More than a dozen robotics researchers expressed the need for robots to play a greater role in managing the ongoing coronavirus pandemic, as well as in future preparedness. They pointed to three broad medical areas where robots can make a difference: clinical care with applications such as telemedicine and decontamination; logistics for delivery and handling of medical waste; and reconnaissance such as quarantine enforcement.

The academics noted that these robotic uses were outlined first during the 2015 Ebola outbreak, and are starting to be put to the test particularly in proof-of-concept efforts in China. Medical robotics companies, such as San Antonio-based robotic disinfection player Xenex Disinfection Services and Austin, Texas.-based hospital robot assistant startup Diligent Robotics Inc., are working toward better supporting a strapped medical community. The editorial appeared in the March 25 issue of Science Robotics.

“We've been working seven days a week for the past several weeks and added shifts to accommodate production,” Xenex CEO Morris Miller told BioWorld. “Initially we saw demand increase from overseas (Asia and then Italy), but now we are getting requests from around the world. We've also seen a surge in the U.S.”

“Those requests have come from new customers as well as existing customers who are expanding their programs to include more robots so they can disinfect more rooms and areas within their facility,” he continued. “One of the things that sets our technology apart is speed. Our robots work in a five-minute cycle, so hospitals can disinfect dozens of rooms per day per robot.”

Robots in the clinic

The robotics researchers explored wide-ranging uses for robotics in the editorial, including to stabilize manufacturing and remote operations of essential functions; to provide social interaction for isolated people; and to monitor infected people to ensure quarantine adherence. But it also identified several specific clinically oriented functions for robots.

In med tech, the routine implementation of robotics has been largely limited to surgical robots, which have recently attracted several high-profile industry players such as Medtronic plc and Johnson & Johnson. But the researchers expect that routine patient care could inspire a whole slew of robotic applications in med tech – that are only made more urgent by this pandemic and the promise of others in the future.

When it comes to clinical care, robotics can be useful when it comes to disease prevention, diagnosis and screening, and patient care and disease management, the researchers argue. Ensuring that providers are adequately protected during the diagnosis and screening process has proven an enormous stumbling block in many countries with the coronavirus. Robotic swabbing and even blood draws could help to protect humans from these risky procedures.

“During a major outbreak, a key challenge is a lack of qualified staff to swab patients and process test samples. Automated or robot-assisted nasopharyngeal and oropharyngeal swabbing may speed up the process, reduce the risk of infection, and free up staff for other tasks,” noted the editorial.

“Some people do not develop symptoms of the virus or harbor the virus at the moment of testing. In these cases, a blood test to check for antibody appearance could be crucial and used to identify silent infections,” it continued. “Automating the process of drawing blood for laboratory tests could also relieve medical staff from a task with a high risk of exposure. Researchers are studying robotic systems based on ultrasound imaging identification of peripheral forearm veins for automated venepuncture.”

The researchers cited a recent Technology paper on the first-in-human testing of an AI-based robot developed by Rutgers University researchers that can conduct blood draws. It performed comparable to clinical standards, with 97% success rates in patients without challenging venous access. This system is expected to also be extended into IV catheterization, central venous access, dialysis and arterial line placement.

In diagnostics and screening, the researchers also call for the use of mobile robots for temperature measurement in public areas and ports of entries. There are relatively mature technologies here, as well including automated camera systems to screen temperature in large areas. They note that these temperature screening systems can be linked to facial recognition software to provide rapid contact tracing. While much more systematic than current approaches, this obviously raises some privacy issues and could easily be abused.

When it comes to disease prevention and infection control, UV robots are already commonly in use in hospitals to disinfect rooms. The editorial pointed out the particular need for this technology that’s driven by the current pandemic.

“Instead of manual disinfection, which requires workforce mobilization and increases exposure risk to cleaning personnel, autonomous or remote-controlled disinfection robots could lead to cost-effective, fast, and effective disinfection,” the editorial said. “Opportunities lie in intelligent navigation and detection of high-risk, high touch areas, combined with other preventative measures.”

The Xenex Lightstrike Germ-Zapping Robots use ultraviolet light to rid hospital rooms of pathogens, including viruses, bacteria, and fungi. The systems are already in use in more than 500 hospitals. It has not been tested specifically with this novel coronavirus, but it was successfully tested against a related virus, Middle Eastern Respiratory Syndrome (MERS), as well as the Ebola virus.

The startup is currently profitable, and anticipates revenue growth of 400% to 600% this year. It has been asked for large bids, in the thousands, to supply its robots. The company recently shipped a large number of its robots to Italy, which has been particularly hard hit by COVID-19. There are other UV-based disinfection systems, but Xenex is distinct in using pulsed xenon to create intense flashes of germicidal UV light that deactivate the entire spectrum of pathogens.

“We applaud the authors for recognizing the opportunities for medical robots to assist in managing pandemics,” Miller commented on the editorial. “As an evidence-based company, we have invested heavily in science and research to validate the effectiveness of our Lightstrike pulsed xenon UV room disinfection technology.”

“More research is needed and that requires investment,” he added. “It's our fervent hope that as the world focuses its attention on the coronavirus pandemic and how to halt its spread, hospital infection preventionists will get the resources they need to expand their infection prevention strategies to include new technologies like our pulsed xenon UV disinfection technology.”

Robotic support

Moxi hospital robot assistant with company founders, Andrea Thomaz (CEO) and Vivian Chu (CTO). Credit: Diligent Robotics

When it comes to improving logistics and limiting the need for nurses to be diverted to do non-nursing tasks, startup Diligent Robotics is already focused on this effort. It has created a hospital robot assistant known as Moxi, which incorporates AI to offer so-called social intelligence that includes an expressive face and human-guided learning.

The company recently raised a $10 million series A round to commercialize Moxi. The robot is specifically intended for non-patient facing tasks, such as gathering and transporting supplies, delivering lab samples, and taking soiled linens to the laundry. Automation helps hospitals maintain consistent care workflows and gives staff more time for patient care.

Robotics weren’t even under consideration as a useful tool prior to the last major outbreak. But perhaps this one will spur sufficient coordinated research and funding to make robotics more useful when the next pandemic approaches, or even as this novel coronavirus perhaps waxes and then wanes again.

“The experiences with the Ebola outbreak identified a broad spectrum of use cases, but funding for multidisciplinary research, in partnership with agencies and industry, to meet these use cases remains limited. Now, the impact of COVID-19 may drive further research in robotics to address risks of infectious diseases,” the researchers concluded. “But without sustained research efforts robots will, once again, not be ready for the next incident. By fostering a fusion of engineering and infectious disease professionals with dedicated funding we can be ready when (not if) the next pandemic arrives.”

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