## Abstract

Robots have long helped humans by doing tasks that are too dangerous, too difficult, and too dull. That is why they proved indispensable in the automotive and other industries. Over the past decade, engineers have also built smarter robots that can orient in place, avoid obstacles, follow voice commands and make decisions. Some of these intelligent robots proved invaluable in natural and man-made disasters. Now, roboticists are realizing another convenient attribute of robotic systems—they are impervious to disease outbreaks. This article looks at how robots are being used to combat COVID-19.

## Article

Whirring softly, a blinding light-emitting robot wheels around a hospital room in Wuhan, China. It looks like a miniature sun on wheels, if the sun was oblong and five or six feet tall. The robot drives to a counter and pauses, letting its bright light shine all around—and then heads behind the operating table. There, it makes another stop, making sure its rays reach all the exposed surfaces. Then it rolls its shimmering corona to yet another spot in the room.

Made by a Danish company, UVD Robots, this robot is solving the important and pressing problem of disinfecting hospital rooms and various items inside them. Only instead of sprays and soaps it uses an ultraviolet light to kill germs.

“Our robot kills 99.999 percent of all viruses and bacteria, and it takes 10 seconds, maybe half a minute,” said Claus Ri-sager, the co-founder and CEO of UVD Robots. “It has two nicknames—'Pathogen Enemy Number One’ and 'Saving Lives Every Day.’”

Sterilizing hospital areas quickly, efficiently, and reliably has always been a challenge, but during the coronavirus pandemic it became, in some cases, a matter of life and death. Because the SARS-CoV-2 virus is highly infectious, rooms where patients are intubated (put on ventilators) or treated must be sanitized perfectly to prevent infection from spreading to other patients and hospital staff.

Ordinarily, cleaners sterilized surfaces and floors manually, but that isn’t an optimal approach during a pandemic. First, spraying and wiping is usually done by hand or by a mop, and hospitals want to minimize human exposure as much as possible. Second, manual work tends to take a long time—a precious commodity during disease outbreaks. Robots kill two birds with one stone—they are fast and they take humans out of the equation.

Robots have long helped humans by doing tasks that are too dangerous, too difficult (and precise), and too dull. That is why they proved indispensable in the automotive and other industries.

Over the past decade, engineers have also built smarter robots that can orient in place, avoid obstacles, follow voice commands, and make decisions. Some of these intelligent robots proved invaluable in disaster situations. From earthquakes and forest fires to nuclear accidents and chemical spills, disaster recovery robots have helped clean up rubble, looked for survivors buried underneath fallen buildings, and flown over radioactive areas surveying the damage. They work around the clock without getting tired or loosing their precision.

Now, roboticists are realizing another convenient attribute of robotic systems—they can’t get infected with biological hazards. They are impervious to disease outbreaks.

In the March issue of Science Robotics, several visionary thinkers published an editorial asking scientists and engineers to explore how robots can help battle pandemics. Titled “Combating COVID-19—The role of robotics in managing public health and infectious diseases,” the editorial calls for immediate action. As nearly every hospital in Europe, the United States, and beyond is or about to become a disaster zone, robots can take over dull, dirty, and dangerous jobs, freeing doctors and healthcare workers to do more critical tasks while keeping them safe from this highly contagious disease.

There are several areas where robotics can make a difference. They can sterilize and decontaminate spaces and equipment, or take over the disposal of contaminated waste. They can help doctors examine patients remotely, whether from another room or another city. They can even take care of patients directly, executing tasks like taking temperature or bringing medications inside a highly contagious ward.

Teleprescence robots enable physicians to work with other doctors, nurses, and patients without sharing the same space.

Photo: In Touch Health

Teleprescence robots enable physicians to work with other doctors, nurses, and patients without sharing the same space.

Photo: In Touch Health

“Robots can remove people from harm’s way,” said Howard Choset, a researcher at Carnegie Melon University’s Robotics Lab and one of the editorial’s authors. The pandemic offers plenty of opportunities to do that. “We wrote the article so that people would read it, get inspired, and come up with new ideas.”

Robots can step in to help outside hospitals, too. When a large percentage of population must stay home, robots can perform vital tasks that can’t be done remotely, including operating power plants, waste treatment facilities, and other services. They can also autonomously operate warehouse docks and stock supermarket shelves. As more produce is grown inside greenhouses, robots could help tend plants or harvest crops while workers practice social distancing. They can also deliver meals and medicines to those quarantined in their homes to reduce human contact.

When professor Guang-Zhong Yang, founding dean of the Institute of Medical Robotics at Shanghai Jiao Tong University, came back from a conference last month, he self-quarantined at a hotel to assure he wasn’t spreading the infection, in case he had contracted it.

