Combating COVID-19—The role of robotics in managing public health and infectious diseases

Sciutti, A.,¹ Battaglia, F.,² Fossati, M.R.,¹ Calderai, V.,³ Catalano, M.G.,¹ Antonelli, G.L.,⁴ Di Nunzio, G.M.,⁵ Dubbini, N.,⁶ Giarré, L.,⁷ Menegatti, E.,⁵ Negrello, F.,¹ Pascucci, F.,⁸ Pivetti, M.,⁹ Zanchettin, A.M.,¹⁰ Baroncelli A.,¹¹ Majorana, S.,¹² Marchisio, C.,¹³ Siciliano, B.,¹⁴ Rocco, P.,¹⁰ Metta, G.,¹ Melchiorri, C.,¹⁵ Laschi, C.,¹⁶ Guglielmelli, E.,¹⁷ De Luca, A.,¹⁸ Dario, P.,¹⁶ Bicchi, A.^1,3

¹Italian Institute of Technology; ²LMU Munich; ³University of Pisa; ⁴University of Cassino; ⁵University of Padua; ⁶Miningful Studio s.r.l.; ⁷University of Modena and Reggio Emilia; ⁸Roma Tre University; ⁹University of Bergamo; ¹⁰Polytechnic of Milan; ¹¹Comau Robotics s.p.a.; ¹²Kilometro Rosso s.p.a.; ¹³ANIPLA Milan; ¹⁴University of Naples Federico II; ¹⁵University of Bologna; ¹⁶Sant’Anna School of Advanced Studies; ¹⁷Campus Bio-Medico University of Rome, ¹⁸Sapienza University of Rome.

Introduction
In their Editorial "Combating COVID 19: The role of robotics in managing public health and infectious diseases" published on 25 Mar 2020, Guang Zhong Yang et al. very timely predicted that, because of globalization and increasingly interconnected economies, most countries were to be affected by COVID-19 and that a global effort was required to break the chains of virus transmission. The Editorial asked the central question: Could robots be effective resources in combating COVID-19?

In this letter, we provide an answer to this question illustrating in some detail how the Robotics community of one country, Italy, has concretely responded to the emergency in the early stages. We also discuss how we are now working to help the recovery phase and to share this experience with the worldwide community, to pass along the many lessons learned. 

Italy has been the first western country severely affected by COVID-19. Its implications were by no means clear from the outset. In early March, some people simply updated their agendas by postponing their commitments for a few weeks. Other people rushed to stockpile basic necessities and all sorts of merchandise. The awareness that some practices would have changed for a long time, maybe for good, struggled to dawn on most of us. Moving many activities to virtual and remote mode implied something dramatically different than simply replicating what these activities used to be “in person”.

This scenario produced an unexpected, significant acceleration on the pervasive use of the wide variety of digital and communication technologies, smart devices for Internet of Things, and the other most advanced enabling technologies: Robots and Intelligent Machines.

Resorting to robots seemed to everybody (not only robotics enthusiasts) the natural option to ensure safe interactions and avert the risks of infection. This full endorsement from ordinary people fueled serious reflections within the robotics community, including a renewed interest for a global strategic orientation. However, the first and foremost reaction was a strong sense of responsibility urging us to put technologies at work to help in the many emergency situations that had to be faced. A true call of duty was further spurred by the media, with popular newspapers asking pointed questions such as, "but where did they end up, these famous robots, now that they are most needed?" [Riccardo Luna, “Ma che fine hanno fatto i Robot?”, La Repubblica, 09 April 2020.]

The Italian community of roboticists from both research and industry, united in the Italian Institute of Robotics and Intelligent Machines (I-RIM; http://i-rim.it/en/), has responded to the challenge in a forceful manner. For discussing the immediate responses and longer-term strategies, the community met in a general Assembly on 26 March, hence with videocalls that were held daily, with several tens of participants, for the first few weeks, and hence weekly.

