Eyeworld

32 | EYEWORLD | MARCH 2020 N EWS Contact Lam: dennislam@hkcmer.com Loon: ploonsc@yahoo.com I n mid-December, health officials reported a novel coronavirus originating in Wuhan, China. According to the World Health Organization (WHO), as of February 23, there were more than 78,800 confirmed cases of the virus, called coronavirus dis- ease 2019 (COVID-2019) or SARS-CoV-2, with more than 2,400 deaths globally (vast majority of cases and deaths are in China). With the WHO declaring COVID-2019 a Public Health Emergency of International Con- cern, what do ophthalmologists need to know about it or any new, rapidly spreading virus? EyeWorld spoke with Seng Chee Loon, MD, and Dennis Lam, MD, who have past experience with novel coronaviruses, namely severe acute respiratory syndrome (SARS), which hit the Asia-Pacific region particularly hard in 2002–03. When SARS appeared, it caused 8,096 cases and 774 deaths in 29 countries, according to the WHO. Middle East respiratory syndrome (MERS), a coronavirus that emerged in Saudi Arabia in 2012, had 2,494 cases and 858 deaths in 27 countries. Dr. Loon coauthored a study that identified the SARS coronavirus in tears. 1 Dr. Lam published a paper after the SARS outbreak, detailing precautions that ophthalmic practices could take during viral outbreaks. 2 "If you're in a non-affected region, your practice should not be drastically affected, if you ask the right questions," Dr. Loon said. "Stateside and other parts of the world should be less affected. You just have to be vigilant and ask the right questions." This vigilance includes taking a good histo- ry of the patient, including a travel history. "Once you know a person comes from the affected region, namely Wuhan, China. ... Right now, anyone who has traveled there within the past 14–30 days, we would ask them more de- tailed questions of fever and any symptoms of flu. That would be key. After that I would take the extra precautions," Dr. Loon said. Precautions include wearing a mask that covers the nose and mouth and frequent hand washing. For ophthalmologists who sit close to patients during examinations, Dr. Lam de- scribed a homemade, transparent, plastic screen that can be attached to the slit lamp, protecting the ophthalmologist from an unexpected sneeze or cough from the patient. "People ask me whether we should wear an eye mask. I think if you are working in areas where you have a high concentration of viral particles, you better wear the mask to protect your eyes. But in an ordinary setting, we do not need that," Dr. Lam said. If you practice in a region more intensely affected by an emerging virus known to be in tears, Dr. Loon advised delaying Schirmer's testing and other examinations and diagnostics that involve tears. Studies have not yet been published to identify COVID-2019 in tears, but Dr. Loon said it's logical to assume its presence. Anecdotal reports from China also suggest infection potential through unprotected eyes. A Chinese ophthalmologist who, according to several news outlets, began to warn people of a SARS-like virus before the full-fledged out- break, contracted COVID-2019 after treating a patient in his clinic who he didn't know had the virus. He later died. There is no vaccine for COVID-2019, though work to develop one quickly got underway. Dr. Lam cited mortality rates of other coronaviruses (9.6% for SARS and 34% for MERS) to put the mortality rate for COVID-2019 (about 2% in China) into context. In addition, according to the WHO, seasonal flu causes 3–5 million severe cases and between 290,000–650,000 respiratory deaths annually. "Compared to SARS and MERS, the mor- tality rate is much lower. Now we are entering maybe the third and fourth wave of infection, so the mortality and the infectivity will become less," Dr. Lam said in early February. The WHO Risk Assessment in its February 23 situation re- port rated China's risk as "very high" and global risk as "high." by Liz Hillman Editorial Co-Director When a new viral epidemic emerges About the doctors Dennis Lam, MD President C-Mer International Eye Care Group Hong Kong Seng Chee Loon, MD Director of Clinical Services National University Health System Department of Ophthalmology Singapore References 1. Loon SC, et al. The severe acute respiratory syndrome coro- navirus in tears. Br J Ophthalmol. 2004;88:861–3. 2. Chan WM, et al. Precautions in ophthalmic practice in a hospital with a major acute SARS out- break: an experience from Hong Kong. Eye (Lond). 2006;20:283–9. Dr. Lam outfitted his slit lamps with a plastic shield to protect him from a sneeze or cough from patients. Source: Dennis Lam, MD

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