British Indian medic creates Covid-safe masks for surgeries

British Indian surgeon Ajith George, working with a colleague, has created an innovative new Covid-safe face mask to protect fellow ear, nose and throat (ENT) medics from coronavirus infections in the line of duty.

Now an initial batch of 30,000 of these SNAP devices are ready for dispatch, with 5,000 going out free to National Health Service (NHS) ENT clinics across the UK.

George, who is based at the Royal Stoke University Hospital in Stoke-on-Trent, created the SNAP device with fellow ENT surgeon, Chris Coulson, as a practical response to the Covid-19 crisis. Their brainchild was then developed within months in collaboration with engineers at Aston University and specialist UK-based manufacturing firms.

George, with family roots in the southern Indian state of Kerala, said: “It's incredibly exciting to see this device going from concept to reality so quickly. As working surgeons, our innovation work is driven by creating things we would want to use ourselves. Covid-19 has led to heightened awareness about the spread of disease in clinical environments, so we see the SNAP device having practical applications during the pandemic and beyond.

“We would like to see this device enable safety for clinicians all around the world. That is one reason why we have teamed up early with a strong surgical instrument manufacturing partner, who can quickly distribute to international markets.”

There has already been interest in the device from the US, Australia, Japan, the Netherlands and the Philippines.

Easy to use

The SNAP device - comprising a two-part valve and speculum - clips onto either side of a standard surgical face mask, creating a hole for an endoscope to be inserted and for patients to keep their nose and mouth completely covered. On withdrawal of the endoscope, a one-way valve closes the hole. Any coughs, splutters or sneezes during the procedure are caught within the mask, which is disposed of at the end.

ENT surgeons performing nasendoscopies, where a small flexible tube fitted with a camera is inserted into the nose, are at risk of contracting coronavirus because the procedure can make patients cough and sneeze. Until now, patients have had to remove their own face masks for the endoscope to be inserted, leaving surgeons reliant only on their own personal protective equipment (PPE) gear.

George and Coulson co-founded their spin-out company Endoscope-i in 2012, which specialises in making endoscopic adapters for smartphones that allow clinicians to carry out complex imaging work. Earlier this year, the duo won a £50,000 grant from Innovate UK to help develop the SNAP device as part of the government agency's support for innovations designed to alleviate the impact of Covid-19.

In tests, the device has been shown to dramatically reduce the spread of particles when a patient coughs, compared to either no mask or a mask with a hole cut in it. This reduction in particulate spread reduces the likelihood of Covid-19 being transferred to clinicians.

Medical innovation

The initial concept process for SNAP began in March 2020 just as the pandemic started to hit the UK health service.

George explains: “Our company specialises in medical innovation, so we purposefully seek out opportunities to solve problems. This particular problem, with nasendoscopy, could potentially have disrupted head and neck cancer diagnosis.

“As a head and neck cancer surgeon, early diagnosis of cancer is something I feel very strongly about. It's much easier treatment for patients with better outcomes. I want to see my patients do well and want to see my colleagues stay well and do what they do best, diagnose, treat and monitor for cancer.”

Among some of the company's other innovations include iPhone attachments and an app which allows for easy remote diagnosis of cancer by capturing high-definition images of the nose and throat.

“Our hospital in Stoke is the first in the world to use this technology and provide our patients with rapid consultations as to whether they have cancer of the throat when they present with a hoarse voice. We also run the whole service for this process, called a Telescopic Referral. Our team use this camera technology for the Military in the UK to aid remote ear care and hearing problems,” adds George.

Simple idea

Many hospitals have had to dramatically scale back the number of nasendoscopies they can perform. In normal times, around 500,000 procedures are performed in the NHS each year, typically to diagnose and treat diseases affecting the nose and throat including cancer and serious infections. The technique is also used in speech and language therapy, in which patients are often required to practise speaking with a tube inserted.It is hoped that the new protective device will help address the scale-back in the procedures.

Mark Prince, a 3D printing expert from Aston University's College of Engineering and Physical Sciences, was seconded to Endoscope-i earlier this year and has led the design work. Using an industrial-grade 3D printer borrowed from the university during the lockdown period, he created around 2,000 prototype versions of the device from his home at Kidderminster in the West Midlands region of England.

Prince said: “It sounds disproportionate for something that is effectively such a simple idea, but each prototype had to be produced in multiples so they could be tested in clinics.

“With something so important, it has to be exactly right. If it helps get the NHS back to a more normal service, even in just this one specialism, it will all have been worth it.”

by Aditi Khanna

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