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The world is coming to a standstill, economies are crashing, people are losing lives, and business owners, specifically the small business owners, are in making the hardest financial decisions they’ll ever make in their lives. People are getting laid off, and there isn’t much that most of us can do other than to stay at home. And it all has to do with one flu virus, the now infamous Coronavirus which causes the disease COVID-19.
Now, if you run an optical practice, you might be unsure about what to do because, as we all know by now, Coronavirus is spread through the mucosal membranes, and that means that the eyes are not spared. So, what now? What happens to the optical practices, and how will COVID-19 affect optical practices?
American Academy of Ophthalmology’s anecdotal reports suggesting this new coronavirus outbreak could cause conjunctivitis. Coronavirus could be transmitted through aerosol with the conjunctiva. You need to be able to offer the best advice and treatment to your patients, especially if they traveled recently to places that could have the disease.
To help us understand the effects of this disease and the virus on the optical practices, we need to look at and understand everything to do with Coronavirus and COVID-19.
What is Coronavirus?
Coronavirus or the coronaviruses fall into the broad family of coronaviruses (discovered 60 years ago) that were primarily known to affect animals. Still, now, as is the case of COVID-19 and the recently declared world pandemic, Coronavirus spreads from animals to humans as well, where they cause a wide range of effects from the common cold to even more severe diseases. This, however, doesn’t mean that we are discounting the fact that some of the coronaviruses affect animals such as cats, camels, bats, and cattle, as explained by the US National Library of Medicine.
The most common class of Coronavirus that is currently affecting humans is the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2, also previously known by the provisional name 2019-nCoV). This highly contagious virus causes severe respiratory disease called COVID-19. The virus was detected first in the Chinese city of Wuhan in December 2019. Reports from unverified sources indicate that the disease/ virus was first flagged off by an ophthalmologist, Dr. Li Wenliang, who alerted officials about this possible RNA virus after an asymptomatic glaucoma patient infected him.
The Coronavirus, SARS CoV-2 virus is an enveloped and a single-stranded RNA virus which causes COVID-19. Although this virus wasn’t expected to result in too many fatalities as it was the case with SARS and MERS, the number of deaths keep increasing.
This virus causes viral diseases called COVID-19, a disease that results in severe respiratory infections such as pneumonia, bronchitis, and kidney failure, with the individuals affected reporting symptoms, which include a cough, shortness of breath, and fever. These symptoms don’t appear after a specific time, but they have been reported to appear in different individuals between 2 – 14 days post-exposure to the virus. In a recent study published by the Annals of Internal Medicine, it was found that the incubation period of this virus is between 2 and 5/7 days, and in at least 97% of the studied cases, the infected developed coronavirus symptoms within 115 days after exposure, hence the 14-day quarantine recommendation.
The more significant issue, however, is that going by a recent paper published by The Lancet, patients who’ve contracted the virus can transmit this virus even before they start experiencing the symptoms of the disease.
According to the Centers for Disease Control and Prevention, CDC, SARS-CoV-2 is the 7th type of Coronavirus known. Coronavirus has also been shown to have a very high mortality rate, rates that are estimated to be between 5 and 35 times higher than the mortality rates recorded for Influenza A. The high fatality rates associated with Coronavirus are especially higher in the older populations, along with the individuals who have medical comorbidities such as cardiovascular diseases and diabetes.
It’s also worth noting that in as much as the new Coronavirus isn’t as lethal a MERS-CoV which was detected in Saudi Arabia in 2012 or the severe SARS-CoV that started from China in 2002, SARS CoV-2’s spread has been extremely rapid with most countries already affected, and thousands of fatalities reported.
How does Coronavirus spread?
According to research and studies by the American Academy of Ophthalmology, the Coronavirus appears to spread through minute respiratory droplets that are produced and passed on to another when the infected person either sneezes or coughs. The virus could also be spread through contact with contaminated objects when someone touches the virus-contaminated surface then they touch their nose, mouth, or eyes.
With these in mind, an understanding of how the Coronavirus affects the eyes and the long-term effects of the disease is crucial, especially for professionals running ophthalmology practices. As mentioned above, this virus might cause conjunctivitis, and it’s easily transmitted via aerosol contact with the conjunctiva.
