If you've been tested for COVID-19, you've likely experienced the inconvenience of having a nasal swab. Someone takes a long-handled cotton swab and sticks it up your nose – far up your nose – until it reaches the back of the mucous cavity, which is your nasal cavity. Upon arrival, they give the swab a good vortex to collect your secretions and strike a compassionate retreat. I can say from my own experience that it is a uniquely unpleasant sensation. It's something that just feels wrong, like the opposite of itching.
Perhaps that is why I was so unsettled by the sight of this autonomous nose swab robot developed by the Taiwanese medtech startup Brain Navi. Of all the entities I don't want to stick cotton swabs up their noses, an industrial robotic arm is high on the list, right between an exciting toddler and a trained mountain gorilla. Swabbing your nose requires trust.
Would you trust a robot to stick a swab up your nose?
Even so, the bot exists, and Brain Navi's argument for it is more compelling than you might think. Given the surge in mass testing around the world, the company argues that automating tests could reduce infection and free medical staff to handle more urgent work. If we can overcome our first impressions of a robot with a cotton swab, the company says, it can benefit all of us. Doctors The Verge spoke to the machine, but was a little more skeptical about its chances in the real world.
First, let's talk about how it all works. At the beginning of the procedure, a patient puts on a nose clip that the device uses to orient itself. They then place their head in a metal bracket similar to the one used for eye exams (grabbing the handlebars like you're riding the world's worst roller coaster is apparently optional). A depth-sensing camera then scans her face and measures the distance from the nostril to the ear canal. According to Brain Navi, this is a reliable indicator of the depth of the nasal cavity and helps the robot to navigate safely inside you.
The robot then picks up a cotton swab from its base and approaches the victim's patient with excruciating slowness. It inserts the swab, rotates it, then pulls it out and places the sample in a sterile tube for transport and analysis. You can see everything below:
Let's be clear: this doesn't look like fun! That looks a little scary! There is something about the slowness and inevitability of the robot's movements that feels like an implicit threat, and the entire operation has the feel of an alien lobotomy.
"We've heard the feedback and we're thinking of ways to reduce this horrible feeling."
Brain Navi knows exactly what it all looks like. "Our founder Jerry (Chen Chieh-Hsiao) was the first to have a nasal swab from the robot, and he was scared," a company spokeswoman Zoe Lee told The Verge. But it, she says, is all a matter of familiarity. "I think people will be scared because it's a new thing, but that's normal. We've heard the feedback and we're thinking about how we can reduce this awful feeling."
The robot does not have pressure sensors to determine if it accidentally enters your meat. However, according to Lee, 3D imaging provides accurate and safe guidance. She also says that someone who is uncomfortable or in pain can just move away. "We're not chasing you around!" she adds
The machine itself is adapted to the main product of Brain Navi: an industrial robot arm that prepares patients for brain surgery. These recently completed clinical trials in Taiwan are pending regulatory approval. The swab machine has now only been tested on employees of Brain Navi (without problems) and approved for our own experiments.
Yes, that is how far back you have to go for a proper nasopharyngeal smear.
Image: New England Journal of Medicine
According to Lee, the CEO of Brain Navi was motivated to develop the machine by the SARS epidemic from 2002 to 2004. A friend of Chen's worked as a doctor during the outbreak and died of the disease. "This is why we want to help and develop a robot to help these (healthcare workers)," says Lee. "They are heroes to us and fight the pandemic."
According to Lee, Brain Navi is in talks with Taiwan’s Taoyuan International Airport about the possibility of testing the robot on arriving passengers. As she explains, this would be the perfect showcase for the machine's benefits. “Every country wants to reopen its economy and reopen it safely. Large-scale testing (at airports) could be key, ”says Lee. She says the robot can do a swab in just two minutes and work non-stop.
"I'd worry the swab might go somewhere it shouldn't be."
However, doctors The Verge spoke to about the Brain Navi machine were skeptical. They found that medical personnel are less at risk from taking nasal swabs as long as they have the proper protective equipment and that the robot is slower than humans. Andrew Lane, director at the Johns Hopkins Sinus Center, told The Verge that the basic concept was reasonable and interesting, but he wanted to know more details about the machine's safety procedures, especially when it comes to navigating the nasal cavity.
"The anatomy of the nose can be variable – the nasal septum is often shifted to one side or the other, and there are structures in the nose that can vary in size and shape," Lane told The Verge via email. “As a result, it is necessary to insert the nasopharyngeal swab carefully, paying attention to whether there is resistance and / or the patient feels pain (beyond the usual uncomfortable feeling of having the swab taken). If the head is a little restrained, I might fear that the machine is either malfunctioning, or just not being designed properly, causing the swab to go where it shouldn't. "
Lane notes that if the angle of approach is also incorrect when passing a swab, there is a risk of serious damage occurring. "The worst case scenario would be if the swab were pushed through a sinus wall into the eye or brain," he says.
A doctor from the UK's National Health Service (NHS) told The Verge that their major concern was the lack of communication with the patient. If it was your first time swabbing your nose, would you feel safe if you couldn't talk about what was happening?
"Nose swabs are painful even if you do it to yourself and I think it would be extremely uncomfortable if someone did," the doctor said. "I think for me, and for the majority of the patients I've met, they want someone who understands what it's like to be on the other side of the swab."
Right now, this is the kind of empathy that robots cannot deliver at just the end of a swab.