How a simple plastic box could protect health-care workers across Canada from COVID-19

For clinicians, inserting a tube into the airway of a COVID-19 patient is a high-risk procedure.

It usually means front-line workers are staring right into someone's open mouth, and directly in the line of fire, should a sudden cough send virus-filled droplets flying.

And with more patients needing help breathing, the risk is growing.

"We're seeing week-by-week, day-by-day, patients are getting sicker, more patients being admitted, and more patients are being put on respiratory support and a ventilator," says Dr. Alyssa Wong, an emergency physician with Trillium Health Partners in Mississauga, Ont.

Wong started wondering about the dangers facing her peers, and she wasn't the only one.

In a WhatsApp group for physicians, where COVID-19 articles were flying back and forth, her colleague Dr. Daniel Shogilev shared coverage of a doctor in Taiwan who'd developed a transparent plastic shield to cover patients during intubation, helping reduce the risk to clinicians.

That was a few weeks ago in mid-March. Wong knew some people outside the medical community who might be able to help make the concept a reality in Canada, and a small team hoping to develop what they've since dubbed the "COVID Box" met on a Zoom teleconference the next day.

Since then, the little volunteer coalition of clinicians, entrepreneurs and tech company founders has designed and tested their cube-shaped shield, inspired by the open-source design from Dr. Hsien Yung Lai in Taiwan.

The early rounds were a bit of trial and error. 

Entrepreneur Dave Phillips, whose wife Dr. Dana Phillips is an emergency physician at Sunnybrook Hospital, says his first prototype was "rough," using hand-tools and a hacksaw.

Then mechanical engineer Jonathan Norris, the co-founder and chief technology officer at Toronto-based tech company Taplytics, built a digital design made for automated machines.

Boxes sent to hospitals across the GTA

Thanks to funding and support from Norris's company, along with Trillium Health and architectural fabrication firm Eventscape, the team has built more than 20 prototypes of the polycarbonate device, and started sending them around to hospitals across the GTA.

In the Wellington Street West office of Taplytics , Norris and Phillips show how easy the COVID boxes are to build.

The sturdy, transparent sheets come flat-packed and can be assembled in minutes, with three pieces connecting to form a shield that's held together by zip-ties, with two circular holes at the front where clinicians can insert their arms to intubate each patient.

After each procedure, the team says the boxes can be quickly disassembled and easily disinfected with medical-grade cleaners.

"The challenge we've seen is the cost of polycarbonate in the last week has basically doubled," Norris says, noting the growing popularity of plastic shields for cashiers and other workers dealing with the public amid the ongoing COVID-19 pandemic.

That hike brought the production cost up to around $200 per box.

The team is now hoping a combination of crowd-funding and corporate donations will help them supply hundreds, if not thousands of boxes, to hospitals across Canada and beyond — since inquiries are pouring in from around the globe.

While the physicians on board say the boxes aren't a perfect fix, they could offer added protection to front-line workers amid a shortage of other personal protective equipment, which is forcing hospitals to ration supplies while government officials scramble to order more amid a surging number of COVID-19 cases.

Wong says the level of "knowledge transfer" and support has been great to see amid the ongoing crisis.

"Everybody's trying to take small steps to mitigate this pandemic," says Shogilev. 

"The mantra of emergency medicine is, 'Do what you can with whatever you've got,' and I think we're all trying to do that."