Tuesday, March 24, 2020

CORONAVIRUS-19 AND OPHTHALMOLOGY (UPDATE)

[COVID-19 SERIES #2]




LINKS TO ARTICLES RELATED TO CORONAVIRUS INFECTION AND OPHTHALMOLOGY GIVEN AT THE END OF THE POST


As I write this update, there is news that the novel coronavirus disease-19 (COVID-19) has spread all over the globe. More than 195 countries and territories have reported this pandemic. Although there is some flattening of the curve in some countries such as China and Italy, others including Spain and some African countries are still seeing an uptrend. As of today, world-wide 38,1761 persons have been infected and 16,558 have died. 





My previous post on COVID-19 is available on touchOPHTHALMOLOGY Insights (Publishers of US Ophthalmic Review and European Ophthalmic Review).
https://www.touchophthalmology.com/insight/coronavirus-and-ophthalmology/ 

Lockdowns and curfews are being implemented in a large number of countries. After months of dithering and a lackadaisical attitude by governments, more stringent measures are in force now.


In China, the epicenter of the outbreak, Wuhan city, was completely in lockdown for the last few months. This has apparently helped in reducing community spread of the infection.


Flights, trains, buses and other modes of transportation have been curtailed. Most countries have stopped international flights. Passengers coming from hot-spot countries such as Italy, South Korea and Iran are being sent for COVID-19 screening or in self-quarantine. 

Countries such as the Kingdom of Saudi Arabia have taken exemplary measures to stop the spread of the virus. The kingdom stopped Umrah (a holy trip by Muslims to Mecca) and visit visas, suspended all International flights and implemented a travel ban to a large number of countries including it's Arab neighbors. Hospital OPDs have curtailed seeing regular (cold case) patients and Health-care workers(HCWs)provided with personal protection. Public information is being disseminated on a large scale.


A number of famous personalities such as the Queen of Spain; Begoña Gómez, wife of the Spanish Premier; Sophie Trudeau, wife of the Canadian Premier; Karl von Habsburg, the archduke of Austria; footballers Callum Hudson-Odoi and Mikel Arteta; actors Tom Hanks and his wife Rita, Idris Elba and Olga Kurylenko have been reported to be affected by the virus.

HCWs are on the frontline to combat this disease. Naturally, they are the ones taking the brunt of the  infection. In the SARS pandemic nearly 1/3rd of the cases were HCWs. More than 23 doctors have died in Italy, reportedly 8 have died in China, 5 have died in France, at least 1 doctor each died in Malaysia and Pakistan.

The story of Dr. Li Wenliang is tragic in many ways. Working in Wuhan, in December 2019 he alerted authorities for an infection which resembled SARS (Severe Acute Respiratory Syndrome). The Chinese authorities asked him to "stop making false comments" and he was investigated for "spreading rumors". The doctor contracted the COVID-19 infection and died in early February 2020. Recently, the Chinese authorities apologized to the family of the doctor and opened an investigation into the incident.
 
Dr Li Wenliang

In some places entire teams of doctors have gone into self-quarantine. Out-patient departments have closed in most hospitals world-wide to break the chain of transmission. Elective surgeries are banned by authorities and personal protective equipment being made available slowly to HCWs. In many health facilities services are badly crippled due to the lack of proper facilities. 

Situation in a Madrid hospital


In UK, the Animal Health Trust has offered to provide ventilators used for animals to the National Health Service (NHS) to help combat shortage of such equipment in NHS hospitals.

Reports of companies and individuals profiting from this disease are coming from all over the world. Shortage of masks and sanitizers have spiraled the cost of such items. Panic buying is leading to supermarkets and shops being emptied of essential items. 

Toilet paper is especially being sought after. So much so, that an Australian newspaper had an extra 8 blank pages to be used as toilet paper. 

In a UK school, a student was apparently expelled for providing hand sanitizer at 50p a shot. 


Symptoms of COVID infection

CONJUNCTIVAL CONGESTION AND PERIORBITAL HYPEREMIA COULD BE SIGN OF INFECTION:
A nurse working with COVID positive patients has claimed that one of the most consistent and reliable signs of infection is congestion and hyperemia around the eyes.

https://nypost.com/2020/03/24/red-eyes-may-be-telltale-symptom-of-coronavirus-nurse/


The elderly are most at risk of deaths from COVID-19. A large number of deaths are being reported in individuals above 60 years of age. More than 20% deaths have occurred in those above 80 years of age.

Death rates have been more in males, compared to females. In a report the number of males dying of suspected infection was 2.8% compared to 1.7% of women. In confirmed cases, the infection was fatal for 4.7% men and 2.8% for women. This is being attributed to better immunity in females and increased prevalence of chronic diseases such as cardiovascular disease (found in 13.2% of confirmed case fatalities), diabetes (in 9.2%) hypertension (in 8.4%), chronic respiratory disease (in 8.0%) as well as social factors such as alcoholism and smoking in males.

PROTECTION FROM COVID INFECTION:

The World Health Organization (WHO) has updated its advisory for public to protect itself from COVID-19 infection. WHO has developed the "risk communication and community engagement (RCCE)" readiness and response strategies to protect public's health.




  • Wash your hands frequently:

Regularly and thoroughly clean your hands with an alcohol-based hand rub or wash them with soap and water.

  • Maintain social distancing:

Maintain at least 1 metre (3 feet) distance between yourself and anyone who is coughing or sneezing.

  • Avoid touching mouth, eyes and nose (M, E, N).

  • Practice respiratory etiquette:

Make sure you, and the people around you, follow good respiratory hygiene. This means covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately.

  • If you have fever, cough and difficulty breathing, seek medical care early:

Stay home if you feel unwell. If you have a fever, cough and difficulty breathing, seek medical attention and call in advance. Follow the directions of your local health authority.
  • Stay informed and follow advice given by your healthcare provider:
Avoid rumors, false-information and unproven or wrong advice regarding COVID-19 infection.
5 Moments of Hand Hygeine


Presently, there is no prophylaxis, vaccine or treatment for this infection. A couple of institutes such as Kaiser Permanente Washington Health Research Institute in Seattle, and Emory Children’s Center in Decaturin, US have started vaccine trials. 

PUBLICATIONS RELATED TO COVID-19 AND OPHTHALMOLOGY:

The ocular features of Coronavirus infection are being presented in some publications. Apparently COVID-19 can cause conjunctivitis, anterior uveitis, retinitis and optic neuritis in animal and murine models. Such manifestations are possible in humans also.











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