My opinion

By Dr. Deepak Gupta
Corresponding Author Dr. Deepak Gupta
Wayne State University, - United States of America 48201
Submitting Author Dr. Deepak Gupta

SARS-CoV-2, COVID-19, Personal Protective Equipment

Gupta D. Can Bat-Gown, Bat-Sack, Bat-Box Protection Counter Bat-Human Contraption? An Envisaged Idea Triplet. WebmedCentral INFECTIOUS DISEASES 2020;11(9):WMC005643

This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submitted on: 20 Sep 2020 06:26:40 PM GMT
Published on: 23 Sep 2020 04:55:17 AM GMT


Dose of exposure cannot be downplayed whether it is the dose of inanimate chemicals, animate bacteria or viruses somewhere-in-between therein. Therefore, as high infectivity of clinical scenarios unravel during COVID-19 pandemic, Bat-Gown, Bat-Sack and Bat-Box as envisaged idea triplet may play a role to counter Bat-Human contraption like SARS-CoV-2 in the healthcare environments.    

Envisaged Idea Triplet

During ongoing COVID-19 pandemic, it is routinely claimed that dose of SARS-CoV-2 exposure may not be scientifically relevant in evolution of COVID-19 symptomatology [1]. Contrarily, it is my belief that dose of exposure cannot be downplayed whether it is the dose of inanimate chemicals, animate bacteria or viruses somewhere-in-between therein [2]. During health promotion strategies for infection control, the core concept may be to reduce the dose of exposure to “homeopathic” levels because although there may be neither a direct-positive effect (treatment-effect) nor a direct-negative effect (adverse-effect) of exposure at “homeopathic” level, this “homeopathic” dose of exposure may still function in the role of antigenic effect to induce body’s innate and enhanced immune response that may counteract not only against the inciting antigens but also against other exogenous or endogenous antigens [3]. Hereby, to counter high infectivity of clinical scenarios as unraveling during COVID-19 pandemic [4-5], comes the role of my below-mentioned an “imperfect” envisaged idea triplet. Interestingly, other unrelated “near-perfect” strategies reduce doses of exposure up to “99.97%” germs and may still be leaving behind at least “0.03%” germs to potentially act as antigenic exposure required to keep our immune systems reactive, responsive and healthy [6].

Bat-Gown (Figure 1)

at-Gown may be simply cut out from transparent vinyl plastic as a coverall for healthcare workers (HCWs) wearing N-95 filter converted snorkel-mask as personal protective equipment (PPE) [7]. A small circular cut as N95 filter’s outlet at the top of Bat-Gown will be a must to allow access to ambient air because Bat-Gown is to be worn only over snorkel-mask based PPE. To cut out Bat-Gown, an analogous online video by Susan Evans may help as guide [8]. Essentially, Bat-Gown may initially need folding of 13X long and 19X wide vinyl plastic dual sheets in the half, widthwise, wherein X is comfortable adult arm diameter (~5 inch). Thereafter, Bat-Gown may be cut out along the solid curved black lines and imprinted handprint allowing the integration of head-cover, gloves and body covering as one-unit leaving the need only for shoe/boot-covers to be donned separately. After unfolding, dual sheets’ edges may be laminated with heated source leaving only the lower (ankles’ level) margin open for donning and doffing Bat-Gown drawn over HCW’s head. For understanding the doffing of Bat-Gown, an analogous online video of T-shirt doffing may help as guide demonstrating how to doff over the head by crossing the hands to grasp the contralateral lower margins and thus avoiding contamination while doffing [9]. It may be worthwhile to keep vinyl plastic not too thin so that it may not collapse creating trapped air pockets between Bat-Gown and HCW’s clothes. Bat-Gown’s baggy shape at waist level may allow freely flowing ambient air ingressing/egressing at open ankles’ level for HCW’s safety and comfort. Bat-Gown’s baggy shape at armscye level (dolman sleeve) may allow HCW to easily draw in and out hands during respectively donning and doffing Bat-Gown. Moreover, dolman sleeve may give HCW’s hands easy access into their clothes’ pockets for making or attending emergency phone calls without needing to doff Bat-Gown. There will be few limitations with Bat-Gown. Bat-Gown may only be worn for short periods over snorkel-based PPE which may have carbon dioxide accumulation concerns if worn for longer periods [10]. Free flowing ambient air circulating beneath Bat-Gown may expose HCWs’ clothes to contamination by airborne particles and pathogens contained in the circulating ambient air. Cost-effective to make and easy to don-doff Bat-Gown can never replace Hazmat suits [11]. Bat-Gown enclosed sound-dampening environment may warrant HCW to wear microphone under mask (MUM) or microphone under gown (MUG) and audio-amplifier under gown (AUG). It is unclear if Bat-Gown will still be easy to make, don or doff once vinyl plastic may get replaced with nonwoven opaque fabrics leaving allowable transparency only around face.