You also need to be aware of the fact that the patients presenting themselves to the ophthalmologists for treatment of conjunctivitis might also exhibit respiratory and non-respiratory symptoms such as shortness of breath and coughing, especially if you are dealing with someone who traveled abroad, to or from a country with reported coronavirus cases. So, if you come across a patient with any of these symptoms, you might want to take extra precautionary measures and involve the necessary medical professionals.
If you must keep the doors to your practice open, the Federal government and the American Academy of Ophthalmology strongly recommend the protection of your nose, eyes, and mouth whenever you are taking care of patients that could be potentially infected with the SARS CoV-2 virus/ COVID-19 disease.
Generally, all the current information provided concerning the spread of the SARS CoV-2 is based on the data known about the transmission and the spread of the other coronaviruses similar to SARS CoV-2. This virus is believed to be spread through person-to-person contact via respiratory droplets from an infected person when they cough or sneeze. Contact with surfaces with the virus could also spread the virus to unsuspecting individuals.
The most recent studies further indicate that viral SARS CoV-2 RNA is present in the stool samples of the infected individuals, which means that the virus could also be transmitted through the oral/ fecal routes.
Asymptomatic transmissions are also possible with a recent report published in JAMA showing in detail how an asymptomatic carrier infected 5 of their family members even though their chest CTs (computed tomography) were clear/ normal. This is also what happened to the Chinese doctor who sounded the coronavirus alarm.
Coronavirus spreads through the tears as well.
How Could Coronavirus Infections Affect Your Optical Practice?
Coronavirus (SARS CoV-2) and Conjunctivitis
A report from a study by the Journal of Medical Virology shows that one out of 30 patients that have been hospitalized for COVID-19 had conjunctivitis and that only this patient, not the others, had the SARS CoV-2 virus in their ocular secretions. This study, therefore, showed that the SARS CoV-2 virus could infect the conjunctiva, causing conjunctivitis, and the ocular secretions will have the virus.
In a different (larger) study published in the New England Journal of Medicine, the researchers reported conjunctival congestion in 9 out of the 1099 patients tested. While this is a 0.8% percentage, as reported from 30 hospitals in different areas of China and even though conjunctivitis is an uncommon event relating to COVID-19, this isn’t something to be ignored. And with affected and asymptomatic patients presenting themselves to emergency departments and eye clinics, your role as an ophthalmologist now includes being the first medical care provider tasked with evaluating the patients that could be potentially infected with the virus.
Relationship between Coronavirus and the eyes
As mentioned above, the patients who’ve contracted the SARS CoV-2 virus might present ocular symptoms, specifically conjunctivitis. Conjunctivitis is a disease that affects the eyes by causing the inflammation of the transparent membrane that covers the eyeball. Conjunctivitis is often called ‘pink eye,’ and it presents as a red or an infected eye that looks red and weepy.
In the case of viral conjunctivitis, the symptoms will present along with upper respiratory infections like flu and colds and going by recent research and studies into COVID-19, viral conjunctivitis could be one of the symptoms of COVID-19 virus.
It should be noted, however, that the relationship between COVID-19’s transmission and the eyes is rather complicated. Mainly, the virus spreads from one person to another through airborne/ respiratory droplets from an infected person when they cough or sneeze, and these droplets landing on the nose, mouth, or the eyes of anyone close by causing the disease when the viral elements are inhaled to the lungs.
In case of a coronavirus infection from the virus landing on the eyes/ ocular membranes, some of the symptoms to be expected include the inflammation of the eye, a fewer, and the buildup of mucus in the nose and the throat.
Effects of Coronavirus on your optical practice
Having spread to over 100 countries (and the numbers keep rising), COVID-19 was declared a pandemic by the WHO, and with conjunctivitis as one of the symptoms of Coronavirus, a lot is changing. More changes are seen continuously throughout the weeks, and now, the changes are evidenced daily.
The number of patients visiting ophthalmology practices has also decreased significantly, even as ophthalmologists are stepping things up, offering phone screening services to their patients, especially for patients needing urgent attention while showing upper respiratory infection symptoms.
