touchless walk. As Cohen wrote on Instagram, “just because we have to social distance doesn’t mean we have to be socially distant.”

Cohen’s quirky, DIY approach made for fun clickbait for a few days. But it’s also a somewhat unflattering metaphor for the kinds of touch-centric entrepreneurialism that has proliferated in the age of COVID-19. From dating to banking, education to retail, the virus has pushed everyone to rethink how touch and proximity factor into daily interactions. Businesses besieged by the uncertainty of shutdown orders, partial re-openings, remote work, disease spikes and changing consumer behavior have been forced to test-drive solutions on the fly.

Amid that confusion, a few common approaches have emerged. Some are rushing to return to normalcy, adopting quick fixes at the expense of more broad-based solutions. Others are using the pandemic as an excuse to accelerate technological shifts, even those that may be unwelcome, impractical or both. Still others are enforcing guidelines selectively or not at all, tempting consumers back, in part, through the promise of “normal” (read: non-distanced and non-regulated) interactions.

Enter haptics. Investment in touch technologies had been on the rise before COVID-19, with virtual reality fueling fresh interest in haptic gloves and full-body suits, and haptics for mobile devices like wearables and smartwatches infusing the field with new resources. While it is difficult to capture the health and growth of the haptics industry with a single number, one estimate puts the global haptics market at US$12.9 billion in 2020, projected to grow to US$40.9 billion by 2027.

In addition to established players like Immersion Corporation, founded in 1993 and active working on haptics applications ranging from gaming and automotive to medical, mobile and industrial, Sony, Apple, Microsoft, Disney and Facebook each have dedicated teams working on new haptics products. Scores of startups, too, are currently bringing new hardware and software solutions to market: Ultraleap (formerly Ultrahaptics), a Bristol-based company that develops midair haptics, has secured $85 million in funding; HaptX, which makes exoskeleton force feedback gloves for use in VR and remote manipulation, has raised $19 million in funding; and Neosensory, focused on routing sound through the skin with a wrist-based wearable Buzz, has received $16 million in funds. A recent industry-wide initiative intended to make it easier to embed haptics in multimedia content suggests that we could soon see growth in this area accelerate even further.

Despite these trends, the business of touch isn’t heading in one clear direction. And with such variety in business responses, customers have responded with confusion, frustration, anxiety and defiance. More than disgruntlement, though, COVID-19 shines a light on a longstanding debate over whether the future will have more touch or less. Tensions around touch were already high, but rapid changes, Band-Aid solutions and short-term thinking are making the problems worse.

What’s needed now is a longer view: serious, systematic thinking about where we — as consumers, citizens, humans — want and need touch, and where we don’t. To get there, we need greater investment not just in technologies that sound good, but ones that will deliver on real needs for connection and safety in the days ahead.

Plexiglass is the new mask

While the mask may be the most conspicuous symbol of the COVID-19 pandemic in much of the world, the new normal has another, clearer symbol: plexiglass.

Plexiglass leads the way as our environments are retrofitted to protect against the virus. In the U.S., demand began rising sharply in March, driven first by hospitals and essential retailers like grocery stores. Traditional sectors like automotive are using much less of the stuff, but that difference is more than made up for by the boom among restaurants, retail, office buildings, airports and schools. Plexiglass is even popping up in temples of bodily experience, surrounding dancers at strip clubsclients at massage parlors and gymgoers in fitness centers.

Like plexiglass itself, the implications for touch are stark, if invisible. Plexiglass may communicate sterility and protection — though, truth be told, it dirties often and it’s easy to get around. More to the point, it puts up a literal barrier between us.

The story of plexiglass — like that of single-use plastic, ventilation systems, hand sanitizer and ultraviolet light — underscores how mundane interventions often win the day, at least initially. It is much easier for a grocery store to install an acrylic sneezeguard between cashiers and customers than it is to adopt contactless shopping or curbside pickup. At their best, interventions like plexiglass are low-cost, effective and don’t require huge behavior changes on the part of customers. They are also largely reversible, should our post-pandemic lifestyles revert back to something more closely resembling our previous behaviors.

