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.