In these meetings and in intensive parallel exchanges in the community, different approaches to devising an emergency response were pondered. There are plenty of lessons learned from the past on top of which to build [1], while not disregarding inspiration which may come from visionary literature [2]. A third, complementary approach that was at the core of I-RIM’s strategy was based on the recognition that precious knowledge about the benefits and risks of applying robotic solutions does not belong to roboticists alone; rather it is shared among many stakeholders and interest groups [3]. A “community-driven approach” in the field of robotics should cover multiple levels of citizen’s engagement: from raising awareness about what present-day technology can do, to encouraging citizens to participate in the technological process by observing, describing, and analyzing how their living and working conditions have been changing, right up to setting the robotics agenda and roadmap for co-designing robotic solutions. It was felt that synergies should be established at different levels, involving designers as well as users, university researchers and open-source digital craftsmen.

The results of these actions were undoubtedly of some utility in the immediacy of the facts and have raised social interest and appreciation. Most importantly, perhaps, the lesson we take from the first phase (lockdown) is the overall philosophy of “Citizen Robotics” – a widely participated approach to robotics – which has been triggered by the pandemic outbreak at a rapid pace. Citizen Robotics is the result of i) surprise; ii) initial reaction; iii) a shared awareness about the social benefits of robotics; iv) the state of art of robotics, which didn't match up to the challenges of the pandemic outbreak. Against the pandemic backdrop, the relationship of robotics with and for society grew deeper. Moreover, we believe the dramatic experience can have profound implications on robotics as a scientific discipline, as a profession and as a practice, that call for further, deeper consideration in our near future.

Activities of I-RIM Against COVID-19
The Italian Institute for Robotics and Intelligent Machines (I-RIM) is a non-profit organization of national stakeholders promoting the development and practice of robots and intelligent machines to improve citizens’ quality of life and well-being. Established in 2019, I-RIM started with 250 members and held its first conference and exhibit in Rome in October 2019, with 500 delegates attending the conference and many tens of thousands of people visiting the exhibit.

The COVID-19 emergency in Italy started with the first outbreak on 20 February 2020. The highest peak was reached on  21 March 2020 with 6,557 new cases. On 4 June, at the time of writing, 177 new cases were counted. Activities of I-RIM to counter pandemic effects are reported on the I-RIM website (https://i-rim.it/en/i-rim-contribution/). A workshop (http://www.i-ras.it/node/273 and https://www.youtube.com/watch?v=O_yZH1JUAI8) was organized on 28 May 2020 to reflect on successes and shortcomings of technology in the lockdown phase and to prepare for the next challenge – safe economic recovery.

The overall strategy of I-RIM to counter the COVID-19 outbreak had three lines of action: 1) careful listening to the societal needs, 2) disseminating the information on what robotic technology can do to fight the consequences of infectious diseases, and 3) forming a coalition with all stakeholders needed to give immediate, practical responses in the emergency.

Listening to the Needs

Our goal of this action was to collect and understand the needs and requests of health workers, of those who kept working and continued to produce under the lockdown, and of those who remained isolated at home. An initiative based on interviews was started, directed to operators in hospitals and elderly care homes. A more systematic approach followed, aimed to understand how life and work in general was changing during the peak of the COVID-19 outbreak. In the spirit of a truly User-Centered Design (UCD) process, an anonymous questionnaire was distributed around mid-April (https://bit.ly/2UoTi9N). The questionnaire, available in Italian and English, was circulated among Italian citizens.

The identified need was that of reducing the possibility of contagion in professional activities. The questionnaire aimed at drafting a picture of the tasks and routines people went through in different contexts, as well as their subjective idea of the risks they were exposed to. About 200 people answered, describing how the pandemic influenced their life and work, the novel risks associated to their tools and environments, and how the interaction with colleagues and customers or patients was affected. The answers to the questionnaire were mostly in free text format so as not to bias the outcomes with forced choices. This posed a challenge to the manual analysis of results, which was undertaken with the help of state-of-the-art natural language processing and data analysis tools (for details, see the I-RIM website: https://i-rim.it/en/i-bisogni/). Respondents were mostly working in fields that were not stopped under lockdown, such as healthcare (about 30%), research (about 19%), and education (about 9%). Medical doctors, managers, consultants, teachers, professors, technicians, physical therapists, and other workers described how they had reorganized their activities. About a third of the respondents had to cope with the novel risks of potential infection in their normal work environment – or in traveling by public transport to get to work. Activities were found to have moved to smart working at a rate of about 50% of respondents, forcing many to abruptly switch to a novel, virtual work dimension, characterized by the impossibility to naturally interact with colleagues, patients, and students. Even in such difficult times (or perhaps because of them) the majority of respondents believed that technology, robotics, and AI could help in minimizing the risk of contagion. The questionnaire also asked for applications where respondents thought technology could help. The responses were different, ranging from the use of robots to sanitize environments or to handle objects at risk to the deployment of technologies to facilitate remote work along with devices enabling faster medical testing and screening.

