The SARS-COV-2 pandemic has forced major changes and revisions in the daily habits and practices in everyone’s personal and work life. SARS-COV-2 virus causes respiratory diseases with more or less serious symptoms, ranging from fever, cough, respiratory distress, and in the worst cases, pneumonia and eventually death from complications. Based on the knowledge acquired from studies on similar coronaviruses, it is expected that the virus is spread from person to person mainly via droplets and small particles produced when people infected cough or sneeze. The spread can also happen when people come into contact with objects or surfaces on which the virus is present, and then they touch their mouth, nose, and eyes. Viral RNA has also been found in infected patient’s stools; hence an oral/fecal transmission cannot be excluded as well.
SARS-COV-2 symptoms can develop between 2 and 14 days after being exposed to the virus. So far, there are no drugs of proven efficacy for the prevention and treatment of the disease, and the only available “weapons” we can rely on are solely precautionary: keep social distances, avoid exposure when possible, and protect nose, mouth and eyes. However, whether the transmission of the virus can really occur through the tears is still controversial. Among the structures at high risk of virus spread are the hospitals; there, rigorous measures of safety and prevention have suddenly been adopted for the tutelage and the safety of both patients and healthcare personnel. These measures are constantly updated according to the evolving pandemic situation, both at the local and global level.
Ophthalmology divisions adopted specific measures as well to contrast the virus spread. In the United States, the American Academy of Ophthalmology (AAO), according to the guidelines released from the World Health Organization (WHO) and the Centers for Disease Control (CDC), issued a series of directives for the ophthalmologists for their patient’s care. The guidelines dictate the cessation of all non-urgent treatments. These involve both office visits and elective surgical procedures. The Academy recognizes that the urgency is determined by the judgement of the physician, who has to take into consideration the individual needs of the patient and the social circumstances.
Two main reasons dictate these choices: the first is obviously the need of decreasing the risk of transmission of the virus, as well as its outbreak. This is the only way to avoid overwhelming the capacity of each hospital to cover the new needs intended as bed places, supplies, ventilators, equipment for oxygenation, and so on. Second, but not less important, is the need of preserving the disposable medical supplies (such as masks, lab coats, gloves, face shields) and concentrate them in the structures where the urgency is higher. Although the Academy demands the rescheduling of non-essential care, there are situations in which the medical intervention is still necessary: for instance, the cases of macular degeneration, and diabetic retinopathies where regular ocular injections are required, or in the presence of changes or loss of vision and eye pain/trauma. In these cases, the patients are required to contact the ophthalmologist to receive the appropriate instructions on the procedure to adopt. Patients may be asked to wait outside the waiting rooms, in some cases in their car. The access to the clinic may be restricted to the patient only and no accompanying persons. A conversation between patient and physician may also not be allowed, until the examination of the patient is concluded and a safe distance between patient and physician can be established. The patients may be asked to wear protection as well, especially if sick, but in this case, they should contact the doctor before going to the appointment, and sick people are recommended to stay home.
Where possible, the elective method of interaction with the patient is telemedicine for virtual visits, accompanied by phone calls, or video chats. Besides the basic hygiene standards (wash hands with soap and water for at least 20 seconds, especially before meals and after using the toilet, sneezing, coughing, or blowing your nose) and the establishment of appropriate behavior (do not touch mouth, nose and eyes; avoid the contact with sick people; stay home where possible; disinfect surfaces and objects you touch; practice social distancing), the AAO also recommends to use the following precautions:
- The usage of glasses instead of contact lenses for a certain time: this avoids touching the eyes, decreases eye irritations, and can add an additional protective barrier for the eyes.
- Stock up on eye prescription medicines of regular usage, in case of quarantine or shortage of provisions.
Each of us has the responsibility to not act as a carrier for a potentially fatal disease, especially in the absence of any treatment. All the other factors, such as business, finance, etc. are of secondary importance with respect to human life.