Bat-Sack (Figure 2)

As inspired from potato sack races of childhood [12], Bat-Sack may create an enclosed environment for patients undergoing lower gastrointestinal endoscopy wherein insufflated gas has potential to egress as aerosolized fecal material containing SARS-CoV-2, intraoperatively as well as postoperatively [13]. To enclose egressing gas and direct its controlled exit into High-Efficiency Particulate Air (HEPA) filtration unit in procedure room as well as in post-procedure recovery room, Bat-Sack made of transparent vinyl plastic may come in handy with self-collapsible slit for lower gastrointestinal endoscope’s access and another slit for surgical smoke-“aerosol”-evacuator. The few limitations with Bat-Sack will be that (a) it is unclear if there will be a fire risk with egressed bowel gas and insufflated gas admixture’s entrapment for suctioning, and (b) the time to completely empty gas egressed into Bat-Sack will depend on the suction power of surgical smoke-”aerosol”-evacuator [14]. Interestingly, if Bat-Sack and HEPA filtration units will be logistically difficult post-procedure, patients may don diapers until ready to wear their own undergarments to adsorb/absorb “aerosols” egressing after lower gastrointestinal endoscopy procedures [15].


Bat-Box (Figure 3)

As the question lingers to balance positive and negative pressure rooms [16-17], I believe that COVID-19 pandemic may be the right time to convert healthcare rooms into “neutral” pressure rooms that I named as Bat-Box. In Bat-Box, intentional positive “ingress” air flow from roof and accidental positive “ingress” air flow from wooden door may coalesce at floor level before egressing through strongly negative “vacuum” pressured near-the-floor vent outlet. Herein, the egressing air may be treated with bactericidal and viricidal strategies like ultraviolet-C or thermodynamic sterilizing system before getting dispersed into city atmosphere [18]. To improve the seal around sliding wooden door, transparent vinyl plastic doors may be integrated on both sides of the wooden door. Being taller than wooden door, the plastic doors may be accommodated and slid inside dedicated floor grooves to ensure better seal against air movement across door assembly. These sliding plastic doors may additionally have mid-splits to allow healthcare personnel’s emergent entry and exit without breaching neutral pressure inside Bat-Box.


In summary, Bat-Human contraption like SARS-CoV-2 may warrant feasibility explorations and safety investigations into the potential of envisaged idea triplet (Bat-Gown, Bat-Sack and Bat-Box) to help patients’ and personnel’s personal protection.


The author sincerely appreciates Shushovan Chakrabortty, Clinical Assistant Professor, Anesthesiology, Wayne State University, and Arvind Srirajakalidindi, Anesthesiologist, Detroit Medical Center, Detroit, Michigan, for their initial inspirations during this now-abandoned pursuit. The author also appreciates Aone Wang, Poster Smith, Brookline, Massachusetts, regarding our initial planning about this now-abandoned prototype manufacturing collaboration.



  1. Caddy SL. Coronavirus: does the amount of virus you are exposed to determine how sick you’ll get? Boston, MA: The Conversation, April 2020. ( exposed-to-determine-how-sick-youll-get-135119.)
  2. Chandrasekaran S, Jiang SC. A dose response model for quantifying the infection risk of antibiotic-resistant bacteria. Sci Rep. 2019;9:17093. ( es/PMC6863845/.)
  3. Gupta D. Elusive mechanism of homeopathy: its miracle may be its curse and time to consider homeopathy vacation. WebmedCentral HOMEOPATHY 2011;2:WMC002452. (
  4. Malhotra N, Bajwa SJ, Joshi M, Mehdiratta L, Trikha A. COVID Operation Theatre- Advisory and Position Statement of Indian Society of Anaesthesiologists (ISA National). Indian J Anaesth 2020;64:355-62. ( es/PMC7286404/.)
  5. Malhotra N, Joshi M, Datta R, Bajwa SJ, Mehdiratta L. Indian society of anaesthesiologists (ISA national) advisory and position statement regarding COVID-19. Indian J Anaesth 2020;64:259-63. ( es/PMC7189907/.)
  6. Bipat C. Controlling airborne germs: how do air purifiers work? New York, NY: Nearby Engineers, March 2020. (https: //
  7. Stanford Bioengineering: Schools of Engineering & Medicine. Pneumask: reusable full-face snorkel mask PPE project. (http s://
  8. Evans S. Bible costume in five minutes. Susan’s Homeschool Blog, November 2010. ( stume-in-five-minutes/.)
  9. YouTube. You’ve Been Taking Off Your T-shirt Wrong. (
  10. Subea. Standards and tests performed on the Easybreath mask. (https://www.
  11. Honeywell North. Air-Fed Suits. ( dam/his-sandbox/products/respiratory-protection/documents/HS_honeywell-north-air-fed-suits_air-fedsu it-brochure_v5.pdf.)
  12. Carnival Savers. Carnival activity idea – potato sack races. ( races/.)
  13. Ong J, Cross GB, Dan YY. Prevention of nosocomial SARS-CoV-2 transmission in endoscopy: international recommendations and the need for a gold standard. Gut 2020;69(6):1145-1148. ( es/PMC7211057/.)
  14. Surgiform. Surgical Smoke Evacuation Guidelines: Where do We Stand in 2019? ( ke-safety?v=c65242dc6c2c.)
  15. Gupta D. "N95/N99" peri-procedure diapers during lower gastrointestinal endoscopies. Med Hypotheses. 2020;144:110026. ( es/PMC7313482/.)
  16. Hendiger J, Chludzi?ska M, Zi?tek P. Influence of the pressure difference and door swing on heavy contaminants migration between rooms. PLoS One 2016;11:e0155159. ( es/PMC4865048/.)
  17. Villafruela JM, Olmedo I, Berlanga FA, Ruiz de Adana M. Assessment of displacement ventilation systems in airborne infection risk in hospital rooms. PLoS One. 2019;14(1):e0211390. ( es/PMC6353581/.)
  18. Airfree. Viruses and heat inactivation. (https://ww

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