Besides their obvious environmental consequences, plasticized approaches can erode our relationship to touch and thereby to each other. In Brazil, for example, some nursing homes have installed “hug tunnels” to allow residents to embrace family members through a plastic barrier. Given that “when will I be able to hug my loved ones again?” is a common and heart-wrenching question these days, the reunions hug tunnels facilitate are, well, touching. But as a shadow of the real thing, they amplify our desperate need for real connection.

The same with circles on the floor in elevators or directional arrows down store aisles: In expecting us to be our best, most rational and most orderly selves, they work against cultural inclinations toward closeness. They indicate not so much a brave new future as a reluctant present. And without proper messaging about their importance as well as their temporariness, they are bound to fail.

Touch tech to the rescue

To feed our skin hunger, futurists are pushing haptic solutions — digital technologies that can replicate and simulate physical sensations. Haptics applications range from simple notification buzzes to complex whole-body systems that combine vibration, electricity and force feedback to re-create the tactile materiality of the physical world. But although the resurgence of VR has rapidly advanced the state of the art, very few of these new devices are consumer-ready (one notable exception is CuteCircuit’s Hug Shirt — released for sale earlier this year after 15+ years in development).

Haptics are typically packaged as part of other digital techs like smartphones, video game controllers, fitness trackers and smartwatches. Dedicated haptic devices remain rare and relatively expensive, though their imminent arrival is widely promoted in popular media and the popular technology press. Effective haptic devices, specially designed to communicate social and emotional touch such as stroking, would seem particularly useful to re-integrate touch into Zoom-heavy communication.

Even with well-resourced companies like FacebookMicrosoft and Disney buying in, these applications will not be hitting home offices or teleconferencing setups anytime soon. Though it would be easy to imagine, for example, a desktop-mounted system for facilitating remote handshakes, mass producing such devices would prove expensive, due in part to the pricey motors necessary to accurately synthesize touch. Using cheaper components compromises haptic fidelity, and at this point, what counts as an acceptable quality of haptic simulation remains ill-defined. We don’t have a tried and tested compression standard for haptics the way we do with audio, for instance; as Immersion Corporation’s Yeshwant Muthusamy recently argued, haptics has been held back by a problematic lack of standards.

Getting haptics right remains challenging despite more than 30 years’ worth of dedicated research in the field. There is no evidence that COVID is accelerating the development of projects already in the pipeline. The fantasy of virtual touch remains seductive, but striking the golden mean between fidelity, ergonomics and cost will continue to be a challenge that can only be met through a protracted process of marketplace trial-and-error. And while haptics retains immense potential, it isn’t a magic bullet for mending the psychological effects of physical distancing.

Curiously, one promising exception is in the replacement of touchscreens using a combination of hand-tracking and midair haptic holograms, which function as button replacements. This product from Bristol-based company Ultraleap uses an array of speakers to project tangible soundwaves into the air, which provide resistance when pressed on, effectively replicating the feeling of clicking a button.

Ultraleap recently announced that it would partner with the cinema advertising company CEN to equip lobby advertising displays found in movie theaters around the U.S. with touchless haptics aimed at allowing interaction with the screen without the risks of touching one. These displays, according to Ultraleap, “will limit the spread of germs and provide safe and natural interaction with content.”

A recent study carried out by the company found that more than 80% of respondents expressed concerns over touchscreen hygiene, prompting Ultraleap to speculate that we are reaching “the end of the [public] touchscreen era.” Rather than initiate a technological change, the pandemic has provided an opportunity to push ahead on the deployment of existing technology. Touchscreens are no longer sites of naturalistic, creative interaction, but are now spaces of contagion to be avoided. Ultraleap’s version of the future would have us touching air instead of contaminated glass.

Touch/less

The notion that touch is in crisis has been a recurring theme in psychology, backed by scores of studies that demonstrate the negative neurophysiological consequences of not getting enough touch. Babies who receive insufficient touch show higher levels of the stress hormone cortisol, which can have all kinds of negative effects on their development. In prisons, for example, being deprived of touch through restraint or solitary confinement is a punishment tantamount to torture. As technology continues to make inroads into our lives, interactions that once required proximity or touch have become mediated instead, prompting ongoing speculation about the consequences of communicating by technology rather than by touch.

