The Academy is sharing important ophthalmology-specific information related to the novel coronavirus, referred to as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was previously known by the provisional name 2019-nCoV. The highly contagious virus can cause a severe respiratory disease known as COVID-19.

The Academy’s web resources related to this ongoing news and education initiative are principally authored by James Chodosh, MD, MPH. Dr. Chodosh is the David G. Cogan Professor Ophthalmology at Harvard Medical School’s Department of Ophthalmology and a world-recognized cornea/external disease expert. He is a member of Harvard’s PhD Program in Virology and holds a Masters in Public Health. The Academy thanks Dr. Chodosh for making his scientific and clinical expertise available to his colleagues.

What you need to know

• Anecdotal reports suggest the virus can cause conjunctivitis and possibly be transmitted by aerosol contact with conjunctiva.
• Patients who present to ophthalmologists for conjunctivitis who also have fever and respiratory symptoms including cough and shortness of breath, and who have recently traveled internationally, particularly to areas with known outbreaks (China, Iran, Italy, Japan, and South Korea), or with family members recently back from one of these countries, could represent cases of COVID-19.
• The Academy and federal officials recommend protection for the mouth, nose and eyes when caring for patients potentially infected with SARS-CoV-2.
• The virus that causes COVID-19 is very likely susceptible to the same alcohol- and bleach-based disinfectants that ophthalmologists commonly use to disinfect ophthalmic instruments and office furniture. To prevent SARS-CoV-2 transmission, the same disinfection practices already used to prevent office-based spread of other viral pathogens are recommended before and after every patient encounter.

Latest statistics:

Global cases: 83,652 (updated February 28, 2020; source: WHO)

U.S. cases: 62 (updated February 28, 2020; source: CDC)

Thus far, more than 50 countries have reported laboratory-confirmed COVID-19 cases. Countries with documented widespread or sustained community transmission include China, Iran, Italy, Japan, and South Korea. At present, no community transmission of SARS-CoV-2 has been documented in the US.

Background

The SARS-CoV-2 is an enveloped single-stranded RNA virus that causes COVID-19. Although the virus appears not quite as likely to cause fatalities as the SARS coronavirus or MERS coronavirus, a significant number of global fatalities have already occurred. There have been numerous worldwide reports of infections, including in the United States.

Patients typically present with respiratory illness, including fever, cough and shortness of breath, as well as conjunctivitis has been reported. Severe complications include pneumonia. Symptoms can appear as soon as 2 days or as long as 14 days after exposure. At this time, there is no vaccine to prevent infection, and no medication known to be effective in treatment. Testing for SARS-CoV-2 infection is not yet widely available in the United States, but should be soon.

Current understanding about how COVID-19 spreads is based largely on what is known about other similar coronaviruses. The virus is believed to spread primarily via person-to-person through respiratory droplets produced when an infected person coughs or sneezes. Viral RNA has also been found in stool samples from infected patients, raising the possibility of transmission through the fecal/oral route. It also could be spread if people touch an object or surface with virus present from an infected person, and then touch their mouth, nose or eyes.

Currently, federal officials are trying to determine if there is asymptomatic transmission. A February 21 report in JAMA details a case of an asymptomatic carrier who possibly infected five family members despite having normal chest computed tomography (CT) findings. These reports, however, are preliminary.

Ophthalmology ties

Because anecdotal reports suggest the virus can also cause conjunctivitis, it is possible that it is transmitted by aerosol contact with conjunctiva. While conjunctivitis is an uncommon event as it relates to COVID-19, other forms of conjunctivitis are common. Affected patients frequently present to eye clinics or emergency departments. That increases the likelihood ophthalmologists may be the first providers to evaluate patients possibly infected with COVID-19.

Therefore, protecting your mouth, nose (e.g., an N-95 mask) and eyes (e.g., goggles or shield) is recommended for health care providers caring for patients potentially infected with COVID-19.

Steps you should take

Evaluate your patients for the following factors to identify possible exposure to SARS-CoV-2:

• Does your patient present for conjunctivitis?
• Does your patient also have respiratory symptoms?
• Has your patient recently traveled internationally?
• Does your patient’s international travel include a recent trip to Iran, Italy, Japan, and South Korea, or with family members recently back from one of these countries?

The CDC is urging health care providers who encounter patients meeting these criteria to immediately notify both infection control personnel at your health care facility and your local or state health department for further investigation of COVID-19.