The robot arrived just a few days after Christine Kiernan, an orthopedic surgeon at Tullamore Hospital in Ireland, was diagnosed with COVID-19. She’d arranged for Violet, an autonomous ultraviolet cleaning machine, to start trials at Tullamore to help the hospital adapt to staff shortages caused by the pandemic. But on Violet’s first day of work, Kiernan was already laid up in bed.
“It was awful, I’m not going to lie,” Kiernan, who’s since fully recovered from the disease, tells The Verge. “Thankfully I wasn’t critically unwell, but you do just feel like crap for weeks. Your energy’s gone for. And I have two kiddies, babies really, and there’s no social distancing you can do from a one-year-old and a two-year-old.”
The unfortunate timing of her diagnosis aside, Kiernan’s experience with Violet was something of a revelation. Like many health care workers around the world, her job has become significantly more challenging with the arrival of COVID-19. The normal busyness of hospital life has been supplemented by new complications: staff shortages, demands for personal protective equipment, and rigorous cleaning regimes to keep the virus at bay.
But machines like Violet, says Kiernan, have helped with these problems, proving their worth in a time of crisis. And like other doctors The Verge spoke to, Kiernan says that when the pandemic is over, the robots should stay.
“The reaction from staff, and anyone who’s seen it really, has been so positive,” says Kiernan of Violet. “They love that we’re embracing technology, but also that the results it’s achieving are exceeding what we can do manually. We’re protecting the staff, we’re protecting the patients, and we’re protecting the cleaners.”
Clean, Lean, Virus-Killing Machine
Violet is the creation of Akara Robotics, a Dublin-based firm that builds robots providing social support in care homes. When the pandemic hit, the firm began adapting an open-source machine named TurtleBot to work as a mobile disinfectant unit using ultraviolet light. And in just 24 hours, it had created a working prototype for tests in hospitals like Tullamore.
Like all UV cleaning robots, Violet is essentially a huge lightbulb on wheels. It trundles around, emitting ultraviolet light powerful enough to slice apart the genetic material inside viruses. UV light is known to be effective against many coronaviruses, and studies suggest it works just as well on SARS-CoV-2, the new coronavirus strain responsible for the current pandemic. As a result, autonomous UV cleaning machines have been deployed not only in hospitals, but a variety of high-traffic spaces where infection is a risk, including airports, hotels, and food banks.
These machines have become the vanguard of pandemic automation, with sales for UV cleaning robots booming in recent months. One US robotics firm Xenex tells The Verge its sales of its UV cleaning robots are up 600 percent compared to 2019. “We began increasing production in December when we started hearing reports from international colleagues about what was happening in China,” Xenex CEO Morris Miller told The Verge over email. “We’ve seen a surge in orders from healthcare.”
In Tullamore, Violet sterilized the hospital’s CT scanning room, a key link in the chain of coronavirus treatment. As a relatively small, 250-bed hospital, Tullamore only has two CT scanners. But as these scans are one of the most effective ways to diagnose COVID-19, it’s essential the machine is always ready for use. That means speedy cleaning is a must.
It takes human cleaners an hour to carefully disinfect the CT scanning room, says Kiernan, wiping down the equipment and surfaces. So when the pandemic hit, and the room had to be cleaned after each use, “a machine that used to be able to do 30 scans a day is down to seven.”
Violet, by comparison, can clean the room in just 15 minutes. It uses machine vision powered by Intel’s Movidius AI chips to map and navigate its surrounding environment. Though, as Kiernan notes, humans still have to wipe down the “nooks and crannies the robot can’t get to, like behind the door handles.” But by cutting cleaning times down from 1 hour to 15 minutes, the hospital’s capacity for CT scans increases four times over.
That sort of extra headroom, delivered while reducing risks to human cleaners, is too good to ignore, says Kiernan. Tullamore is now expanding its trials of Violet to cover more spaces within the hospital.
Robots on the frontline
No hands, no brain, just a wheeled lightbulb pumping out deadly light: UV robots certainly show how limited health care automation is right now. Machines that can actually look after patients like humans can are still a sci-fi dream, say doctors, but there is one simple characteristic that makes robots well-suited for work during a pandemic: their immunity.
Machines don’t cough, sneeze, or shake hands, so they can’t actively spread coronavirus around a hospital. That means, in addition to ultraviolet cleaning, most of the jobs they’ve been doing help minimize contact between potentially infectious humans. Since the pandemic hit, we’ve seen robots delivering food and medicine to isolated patients, transporting test samples for diagnosis, and acting as receptionists.
In Antwerp University Hospital in Belgium, for example, robots have taken up positions on the literal frontline of health care. Patients arriving at the hospital who suspect they have COVID-19 are greeted by a child-sized robot with stubby arms and a spherical torso.
The robot is made by Chinese firm Ubtech, though it is programmed and resold by Belgium firm Zorabots. A camera on top of the machine checks each visitor’s temperature and verifies that they’re wearing a mask (telling them to go away and get one if not). It then scans a QR code generated by a questionnaire that patients have to fill out before entering the hospital. This assesses whether they’re a high-risk case, and the robot then directs them to the appropriate ward within the hospital.
