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Potential transmission of SARS-CoV-2 via robot pets in care homes

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Abstract

Robots pets have reported potential in improving wellbeing for older adults and people with dementia, including through reducing depression, agitation, loneliness and medication use. Such devices are becoming widespread in care homes, and may be particularly beneficial at present, in light of increased loneliness and social isolation as a result of COVID-19 restrictions. However, we conducted work previously that suggested robot pets may transmit bacteria between care home residents, and we tested the efficacy of a cleaning procedure to aid in safe use of the devices. Here, in light of the SARS-CoV-2 pandemic, we reflect on the plausibility of viral transmission via the robots and report an urgent need for further research and immediate action in care homes to respond to the identified risk.
Bradwell HL, Johnson CW, Lee J, Soler-Lopez M & Jones RB.
Potential transmission of SARS-CoV-2 via robot pets in care homes. 2020
1
Uploaded to ResearchGate August 2020
Potential transmission of SARS-CoV-2 via robot pets in care homes.
Authors: Hannah Louise Bradwell1*, Christopher W. Johnson2, John Lee2, Mar Soler-Lopez3
and Ray B. Jones1
1 Centre for Health Technology, University of Plymouth, Plymouth, Devon, UK
2 Department of Microbiology, Royal Cornwall Hospital, Truro, Cornwall, UK
3Faculty of Health, University of Plymouth, Plymouth, Devon, UK
* Corresponding author: hannah.bradwell@plymouth.ac.uk, christopher.johnson12@nhs.net,
john.lee14@nhs.net, mar.soler-lopez@plymouth.ac.uk, ray.jones@plymouth.ac.uk
Xiao and Torok rightly put limiting person-to-person transmission as the first measure to
control COVID-19 (1). Older adults have been particularly susceptible to SARS-CoV-2, with
dramatic case fatality rates reported, and care homes presenting challenges for preventing
its spread (2,3). Although there is published advice about SARS-CoV-2 persistence on various
surfaces (4,5), we have not yet seen publications regarding persistence on soft, artificial fur-
type surfaces, like those used for robot pets.
Robot pets (e.g. Paro the seal and Joy for All cat and dog) may benefit care home residents,
improving wellbeing and reducing loneliness, agitation and depression (6). Such devices
could therefore reduce loneliness and depression among older adults resulting from social
distancing (3). Their use is becoming widespread (7) and care home staff have informed us
that their robot pets are indeed demonstrating particular usefulness at present, assisting
with loneliness and depression in the absence of usual visitors or scheduled activities.
However, while robot pets could assist in this regard, they are often a shared resource,
passed between residents and staff. The plausibility of SARS-CoV-2 transmission on fomites
therefore raises implications for such devices.
We previously carried out empirical work demonstrating that robot pets could transmit
bacteria between care home residents, and tested the efficacy of a cleaning procedure to
stop it (8). We included eight different devices with varying surfaces (plastics, polyester,
acrylic, and lurex). To understand microbial load following standard use in care homes, we
sampled from the robots following 20 minutes of group interaction with four care home
residents. Colony counts and CFU/cm2 calculations suggested that during this short
interaction robots acquired unacceptable levels of bacterial contamination. Although our
study focussed on bacteria and not viruses, it nevertheless indirectly raises the possibility of
a significant source of viral transmission in long-term care facilities.
In the second stage of our work, we tested our cleaning procedure on contaminated devices
(8). This procedure used two disinfectant products; PDI Super-Sani Germicidal Cloths (9) and
Ecolab Sirafan Speed spray (10). We removed visible dirt with PDI wipes, before robots were
sprayed with the Ecolab spray, and brushed in a head-to-tail direction with a solid plastic
brush to disperse disinfectant. Devices were allowed to air dry before PDI wipes were
vigorously applied to all areas, in a head-to-tail direction, to ensure complete coverage and
fur fibre contact through the depth of the covering. Devices were maintained wet for 2
minutes, with wipes replaced upon drying. The results strongly supported cleaning efficacy,
with CFU/cm2 falling well within the acceptable threshold on all devices.
Bradwell HL, Johnson CW, Lee J, Soler-Lopez M & Jones RB.