The coronavirus pandemic intensifies this crisis by demanding a sudden, collective withdrawal from physical contact. The virus lays a cruel trap: the longer we’re apart, the more we crave togetherness and are willing to take dangerous risks. But giving in to the desire to touch not only exposes us and those we care about to a potentially mortal danger, it also extends the amount of time before we can resume widespread touching.

The pandemic has already revealed important lessons about touch, haptics and humanity. First is that while circumstances can change quickly, true social and behavioral change takes longer. The many examples of Americans acting as though there is no pandemic going on should give pause to anyone thinking touch-free futures are just around the corner. Atop this, there is plain-old inertia and malaise, which suggests some pandemic-era interventions will stick around while others will disappear or slacken over time. Consider 9/11 — nearly two decades later, though we still can’t greet our loved ones at their gate, most airports don’t strictly monitor our liquids and gels.

By the same token, one can imagine unfilled hand sanitizer stations as the ultimate hangover from these times. We may begin to like the plexiglass barriers between ourselves and our fellow subway passengers, but hate them at restaurants and sporting events. We may encounter more motion-detecting sliding doors and hand-tracking options, but when they falter we may revert to revolving doors, handles and push-buttons.

A second and equally important insight is that the past and the future exist side by side. Technological development takes even longer than behavioral change, and can be bedeviled by momentary trends, expense and technological limitations. For example, there are a lot of pressures right now to transform stores and restaurants into “last-mile” fulfillment centers, to embrace AR and VR and to reimagine space as contact-free. In these scenarios, objects could be touched and handled in virtual showrooms using high-fidelity digital touch technologies. But some of this pressure is based on promises that haptics have yet to fulfill. For instance, being able to touch clothing through a mobile phone may be possible in theory, but would be difficult in practice and would mean other trade-offs for mobile phones’ functionality, size, weight and speed.

Touch/more?

But just as the coronavirus pandemic did not create making us miss touching, it also did not create all the problems with touching. Some of the touch we were used to — like the forced closeness of a crowded subway car or the cramped quarters of airline seats — is dehumanizing. Social movements like #MeToo and Black Lives Matter have drawn attention to how unwanted touch can have traumatic consequences and exacerbate power imbalances. We must think broadly about the meaning of touch and its benefits and drawbacks for varying types of people, and not rush toward a one-size-fits-all solution. Although touch may seem like a fundamentally biological sense, its meaning is continually renegotiated in response to shifting cultural conditions and new technologies. COVID-19 is the most rapid upheaval in global practices of touching that we’ve seen in at least a generation, and it would be surprising not to see a corresponding adoption of technologies that could allow us to gain back some of the tactility, even from a distance, that the disease has caused us to give up.

Too often, however, touch technologies prompt a “gee whiz” curiosity without being attentive to the on-the-ground needs for users in their daily lives. Businesses looking to adopt haptic tech must see through the sales pitch and far-flung fantasies to develop a long-term plan for where touch and touch-free make the most sense. And haptic designers must move from a narrow focus on solving the complex engineering problem touch presents to addressing the sorts of technologies users might comfortably incorporate into their daily communication habits.

A useful exercise going forward is to consider how would we do haptic design differently knowing we’d be facing another COVID-19-style pandemic in 2030? What touch technologies could be advanced to satisfy some of the desires for human contact? How can firms be proactive, rather than reactive, about haptic solutions? As much as those working in the field of haptics may have been motivated by the noble intention of restoring touch to human communication, this mission has often lacked a sense of urgency. Now that COVID-19 has distanced us, the need for haptics to bridge that physical gap, however incompletely, becomes more obvious and demanding.

Businesses feel it too, as they attempt to restore “humanity” and “connection” to their customer interactions. Yet as ironic as it might feel, now is the time not to just stumble through this crisis — it’s time to prepare for the next one. Now is the time to build in resilience, flexibility and excess capacity. To do so requires asking hard questions, like: do we need VR to replicate the sensory world in high fidelity, even if it’s costly? Or would lower-cost and lower-fidelity devices suffice? Will people accept a technologized hug as a meaningful proxy for the real thing? Or, when touch is involved, is there simply no substitute for physical presence? Might the future have both more touch and less?

These are difficult questions, but the hardship, trauma and loss of COVID-19 proves they demand our best and most careful thinking. We owe it to ourselves now and in the future to be deliberate, realistic and hopeful about what touch and technology can do, and what they can’t.