Healthcare workers face unprecedented risks during the COVID-19 pandemic. The SARS-CoV-2 virus is highly contagious and is transmitted via respiratory droplets, with evidence suggesting the possibility of airborne transmission. Air and surface contamination has been demonstrated four meters from the source. Nosocomial transmission from patients with severe acute respiratory distress syndrome to healthcare workers has been reported, while many institutions face shortages of personal protective equipment and negative pressure rooms. Patients with COVID-19 may require aerosol generating procedures (AGP) or therapies (including intubation, extubation, nebulized breathing treatments, non-invasive ventilation [NIV], heated high-flow nasal cannula [HHFNC], tracheostomy, and cardiopulmonary resuscitation). These factors amplify the risks faced by healthcare workers, and are further magnified in low- to middle-income countries, where access to safety equipment may be limited. Physicians’ fear of contracting the virus has been reported to lead to deviations from standard care.

Strategies to mitigate these risks are desperately needed. “Clinical distancing”, a parallel to the practice of social distancing, has been proposed wherein healthcare workers reduce unnecessary contacts with patients to reduce transmission. Barrier enclosure devices for use during endotracheal intubation have also been proposed, although these have limited broad clinical applicability. Most existing solutions are heavy, rigid, non-disposable (with risk of patient-to-patient transmission), non-adjustable (for differences in proceduralist or patient height or movements), neutral pressure (compared to negative pressure), limited scope (endotracheal intubation only), and limited clinical experience for patients with COVID-19.

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