His food was delivered to his door by a robot, which the hotel had deployed even before COVID-19—simply for convenience. “We should have robots doing such tasks during quarantine,” Yang, another co-author of the editorial, said. “And we can do much more than that.”

Yang envisions robots that can perform complex medical jobs, such as traversing patients’ airways, swabbing throats, and drawing blood. Building these complex machines will certainly take time and money, so they won’t appear in hospitals overnight. But simpler bots are already rolling around medical wards—and beyond—today.

## Roomba and Sunlight

Using robots to disinfect contaminated spaces with UV light was a natural idea, UVD’s Risager explained. A component of the electromagnetic spectrum that falls between visible light and X-Rays, ultraviolet light is energetic enough to break down microorganisms.

There are three type of the UV light—UVA, UVB, and UVC, with the UVA rays having the longest wavelengths and UVC the shortest. The sun emits all three, but the earth’s atmosphere lets in UVA and a small amount of UVB while stopping the UVC. UVA and UVB have some germicidal qualities, but the UVC is the most potent and damaging of the three. It penetrates virus shells and microbial cells and destroys the fragile RNA and DNA inside, preventing pathogens from reproducing. That’s the light UVD Robotics uses for Pathogen Enemy Number One.

Ultraviolet light emitted by a robot disinfects a room and the equipment used to scan patients in Italy.

Photo: UVD Robots

Ultraviolet light emitted by a robot disinfects a room and the equipment used to scan patients in Italy.

Photo: UVD Robots

Chinese researchers developed a robot with a mechanical arm to take throat cultures from patients suspected of having COVID-19.

Photo: Hao Liu, Chinese Academy of Sciences

Chinese researchers developed a robot with a mechanical arm to take throat cultures from patients suspected of having COVID-19.

Photo: Hao Liu, Chinese Academy of Sciences

Scientists and laymen alike have known that sunlight can kill germs for more than 100 years. In fact, Supreme Court Justice Louis Brandeis used its germicidal properties as a metaphor in 1914, when he wrote, “Sunlight is said to be the best of disinfectants.” UVC lamps have been used to disinfect spaces in various settings, from hospitals to food processing facilities.

These UV lamps are stationary and require a human in the loop. To disinfect a large space, a person has to move the lamp multiple times and typically activate it remotely or use a delay switch. This is because UVC light is highly damaging to human cells, so operators must leave the room when the light is on. The process is cumbersome and slow.

“If you have 10 rooms to disinfect, it’s impossible to use a stationary light—you’d have to move it 200 times,” Risager said. So UVD Robots essentially combined “sunlight” with Roomba. “When we got our first U.K. contract, we put in a fleet of robots. With five robots we disinfected about 5,000 square feet in 40 minutes.”

Pathogen Enemy Number One works like many other smart robots. It autonomously maps an area, then human operators add additional objects or obstacles to its course—for example, an extra bed.

The robot knows how long it shines the light onto a surface and when it is properly decontaminated. If something is left on the surface—a vial, a towel, or an instrument—the robot will alert the operators that it could not clean underneath. And if it encounters a human in its way, it will immediately shut off the UV light to avoid harming that person.

UVD Robots started working on their system in 2015. Their goal was to create a device that could kill germs without creating “superbugs” that eventually develop resistance to antibiotics and other antiseptic substances. The team started with intensive care units, but quickly realized that the robots could disinfect other places—shopping malls, supermarkets, train stations, offices, assisted living and nursing homes, fitness centers, schools, and prisons.