Since the beginning of May 2020 things started to get better; strict lockdown was over, and activities were progressively restarting in the so-called “phase 2”. Needs and priorities of citizens are changing accordingly: some workers moved back from smart working to their “in presence” job, while others are reopening their activity after full closure. Novel challenges are posed by COVID-19 to sectors like education, tourism, culture, and commerce, which need to be addressed. A new questionnaire has been therefore prepared by an I-RIM UCD working group and is being circulated in June 2020 to capture these changes and intercept the needs and hopes of all involved actors.

Pilot Projects

A window on what robotic and intelligent machines could do against infectious diseases was opened in the I-RIM website, with a collection of pilot projects (https://i-rim.it/en/pilot-projects/) presented by companies and research groups in Italy and worldwide. Pilot projects are technological demonstrators with high Technology Readiness Level (TRL), i.e., tested in the clinical field or in relevant environments, which can be brought to commercialization and made available for generalized use in the medium term. Projects are classified based on the application field, geographical region of provenience, TRL, and development status.

The database, including more than 70 applications of robots and intelligent machines, can be analyzed by filtering entries according to one or more of these categories. Simple statistics of the collected data are also reported about the distribution of new robotic technologies for each category. New projects can be added by developers autonomously and are validated by I-RIM staff.

Our analysis of existing pilot projects showed that the impact that robotics and intelligent machines could have had during the crisis was also limited by three factors: i) the state of the art only allows reliable and effective performance in limited, controlled, and well-defined tasks; ii) these systems often require assistance by technologically skilled people; and iii) even existing technologies were not widely available at the pandemic outbreak.

We believe that only a substantial further investment in research and innovation can successfully tackle the first and second issues (cf. [1]) fostering a UCD approach to Citizen Robotics. For a response in the heat of the pandemic outbreak, I-RIM dedicated a special emergency effort, described in the next session.

Robots in Emergency and TechForCare Coalition

The difficulties of a robotic intervention of the appropriate size – hundreds of hospitals, hundreds of thousands of people involved – in the extremely tight times of the emergency, are obviously enormous. This is not only a technology problem (pilot projects prove that there exist technical solutions which, albeit limited, could be useful), but also a logistic gap. There were simply not enough robots yet on the market. Robots for telepresence, for example, were in high demand according to the results of our interviews and questionnaires, but only a few units were available to hospitals in Italy at the time of emergency, and nobody was prepared to produce more of them in such a short time.

Nevertheless, the I-RIM community made an endeavor to bring together all who design and produce advanced technologies, artificial intelligence, and robotics in Italy, in Europe and across the world, with the aim of making useful, if not ambitious or sophisticated, contributions. The idea was to collect simple and well-documented robot projects, using off-the-shelf hardware easily available even in lockdown (ecommerce never stopped delivering in Italy) and open software made available free of charge by research centers. Most important, these robot projects could be assembled and used by non-specialized personnel to solve concrete problems in the actual environment of our hospitals and care homes in the provinces. To make this possible, I-RIM launched TechForCare, a common space or coalition (https://i-rim.it/en/short-term-solutions/), as it were, aimed to bring together the innovation capacity of communities of experts in new technologies with the pressing needs of all operators involved in the emergency. The TechForCare.com web platform (https://techforcare.com/en/), built by I-RIM in collaboration with Maker Faire Rome (a meeting point for the community of makers and innovators in Italy), offers a selection of resources, solutions, technologies, intelligent machines and robots to fight the epidemic and its effects. These projects are accessible and available to everyone: from healthcare professionals to manufacturers of essential goods and services. Anyone can either simply look through the available solutions or collaborate in defining new ones. As an example, the NoFaceTouch project (https://sites.google.com/unisi.it/noface-touchapp/; SIRSLab - University of Siena) provides software that makes a smartwatch vibrate as soon as your hand gets to your face, to warn of possible contagion. A second example is LHF-Connect (Italian Institute of Technology and University of Pisa), consisting of a telepresence robot realized using a modified vacuum cleaner robot, two tablets, and few 3D-printed parts, together with a free open software for guidance and communication management between a patient, their family, and a volunteer robot supervisor. This system was replicated and used inside several COVID-19 hospitals and elderly care homes.

