As the coronavirus disease 2019, COVID-19, starts to sweep across America the three states most affected are still New York with 4,100+ outbreaks, Washington with 1,000+ outbreaks, and California with 800+ outbreaks. Coming in fourth on the list with 700+ outbreaks is New Jersey and a two-way tie for fifth with 300+ outbreaks is Florida and Louisiana. “West Virginia became the 50th state to report its first case and now is up to two.”1 Among humans, “COVID-19 infections most often occur during the winter months and early spring.”2 The first case in the United States was identified on January 21, 2020, and this individual traveled from Wuhan, China. As of 4:15 PM on March 19, 2020 “there are an estimated 236,308 cases around the world with 9,866 reported deaths and 67,003 have recovered.”3 In the United States alone there are 10,491 confirmed cases with 150 reported deaths and 8 recovered”3 With the rise of celebrities such as Tom Hanks and Idris Elba as well as NBA superstars such as Kevin Durant and Donavan Mitchell each contracting the disease we are all potentially at risk, however people with the highest risk are individuals over the age of 60 and people who are immunocompromised such as diabetes, heart and lung disease. The World Health Organization (WHO) declared COVID-19 as an international public health emergency and has restricted travel to and from China. There have also been travel bans to Europe for at least the next 30 days. “Early in the outbreak, many of the patients with respiratory illness caused by 2019-nCoV in China had exposure to a large seafood and live animal market, suggesting animal-to-human transmission.”4 However, more recently “cases have been confirmed with no exposure to animal markets, indicating that person-to-person spread of the virus has occurred.”4
As optometrists and health care professionals we have a duty to protect our patients and also have an understanding of the risks associated with this outbreak so that we may protect ourselves in our offices with everyday patient encounters. The centers for disease and control prevention (CDC) have recently recommended that all routine care for both dental and eye care visits be suspended at this time and to treat only medical issues. The American Optometric Association (AOA) has also suggested these recommendations and have even implemented the use of telemedicine or tele-optometry during this crisis to help care for our patients as well as to protect the spread of the virus. Any patients presenting with any type of conjunctivitis could potentially put up a red flag as a possibility of the virus. There are several reports suggesting “the virus can cause conjunctivitis and possibly be transmitted by aerosol contact with conjunctiva.”5 The virus may be spread by “respiratory droplets and optometrists and ophthalmologists should take care to protect their mouth, nose or eyes with goggles or an N-95 mask.”6 If someone is feeling sick and is a contact lens wearer I would suggest switching to glasses for the meantime to minimize touching of the face/eyes. Some pertinent questions to ask our patients are:
- Have you traveled to China within 14 days of symptom onset?
- Do you have any trouble breathing/shortness of breath, cough, sneezing, runny nose, fatigue, sore throat, flu-like symptoms?
- Have you had any contact with any sick individuals recently or a person known to have the illness?
If both exposure and illness are present in an individual then you need to isolate the patient by placing a facemask on them and moved to a separate or private room with at least 6 feet of separation from other individuals. Then need to inform or contact the health department to report the at-risk patient and their clinical status. To help prevent the spread of the virus is to avoid close contact with people who are sick and also social distancing, avoid touching eyes, mouth and nose, wash hands often and to stay home when one is sick.
Currently, there is no vaccine or treatment for this infection, however, one is trying to be developed, so we all need to be cautious until one becomes available. We need to drink lots of water, avoid smoking or smoky areas, avoid overexertion, use a humidifier and get lots of rest. There have been curfews set in certain states where restaurants, bars, gyms and night clubs are closed. Because of the high outbreak rate happening in New York City, precaution has been taken where Vision Expo East has been “consolidated” and will be merging with Vision Expo West in Las Vegas in September. Also, Vision By Design which was to be held in Bellevue, Washington this April has been cancelled with full refunds. The next major conference to cancel was COVD, which was supposed to be held in Toronto this April. Also, the most stressful time of the year for optometry students is Part I of National Boards and now all the Pearson’s centers in the United States and Canada, where the test is to be administered, have been closed. They were told the night before their exam that the center was closed and will have to continue studying until potentially April 16 if that is really the day they can even take the exam again! March Madness has turned into March sadness since a majority of the sports world is shut down due to the virus. Some sports are still being played, however with zero fans in attendance!
For more up to date information please follow the websites below from the AOA, CDC, and WHO!
AOA: https://www.aoa.org/coronavirus
CDC: https://www.cdc.gov/coronavirus/2019-ncov/index.html
WHO: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
References:
- https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
- https://www.medicalnewstoday.com/articles/256521
- https://infographics.channelnewsasia.com/covid-19/map.htmlUpdate and Interim Guidance on Outbreak of 2019 Novel Coronavirus (2019-nCoV)
- https://emergency.cdc.gov/han/han00427.asp
- https://www.aao.org/headline/alert-important-coronavirus-context
- https://www.healio.com/ophthalmology/cornea-external-disease/news/online/%7B78d024f6-92ac-4f01-a248-25b9aa190cab%7D/what-ophthalmologists-need-to-know-about-coronavirus
