Introduction
The novel coronavirus (SARS-CoV-2) is a highly-transmissible zoonotic respiratory virus with an astonishing global impact.1In December 2019, the first cases emerged in Wuhan, China2, and on March 11, 2020 the novel coronavirus disease (COVID-19) was declared a worldwide pandemic by the World Health Organization (WHO). During this pandemic, patients continue to present with urgent head and neck, and skull base conditions requiring timely surgery. Strategies to reduce risk of spread of infection during surgery are needed to protect the surgical team and patients.
While many infected with SARS-CoV2 will be asymptomatic, there are those with COVID-19 who will develop an advanced form of the disease presenting as an atypical pneumonia requiring ventilatory support and associated with significant morbidity and mortality.1It is known that there is a high viral load in the nasal cavity, nasopharynx, and oropharynx; the only higher subsite being the lower respiratory tract.3 What is more worrisome, is that infected asymptomatic carriers carry the same high viral load in these anatomic sites as those with symptoms.4,5 Among healthcare workers, certain personal protective precautions are taken, particularly during aerosol generating procedures, but these are not guaranteed to work. 6
At the onset of the pandemic, anecdotal international reports suggested otolaryngologists are also placed at great risk during surgery.7 Intuitively, surgery of the aerodigestive tract can expose workers to infected fluids and the use of high-speed drills in these anatomic sites can be a contributing factor. Workman et al. demonstrated in a simulated skull base surgery scenario that high-speed drills generated aerosols and droplet contamination up to 36 cm away from the patient.8 Coronaviruses are well studied, and measure approximately 0.125 microns and are transported in respiratory droplets.9 Coronaviruses can remain aerosolized for up to 3 hours, and are stable on surfaces like plastic and stainless steel.10  Improved methods for preventing droplet and aerosol spread are needed especially during high-risk procedures. Here we describe our experience developing the Negative-Pressure Otolaryngology Viral Isolation Drape (NOVID) to reduce aerosol and droplet spread in and around the surgical field.