The robot began trials in Antwerp in May, right as coronavirus cases spiked in Belgium, says Michael Vanmechelen, who manages operating theaters at the hospital and has overseen the machines’ integration. But, says Vanmechelen, the automatons have actually become more useful now the hospital has resumed normal operations and the number of staff available to handle incoming patients has been reduced.
The machine didn’t slot into place right away, he says. Initially, the camera that scanned patients’ QR codes was too slow, frustrating people and creating more issues for human staff. But a quick hardware upgrade later, and he says the robot receptionists now work like a dream, helping direct patients without exposing human staff to COVID-19.
“From now on it is working every day,” Vanmechelen tells The Verge. He says the bots are “magnetic,” drawing people straight toward them for processing into the hospital proper. “People are very attracted by it. It’s really a bit of magic.”
That sense of robotic wonder has been useful at the Phoenix Children’s Hospital in Arizona, where telepresence bots built by OhmniLabs have been used to entertain children confined to their rooms because of the pandemic. A number of hospitals are using telepresence robots (which are essentially iPads on wheels) to help doctors see patients without risk of infection. But in Phoenix, the robots are helping the young patients get out and about.
Using the telepresence robots, children have been able to take trips outside the hospital to places like fire stations; to participate in the hospital’s close circuit TV channel, which beams live game shows and quizzes into patient’s rooms; and to host visitors like family members, local sports stars, and even a caricature artist, who used the telepresence bots to sketch the children remotely and then send their portraits to the hospital to be printed out.
Having a physical avatar for these visits makes a huge psychological difference, staff tell The Verge. When there’s a robot that can be steered around remotely, rather than a simple Skype call on a tablet, the children feel a greater sense of connection to the outside world.
“They’ve been a surprising asset to have during this time,” Matt Bryson, who maintains electronic equipment for the children’s ward at the Phoenix Children’s Hospital, tells The Verge. “If we didn’t have the robots we wouldn’t have been able to have these special visits. It’s a huge benefit for our patients, to have these experiences when they’re not allowed to experience a lot of other things.”
The Phoenix Children’s Hospital has actually had two telepresence robots since 2018, but since the pandemic hit and the machines have become more valuable, they’ve ordered two more to supplement their fleet. The robots are now in use every day, says Stephanie Smith, who coordinates activities for the children, and the feedback has been enthusiastic.
“Just yesterday, when one of the children was using the robot for a scavenger hunt with our staff, her mom said ‘Thank you for spending the time with us,’” says Smith. “It’s all about that connection.”
Making the most of a crisis
Although COVID-19 has placed a tremendous strain on health care systems around the world, doctors told The Verge they were gratified that the pandemic had spurred these tests of new technologies.
“We’re moving at a rate of five times the normal rate of innovation,” Tullamore’s Kiernan tells The Verge. “The pandemic has actually enabled projects to happen. The bureaucracy has been removed. People are more willing to take a measured risk approach that says ‘Okay, let’s try something.’ In a safe environment, of course.”
Around the world, health care workers have had to change how they deliver care overnight, with new focuses on telemedicine and remote diagnosis. For many, this has created an environment where new approaches are treated with less suspicion and more optimism.
In addition to the trial of Violet, Kiernan offers examples from her own department of orthopedics. She says Tullamore hospital has gone from seeing over 100 patients in a typical morning to around 20, with doctors and nurses compensating by taking services online. They now do physiotherapy sessions over Zoom, for example, and created a website that briefs patients ahead of hip and knee replacements and gets their consent for surgery. Doing so in person before the pandemic hit would have taken a whole afternoon; now, it just takes minutes.
“If you’d tried to introduce that [the website] in normal times, well, just imagine the amount of people you’d have to get approval from,” says Kiernan.
Belgium’s Vanmechelen agrees, adding that the need to deal with the specific problems presented by COVID-19, like reducing infections from incoming patients, made the process of change more manageable. Rather than simply trying to “modernize” the hospital on all fronts, he says, managers have been able to concentrate on individual challenges.
“We had a problem that needed urgent solutions. And that’s a good environment for innovation,” says Vanmechelen. “What took three months or even a year before, we developed in a week now. Because everyone was focused.”
It’s a truism that medical advances often flourish in times of crisis. When the 1918 flu devastated the world a century ago, killing an estimated 50 million individuals or around 2.5 percent of the global population, the unprecedented speed and lethality of the virus pushed governments toward centralized health care. A disease that cut through broad swathes of the public demanded a response with the same breadth, so governments began offering their own health insurance and collecting medical data to better anticipate and track future outbreaks.
Right now, the world is facing a very different pandemic. But there’s a similar opportunity for lessons to be learned — not just by accepting the helping hands of robots, but by creating more adaptable health services in general. If not for this pandemic, then for the next one.
“It’s coronavirus now but it could be something else in a few years,” says Kiernan. “I think a lot of the changes that have happened now are going to stay.”