In Europe, the robots quickly grew popular while the United States was slow to catch up. That, however, changed quickly with COVID-19. When it comes to saving lives, UVD robots are convenient and affordable, they cost about $90,000. “Our robots are everywhere now,” Risager said. ## Hello, NurseeBot Disinfection is not the only task robots can do. Because robots do not get sick, engineers are now adopting their existing autonomous platforms to operate within coronavirus wards—taking temperature and other vital signs or perhaps even examining the patients by following doctors’ commands remotely. “The doctors working on the front lines would love to have a teleoperated robot that they could drive to a patient while they stand 25 feet away,” said Henrik Christensen, director of the Contextual Robotics Institute, at the University of California, San Diego, another co-author of the editorial. They would also like to equip it with a stethoscope and high-resolution camera they can operate from afar. And they would also like it to swab a patient’s throat and run a test. “This would enable the personnel to not have to be in direct contact with the patient,” Christensen said. As Christensen was reciting a physician’s wish list of robot capabilities, engineers at RoboTiCan, an Israeli startup specializing in intelligent autonomous systems, were building something similar. When the COVID-19 struck Israel, medics at Soroka Medical Center in Beer Sheva faced a logistical problem. To keep safe, doctors and nurses wore personal protective equipment—masks, gloves, face shields, and even full body suits. Suiting up took time and the equipment was uncomfortable to wear. This was especially onerous when it came to suiting up for simple, one-off tasks, such as bringing a patient a pill or a change of clothes in the middle of the night. “They wanted to be able to virtually ‘walk’ between the rooms and talk to the patients, look at the monitors, and know what is happening,” said Amir Shapiro, chief scientist of RoboTiCan and professor at Ben-Gurion University’s Robotics Lab. “They wanted a telepresence robot with a capability to carry things. And their special request was that the robot’s 'head’ should be high enough to see and communicate with people lying in bed.” RoboTiCan already had an intelligent autonomous platform, Komodo, designed for agriculture. So, the team converted Komodo into NurseeBot, a telepresence automaton with a screen and a camera on top. The team also coded more intuitive software and built a joystick controller that was easier for the medical staff to use. The hot passed its first test, and the team plans to implement autonomous capabilities in the next iteration. While NurseeBot cannot yet swab throats, the team is equipping it with more advanced skills, such as carrying thermometers and pulse checkers. “The patient would put the device on his or her finger or the thermometer in the mouth, at the remote guidance of a doctor or nurse,” Shapiro said. “The robot is now in final testing stage, and in few days will be fully operational in the coronavirus department of the Soroka hospital.” Doctors fighting the pandemics certainly appreciate robotic eyes and ears—or even hands. So roboticists are working on that too. ## Teleporting the Doctor Sitting at his office desk in Vigevano, a town near Milan, Italy, Federico Ciccarese attaches two black harnesses over his arms. They contain sensors and extend from above his elbows to part way down his fingers. The harnesses connect to two 3D-printed, servo-driven robotic arms, which mount further down his arms and give them an additional reach. When he moves his arm or wiggles his fingers, the robotic hands follow the same, exact movements. Adapted from an agricultural robot, the NurseeBot (above) enables doctors to monitor contagious patients remotely from a desk console (below). Photo: RoboTiCan Adapted from an agricultural robot, the NurseeBot (above) enables doctors to monitor contagious patients remotely from a desk console (below). Photo: RoboTiCan Robotic hands may allow doctors to treat patients at a safe distance. Photo: Youbionic Robotic hands may allow doctors to treat patients at a safe distance. Photo: Youbionic “It is as if your arms and hands have teleported,” Ciccarese explained. From his desk, for example, his robotic hands easily touch a shelf that his human hands cannot reach. A former boat builder who formed his own company, Youbionic, Ciccarese originally began building affordable robotic extremities to help amputees. He would post the technical drawings, 3D-printing files, Arduino code, and instructions on his website, so people could 3D print “body parts” at home. With time, Ciccarese realized his technology could help provide remote medical assistance. Doctors could don his harness, mount the arms on a cart or robot, and examine patients, swab throats, and handle samples from behind a plastic screen. And the price is attractive—the printing files go for$399 on his website.

There are a few more features the arms must have to enter the commercial realm. Their fingers, for example, need a more “gentle touch.” That would require equipping Ciccarese’s robotic arms with pressure sensors that provide haptic feedback to his own fingers. He is already working on it.

“This month and next month I will be designing a feedback system that can give me the feeling of an object and the ability to hold a delicate device, such as a stethoscope,” he said.

Doctors could do many things remotely using robots as a proxy, Shanghai Jiao Tong University’s Yang said. The well-known Da Vinci surgical robot offers such features—doctors can do image-guided surgeries remotely using its master-slave console, which operate on the same principles as Ciccarese’s robotic hands.

Other medical procedures can be implemented in a similar fashion. Drawing blood, for example, may be too delicate an operation for a robot to do autonomously, but a technician could use remote hands and an infrared camera to locate and puncture a vein. Throat swabbing is slightly easier, and the Chinese Academy of Sciences has already developed a prototype that can do that, taking human workers out of the loop.

Another candidate for robotic intervention is intubation, which involves fitting a tube down a patient’s windpipe. It poses a high infection risk for the doctor. Yang thinks it can be done remotely or in semi-automatedly, and he has a solution up his sleeve. His team is developing a miniature snake-like robot for endobronchial intervention, which can enter and navigate tortuous pathways.

“It can go into very distant parts of the lungs, deep into the airways, to the locations that the current endoscopes can’t reach,” Yang explained.

“I just wish our technology was one year ahead, so we could have maybe deployed it,” he added. “I think many roboticists are feeling the same way.”

Over the next three years, Yang wants to recruit more faculty members and students and focus on new generations of surgical and rehabilitation robots, as well as those for hospital automation.

He also wants roboticists from all over the world to collaborate more extensively, brainstorming and building robots for infectious diseases together rather than siloed within their own labs. These efforts should be as global as the pandemics we face.

“If and when the next pandemic happens, we want to be ready,” he said. “We hope it won’t happen, but we should be prepared.”