Potential transmission of SARS-CoV-2 via robot pets in care homes. 2020
2
Uploaded to ResearchGate August 2020
Although we did not test for viruses, in particular SARS-CoV-2, we have reviewed the
cleaning products we used against the USA Environment Protection Agency List N of
Disinfectants for Use Against SARS-CoV-2 (11). PDI Super-Sani Germicidal Cloths have an EPA
number and are included on List N, confirming that the product is registered as an agent
meeting EPA criterion for use against SARS-CoV-2.
However, we could not find an EPA number for the Ecolab Sirafan Speed spray. Ecolab
Sirafan Speed spray has a chemical composition of 35% 2-propanol and 25% 1-propanol.
Kampf et al. (5) reported that a biocidal agent with a “combination of 45% 2-propanol with
30% 1-propanol [sic], readily inactivated [SARS-CoV] coronavirus infectivity by
approximately 4 log10 or more” in 30 seconds in suspension tests. This was similar to the
effect of Ethanol at 80% or Sodium Hypochlorite (bleach) at 0.21%. Given that the Ecolab
Sirafan Speed spray’s composition is only 35% 2-propanol and 25% 1-propanol it may
therefore not be effective against SARS-CoV-2, although we cannot confirm this without
more research.
Due to potential limitations of the Ecolab spray in combatting this virus, it is possible the
order of application should change from our original procedure, to prioritise use of the PDI
wipes first and avoid brushing any SARS-CoV-2 contamination further through the soft
materials before adequate disinfectant is applied. Maintaining use of the Ecolab spray
secondarily would still be beneficial for bacterial control.
Robot pets may be particularly useful during this pandemic and consequential isolation, but
safety must be prioritised, and shared use of such devices appears unsafe at present. We
are aware and concerned that robot pets are still in use in care homes, and often kissed and
cuddled. We are also unaware of SARS-CoV-2 advice being provided by the main robot pet
producers. We therefore report an urgent need for empirical investigation of SARS-CoV-2
transmission on robot pets and immediate action within care homes to respond to this
identified risk, particularly to remove devices from shared use.
References
1. Xiao Y, Torok ME. Taking the right measures to control COVID-19. The Lancet
Infectious diseases. 2020;20(5):523-4.
2. Aprahamian I, Cesari M. Geriatric Syndromes and SARS-COV-2: More than Just Being
Old. J Frailty Aging. 2020:1-3.
3. Wang H, Li T, Barbarino P, Gauthier S, Brodaty H, Molinuevo JL, et al. Dementia care
during COVID-19. The Lancet. 2020;395(10231):1190-1.
4. Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on
inanimate surfaces and their inactivation with biocidal agents. Journal of Hospital Infection.
2020;104(3):246-51.
5. van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN,
et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. New
England Journal of Medicine. 2020;382(16):1564-7.
Bradwell HL, Johnson CW, Lee J, Soler-Lopez M & Jones RB.
Potential transmission of SARS-CoV-2 via robot pets in care homes. 2020
3
Uploaded to ResearchGate August 2020
6. Abbott R, Orr N, McGill P, Whear R, Bethel A, Garside R, et al. How do “robopets”
impact the health and well-being of residents in care homes? A systematic review of
qualitative and quantitative evidence. International Journal of Older People Nursing.
2019;14(3):e12239.
7. Bradwell HL, Winnington R, Thill S, Jones RB. Longitudinal diary data: Six months
real-world implementation of affordable companion robots for older people in supported
living. Companion of the 2020 ACM/IEEE International Conference on Human-Robot
Interaction (HRI ’20 Companion); 2020 23-26 March 2020; Cambridge, UK.
8. Bradwell HL, Johnson, CW, Lee J, Winnington R, Thill S, Jones RB. Infection control
study of Paro and other companion robot animals for use in care homes: Efficacy of a
cleaning procedure. PLOS ONE. 2020;15(8): e0237069.
https://doi.org/10.1371/journal.pone.0237069
9. PDI I. Super Sani-Cloth® Germicidal Disposable Wipe: PDI Healthcare; 2020. Available
from: https://pdihc.com/products/environment-of-care/super-sani-cloth-germicidal-
disposable-wipe/.
