Eyeworld

50 | EYEWORLD | APRIL 2020 N EWS A novel coronavirus—severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes the respiratory disease COVID-2019— began its identified spread around the globe in February. A few weeks later, by March 11, it was declared a pandemic by the World Health Organization (WHO). Originally identified in Wuhan, Chi- na, in December 2019, as of April 1, 2020, COVID-19 had more than 823,600 confirmed cases globally and had caused more than 40,500 deaths, according to WHO. While the majority of cases in February had been largely con- fined to China, by mid-March COVID-19 had reached every continent, except Antarctica. In the U.S. specifically, COVID-19 cases had been confirmed in all 50 states, amounting to more than 186,100 confirmed and presumptive cases and more than 3,600 deaths as of April 1, re- ported by the Centers for Disease Control and Prevention. There is no vaccine against the virus— though efforts toward one have been expedit- ed—or proven cure for the disease. Though the majority of people who contract the virus, which most commonly causes fever, persistent dry cough, and shortness of breath, survive the illness, it can be life-threatening, especially for older patients. Research about this novel coronavirus is emerging daily. A report published in the Annals of Internal Medicine found that the average incubation time for SARS-Cov-2 is 5–7 days, with most patients developing symptoms (97%) in less than 12 days. 1 It is thought to be spread primarily via respiratory droplets that come into contact with mucus membranes, though a study published in the New England Journal of Medicine stated that its detection in the gastro- intestinal tract, saliva, and urine suggest other potential modes of transmission that should be investigated. 2 Patients might ask ophthal- mologists about the possibility of transmission through the eye. A correspondence published in The Lancet presented cases that suggest early transmission of SARS-CoV-2 through the eyes was "ignored." 3 Officials have been encouraging the public to avoid touching their eyes and face to help prevent infection and health workers in contact with COVID-19 patients should take measures to protect their eyes, in addition to wearing a mask, gloves, and other protective coverings. A study published in the Journal of Medical Virology noted SARS-CoV-2 in the ocular secre- tions of a patient hospitalized for COVID-19 who also had conjunctivitis; other patients in this study who didn't have conjunctivitis did not have the virus in their ocular secretions. 4 According to the American Academy of Oph- thalmology (AAO), this finding "increases the likelihood ophthalmologists may be the first providers to evaluate patients possibly infect- ed with COVID-19," though conjunctivitis is seemingly rare with this condition. 5 Major medical societies and governing bodies are continually updating those working in the medical field with the latest guidance and information during this time. The American Medical Association put to- gether a guide for physicians practicing among the COVID-19 outbreak and created a separate resource for practices interested in starting a telemedicine plan at this time. The American College of Surgeons has recommended that non-emergent, elective surgeries be postponed or performed in an ASC, rather than a hospital setting. For ophthalmologists specifically, AAO has issued guidance. This includes postponing/ rescheduling non-emergent outpatient visits and procedures; taking steps to assess a patient's possible illness status, travel, and/or contact with someone who was ill before they even enter the waiting room; reducing the number of patients in a waiting room at a given time; using slit lamp barriers; and telling patients you intend to speak as little as possible while sitting close to them during a slit lamp exam and asking them to do the same. ASCRS supports AAO's position and continues to update its members with new guid- ance and resources regarding SARS-CoV-2 as it becomes available. by Liz Hillman Editorial Co-Director Update on the novel coronavirus References 1. Lauer SA, et al. The incubation period for coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application. Ann Intern Med. 2020. Epub ahead of print. 2. Guan W, et al. Clinical charac- teristics of coronavirus disease 2019 in China. N Eng J Med. 2020. Epub ahead of print. 3. Lu CW, et al. 2019-nCoV transmission through the ocular surface must not be ignored. Lancet. 2020;395:e39. 4. Xia J, et al. Evaluation of coro- navirus in tears and conjunctival secretions of patients with SARS- CoV-2 infection. J Med Virol. 2020. Epub ahead of print. 5. American Academy of Ophthal- mology. Important coronavirus updates for ophthalmologists. www.aao.org/headline/alert-im- portant-coronavirus-context. Accessed March 18, 2020.

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