A European Perspective

The COVID-19 crisis has cast a new light on the existing tensions between innovation, production, and fair distribution of private and public health resources. In normal times, the answer to this problem is typically dictated by a combination of incentives to innovation, removal of trade barriers, and state intervention in favor of the most vulnerable parts of the population.

This precarious and partial equilibrium has been shaken by the restrictions to research brought about by intellectual property rights, the return to state protectionism (export bans, resource storage), the collapsing, and the transnational supply chain structure in the pharmaceutical and medical devices sectors – all factors that have hampered the fight against the pandemic outbreak.

At a hearing in the European Parliament on 21 April, the Commissioner for Health and Food Safety, Stella Kyriakides, stressed vigorously both the need to encourage the production of medicines and medical devices in Europe, and the necessity to overcome the limits to EU intervention in the area of public health policies, which are still essentially centralized at the member state level.

The I-RIM project contributes to these challenges by offering projects built around the expectations, the needs, and the ideas of people who are, in different ways, directly involved in the development of technologically advanced, inclusive responses to the demand for care and work in safety. In this sense, it can be a blueprint for similar initiatives at the European level, inspired by the awareness that a forward-looking innovation policy shall start from citizens’ expectations and demands.

We believe this project can be also an inspiration for science robotics research and for science-based, strategic, large innovation projects featuring a distinctive mission-driven approach, fully in line with the ongoing planning methodology of the new European Research Framework Program (Horizon Europe).

Concluding Remarks
The world has changed and will continue to change as it comes to terms with the pandemic and its aftershocks. To match the challenges brought by this change, we need to establish a lively and open dialogue between society and technology. If citizens must help the scientific community to identify and respond to the new challenges, the world of technology must be ready to listen and communicate honestly its shortcomings and successes. The aim should not be restricted to short-term analyses. Robotics and Intelligent Machines can be the key enabling technologies, not only for the future of healthcare, as widely experienced in this exceptional period, but also for a fully inclusive and sustainable Society. We need to focus on basic research to address the key problems of robotics and smart machines. Understanding what it takes for robots to be reliable, safe, and considerate of the users, and thus be integrated as an effective component of our societies, is the necessary step for robotics to be among us – and help us – whenever a new and unpredictable challenge strikes our existence, health, and quality of life as COVID-19 has done.

References
1. Guang-Zhong Yang, Bradley J. Nelson, Robin R. Murphy, Howie Choset, Henrik Christensen, Steven H. Collins, Paolo Dario, Ken Goldberg, Koji Ikuta, Neil Jacobstein, Danica Kragic, Russell H. Taylor and Marcia McNutt, Combating COVID-19—The role of robotics in managing public health and infectious diseases, Science Robotics 25 Mar 2020: Vol. 5, Issue 40, eabb5589 DOI: 10.1126/scirobotics.abb5589
2. Robin R. Murphy, Robots and pandemics in science fiction. Science Robotics 13 May 2020: Vol. 5, Issue 42, eabb9590 DOI:10.1126/scirobotics.abb9590
3. Rome Declaration on Responsible Research and Innovation in Europe
http://ec.europa.eu/research/swafs/pdf/rome_declaration_RRI_final_21_November.pdf

A LHF-Connect telepresence robot makes relatives talk to a patient in the ASFARM elderly care home of Induno Olona (Lombardy). The robot was realized under strict lockdown conditions by ASFARM personnel, using open software and instructions published by researchers of the Italian Institute of Technology and University of Pisa with the support of I-RIM.