10. Ecolab. Sirafan Speed RAPID SURFACE DISINFECTANT, RINSE FREE; 2008. Available
from: https://www.essef.be/images/documenten/9033070_pf1_E.pdf.
11. United States Environmental Protection Agency; Pesticide Registration; List N:
Disinfectants for Use Against SARS-CoV-2; 2020. Available from:
https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2.
... All the robots used for companionship had an anthropomorphic appearance and were dialogue based, while many companion robots used in care homes before the pandemic are zoomorphic and non-verbal (e.g., Paro [28], JustoCat [15] and the Joy for all pets [5]). One possible reason for the lower numbers of reports of these types of robots during the pandemic could be the risk for the social companion robots to spread COVID-19 between residents due to procimity to the robots (e.g., older adults petting and kissing the robots) [6]. Another reason could be the difficulties to get access to the facilities and the people who work there. ...
... In light of COVID-19, the issue of infection control is especially pertinent, as shared use may increase the risk of transmission of infections between users [27,28]. In fact, the shared use of robotic pets within care settings has recently been advised against [29]. Therefore, there is value in exploring lower cost alternatives. ...
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Background: Older adults and people with dementia are particularly vulnerable to social isolation. Social robots, including robotic pets, are promising technological interventions that can benefit the psychosocial health of older adults and people with dementia. However, issues such as high costs can lead to a lack of equal access and concerns about infection control. Although there are previous reviews on the use of robotic pets for older adults and people with dementia, none have included or had a focus on low-cost and familiarly and realistically designed pet robots. Objective: The aim of this review is to synthesize evidence on the delivery and impact of low-cost, familiarly and realistically designed interactive robotic pets for older adults and people with dementia. Methods: The Arksey and O’Malley framework was used to guide this review. First, the research question was identified. Second, searches were conducted on five electronic databases and Google Scholar. Studies were selected using a two-phase screening process, where two reviewers independently screened and extracted data using a standardized data extraction form. Finally, the results were discussed, categorized, and presented narratively. Results: A total of 9 studies were included in the review. Positive impacts related to several psychosocial domains, including mood and affect, communication and social interaction, companionship, and other well-being outcomes. Issues and concerns associated with its use included misperceptions of the robotic pets as a live animal, ethical issues of attachment, negative reactions by users, and other pragmatic concerns such as hygiene and cost. Conclusions: Overall, the findings resonate with previous studies that investigated the effectiveness of other social robots, demonstrating the promise of these low-cost robotic pets in addressing the psychosocial needs of older adults and people with dementia. The affordability of these robotic pets appeared to influence the practicalities of real-world use, such as intervention delivery and infection control, which are especially relevant in light of COVID-19. Moving forward, studies should also consider comparing the effects of these low-cost robots with other robotic pets.
... In light of COVID-19, the issue of infection control is especially pertinent, as shared use may increase the risk of transmission of infections between users [27,28]. In fact, the shared use of robotic pets within care settings has recently been advised against [29]. Therefore, there is value in exploring lower cost alternatives. ...