According to Boston-based MD, Michael Raizman of Massachusetts Eye and Ear in Harvard University, patient traffic has dropped significantly, and he’s reporting a 15% cancellation rate, with the cancellations expected to increase, especially with the increasing restrictions placed by the government. He also notes that there has been an increase in more stringent measures, especially for physicians whose services interface with governmental and educational institutions. Then you have hospitals that are now restricting elective surgeries, as well as meetings of groups exceeding ten people.
There has also been the cancelation of grand rounds, as well as educational activities, and the ones that are still running are now limited to video conferences, even as medical centers prohibit air travel for local and international flights for doctors. And with medical centers canceling patient visits unless the visits are urgent and they cannot be rescheduled, optical practices, like all other private practices, have been hurt significantly.
And going by the current happenings around the world, things are about to get even worse, with the current situation changing rapidly, daily.
But with some eye patients still trickling in, as noted by Laura M. Periman MD, no-touch techniques are used for eye examination and for instilling drops. There’s the use of cotton swabs to check the eyes, patients are treated warmly but without any handshakes, and screening is offered at the door, even as all the surfaces, equipment and handles are thoroughly wiped down in between patients.
Most other ophthalmologists have had to close shop given the high risk associated with the disease, contact with the eyes, as well as contact with the examination equipment (retinal cameras, autorefractors, and the phoropter). Some patients need frame adjustments and fittings, and these both need the optician to stand a few inches from the patient’s face, and they’d also have to make contact with the patient’s head. This is too risky, and brick-and-mortar optometrists have no other option but to close doors.
Finally, some physicians are out on quarantine, and what all this means is that some ophthalmology practices are either closing down and the ones that see patients do that only in emergencies as they cancel most appointments. Some patients now have to wait for months for their appointments.
Recommendations to ophthalmologists anticipating-coronavirus
- One of the most important things that ophthalmologists need to do is protect their nose, mouth, and eyes by wearing the best-quality N-95 masks, shields, or goggles. And at this time, it would be prudent to wear these and other forms of protective gear at all times and around all patients, whether they are symptomatic, healthy, or asymptomatic. Slit-lamp breath shields are also recommended for the protection of patients, as well as healthcare workers from the respiratory illness.
- Patients feeling a bit under the weather are encouraged to stay at home.’
- Rescheduling of appointments is now the norm because whether one likes it or not, systemic health is a lot more critical than cataract surgery. With that in mind, ophthalmologists are asking patients with sore throat or the flu to stay at home and reschedule their elective surgeries for when they will be feeling 100%. This is also recommended if the patient lives with someone who is ill or showing symptoms, as well as persons (and known associates/ family) who traveled recently.
- Ask about recent travel to high-risk areas, in and out of the country
- Identity the patients that have conjunctivitis
- For necessary procedures, ophthalmologists anticipating patients with Coronavirus are wearing masks, goggles, shields, washing their hands thoroughly before and after the process, as well as the pro-active use of no-touch techniques and the use of slit lamps.
- Patients are also encouraged and asked to wear protective masks, and there’s no touching of surfaces and no hand-contact.
- And like everyone else, no touching of the face – eyes, nose, or mouth. Also, wearing glasses would be a good idea.
- For patients needing eye medicine prescriptions, they are encouraged to take prescriptions to last them up to 3 months.
- If you have to see a patient, then you must wear gloves at all times, even when dealing with asymptomatic patients.
- Keep the waiting rooms as empty as you can and schedule appointments such that patients don’t have to meet.
- Finally, ophthalmologists now need to ask their patients to call the doctor ahead of their visit to determine whether the trip is safe or even worth the risk of exposure.
The emergence of the severe acute respiratory syndrome, coronavirus 2, SARS-CoV-2, which causes COVID-19, is, as defined by the WHO, a pandemic and the best that we can do is to wash hands, avoid touching our faces, and staying home. But if you run an ophthalmologist, the specs might not be too good for your business, especially with conjunctivitis regarded as one of the symptoms of COVID-19.
However, you could lower your risk of infection by following the precautions above. Cancel or reschedule appointments as much as possible, and if you must have patients, maintain social distancing (don’t keep patients waiting in the waiting room), everyone needs to wash their hands, wipe down surfaces, handles, and equipment after every patient visit; wear gloves, glasses, goggles, etc.; and ask symptomatic patients to stay at home, and limit your interactions with other people as much as possible. And if you must, close your doors for as long as this lasts, and stay safe.