What Ophthalmologists Need to Know About the 2019 Coronavirus Disease (COVID-19)
Written by Abby Kiesner
Communications Manager
The Discovery of the 2019 Coronavirus Disease
The life-threatening viral epidemic responsible for the severe respiratory disease, was first recognized by an ophthalmologist in China. Dr. Li Wenliang, of Wuhan, China, is credited with being the first medical professional to blow the whistle on the new Coronavirus. Dr. Li saw seven patients that had a SARS-like infection with conjunctival involvement. The ophthalmologist then sent a message on WeChat about his concerns to his medical school alumni to forewarn them of his observation. He was later reprimanded for rumor-mongering by the Wuhan police. Nothing Dr. Li said regarding the virus was incorrect; China’s Supreme Court has since vindicated Dr. Li’s actions. Sadly, Li Wenliang, who has been referred to by many fellow Chinese citizens as a hero, passed away from the virus during his efforts against the viral epidemic.
For more information on Dr. Li Wenliang’s involvement with the Coronavirus epidemic, click here.
What is the New Coronavirus Disease?
The new Coronavirus, also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which can cause a severe respiratory disease - the 2019 Coronavirus Disease (COVID-19). The virus is spread person-to-person (people in close contact, respiratory droplets from coughing or sneezing, and touching contaminated surfaces that an infected person touched). The Coronavirus was first detected in China and has since been exposed to more than 100 countries, including the United States.
Symptoms include:
Shortness of breath
Cough
Fever
*Symptoms may appear 2-14 days after exposure.
Who is most at Risk?
Older adults
People with weak immune systems
Medical staff
As of March 16th, 2020, there have been 3,487 reported cases and 68 deaths in the U.S. (source: CDC). * Data include both confirmed and presumptive positive cases of COVID-19 reported to CDC or tested at CDC since January 21, 2020, with the exception of testing results for persons repatriated to the United States from Wuhan, China and Japan.
Click here for the latest update on COVID-19 cases in the U.S.
How does COVID-19 Affect Ophthalmologists?
Two recent reports suggest the virus can cause conjunctivitis (Journal of Medical Virology and another study in New England Journal of Medicine). Therefore, it is possible that the new Coronavirus is transmitted by aerosol contact with the conjunctiva.
While it appears conjunctivitis is an uncommon event as it relates to COVID-19, other forms of conjunctivitis are common. Affected patients frequently present to eye clinics or emergency departments. That increases the likelihood ophthalmologists may be the first providers to evaluate patients possibly infected with COVID-19.
*Source: AAO.
It is important that you are protecting your mouth, nose (N-95 mask) and eyes (goggles or shield) when caring for patients potentially infected with the New Coronavirus.
According to the American Academy of Ophthalmology:
Patients who present to ophthalmologists for conjunctivitis who also have fever and respiratory symptoms including cough and shortness of breath, and who have recently traveled internationally, particularly to areas with known outbreaks (China, Iran, Italy, Japan, and South Korea), or with family members recently back from one of these countries, could represent cases of COVID-19.
The virus that causes COVID-19 is very likely susceptible to the same alcohol- and bleach-based disinfectants that ophthalmologists commonly use to disinfect ophthalmic instruments and office furniture. To prevent SARS-CoV-2 transmission, the same disinfection practices already used to prevent office-based spread of other viral pathogens are recommended before and after every patient encounter.
Questions you should ask to identify patients with possible exposure to SARS-CoV-2 (AAO):
Does your patient have respiratory symptoms?
Has your patient recently traveled internationally?
Does your patient’s international travel include a recent trip to Iran, Italy, Japan and South Korea, or do they have family members recently back from one of these countries?
The CDC is urging health care providers who come across patients with these symptoms to immediately notify both infection control personnel at your health care facility and your local/state health department for further investigation of COVID-19.
Recommended Protocols when Scheduling or Seeing Patients (AAO):
When phoning about visit reminders, ask to reschedule appointments for patients with non-urgent ophthalmic problems who have respiratory illness, fever or returned from a high-risk area within the past 2 weeks.
Patients who come to an appointment should be asked prior to entering the waiting room about respiratory illness and if they or a family member have traveled to a high-risk area in the past 14 days. If they answer yes to either question, they should be sent home and told to speak to their primary care physician.
Keep the waiting room as empty as possible, and reduce the visits of the most vulnerable patients.
Sick patients who possibly have COVID-19 with an urgent eye condition can be seen, but personal protective equipment should be worn by all who come in contact with the patient. The CDC's recommendations for personal protective equipment include gloves, gowns, respiratory protection and eye protection. Place a face mask on the patient and isolate them in an examination room with the door closed; use airborne infection isolation rooms if available.
Rooms and instruments should be thoroughly disinfected afterward (slit lamps, including controls and accompanying breath shields, should be disinfected after every patient, particularly wherever they put their hands and face).
More information for Health Care Professionals from the CDC, including: Resources for Healthcare Professionals Caring for COVID-19 Patients, Infection Control, Healthcare Personnel with Potential Exposure to COVID-19, click here.
For more information on the Coronavirus Disease 2019 (COVID-19), click here.
RESOURCES
American Academy of Ophthalmology
Important Coronavirus Context
Centers for Disease Control and Prevention
Coronavirus Disease 2019 (COVID-19)