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Full-text available
Background: Older adults and people with dementia are particularly vulnerable to social isolation. Social robots, including robotic pets, are promising technological interventions that can benefit the psychosocial health of older adults and people with dementia. However, issues such as high costs can lead to a lack of equal access and concerns about infection control. Although there are previous reviews on the use of robotic pets for older adults and people with dementia, none have included or had a focus on low-cost, familiarly and realistically designed pet robots. Objective: The aim of this review was to synthesise evidence on the delivery and impact of low-cost, familiarly and realistically designed interactive robotic pets for older adults and people with dementia. Methods: The Arksey and O'Malley framework was used to guide this review. First, the research question was identified. Next, searches were conducted on five electronic databases and Google Scholar. Studies were selected using a two-phase screening process, where two reviewers independently screened and extracted data using a standardized data extraction form. Finally, the results were discussed, categorised and presented narratively. Results: A total of nine studies were included in the review. Positive impacts related to several psychosocial domains, including mood and affect, communication and social interaction, companionship, and other well-being outcomes. Issues and concerns associated with its use included misperceptions of the robotic pets as a live animal, ethical issues of attachment, negative reactions by users, and other pragmatic concerns such as hygiene and cost. Conclusions: Overall, findings resonate with previous studies that investigated the effectiveness of other social robots, demonstrating the promise of these low-cost robotic pets in addressing the psychosocial needs of older adults and people with dementia. The affordability of these robotic pets appeared to influence the practicalities of real-world use, such as intervention delivery and infection control, which are especially relevant in light of COVID-19. Moving forward, studies should also consider comparing the effects of these low-cost robots with other robotic pets. Clinicaltrial:
... Another challenge people can easily ignore is the potential virus transmission via shared robots with frequent physical human-robot interaction (pHRI). For example, although the robotic pets could help relieve elderly people's loneliness, as a shared public resource among senior adults they might carry the virus and spread it out [144]. Finally, someone may also argue that robots can easily replace human labor in the elderly care field, causing the loss of experience capacity of human caregivers after the pandemic is over [143]. ...
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Background Robopets are small animal‐like robots which have the appearance and behavioural characteristics of pets. Objective To bring together the evidence of the experiences of staff, residents and family members of interacting with robopets and the effects of robopets on the health and well‐being of older people living in care homes. Design Systematic review of qualitative and quantitative research. Data sources We searched 13 electronic databases from inception to July 2018 and undertook forward and backward citation chasing. Methods Eligible studies reported the views and experiences of robopets from residents, family members and staff (qualitative studies using recognised methods of qualitative data collection and analysis) and the effects of robopets on the health and well‐being of care home residents (randomised controlled trials, randomised crossover trials and cluster randomised trials). Study selection was undertaken independently by two reviewers. We used the Wallace criteria and the Cochrane Risk of Bias tool to assess the quality of the evidence. We developed a logic model with stakeholders and used this as a framework to guide data extraction and synthesis. Where appropriate, we used meta‐analysis to combine effect estimates from quantitative studies. Results Nineteen studies (10 qualitative, 2 mixed methods and 7 randomised trials) met the inclusion criteria. Interactions with robopets were described as having a positive impact on aspects of well‐being including loneliness, depression and quality of life by residents and staff, although there was no corresponding statistically significant evidence from meta‐analysis for these outcomes. Meta‐analysis showed evidence of a reduction in agitation with the robopet “Paro” compared to control (−0.32 [95% CI −0.61 to −0.04, p = 0.03]). Not everyone had a positive experience of robopets. Conclusions Engagement with robopets appears to have beneficial effects on the health and well‐being of older adults living in care homes, but not all chose to engage. Whether the benefits can be sustained are yet to be investigated. Implications for practice Robopets have the potential to benefit people living in care homes, through increasing engagement and interaction. With the robopet acting as a catalyst, this engagement and interaction may afford comfort and help reduce agitation and loneliness.
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Potential transmission of SARS-CoV-2 via robot pets in care homes
  • H L Bradwell
  • C W Johnson
  • J Lee
  • M Soler-Lopez
  • R B Jones
Bradwell HL, Johnson CW, Lee J, Soler-Lopez M & Jones RB. Potential transmission of SARS-CoV-2 via robot pets in care homes. 2020
Infection control study of Paro and other companion robot animals for use in care homes: Efficacy of a cleaning procedure
  • H L Bradwell
  • C W Johnson
  • J Lee
  • R Winnington
  • S Thill
  • R B Jones
Bradwell HL, Johnson, CW, Lee J, Winnington R, Thill S, Jones RB. Infection control study of Paro and other companion robot animals for use in care homes: Efficacy of a cleaning procedure. PLOS ONE. 2020;15(8): e0237069. https://doi.org/10.1371/journal.pone.0237069
Super Sani-Cloth® Germicidal Disposable Wipe: PDI Healthcare
  • Pdi I
PDI I. Super Sani-Cloth® Germicidal Disposable Wipe: PDI Healthcare; 2020. Available from: https://pdihc.com/products/environment-of-care/super-sani-cloth-germicidaldisposable-wipe/.