Journal of Clinical Ophthalmology and Research

EDITORIAL
Year
: 2020  |  Volume : 8  |  Issue : 2  |  Page : 49--50

Ophthalmology during COVID-19 pandemic


Barun K Nayak 
 Department of Ophthalmology, PD Hinduja National Hospital and Medical Centre, Mumbai, Maharashtra, India

Correspondence Address:
Barun K Nayak
Department of Ophthalmology, PD Hinduja National Hospital and Medical Centre, Mumbai, Maharashtra
India




How to cite this article:
Nayak BK. Ophthalmology during COVID-19 pandemic.J Clin Ophthalmol Res 2020;8:49-50


How to cite this URL:
Nayak BK. Ophthalmology during COVID-19 pandemic. J Clin Ophthalmol Res [serial online] 2020 [cited 2020 Oct 29 ];8:49-50
Available from: https://www.jcor.in/text.asp?2020/8/2/49/288850


Full Text



COVID-19 has created havoc not only in India but also all over the globe just in 3 months, although the first case was diagnosed and reported in Wuhan, China, in 2019, itself.[1] The first alarm bell was struck by an ophthalmologist from Wuhan,[2] who succumbed to COVID-19, later. Many publications have appeared since then in various journals, regarding how to practice ophthalmology in these testing times.[3] This Editorial is aimed at discussing some general, yet vital, aspects of handling this situation so that each ophthalmologist can take their own decision regarding the way to move forward.

Why is COVID-19 dangerous? It is a new and highly infectious disease. The infectivity is judged by R0 (pronounced as “R-naught” or “R-zero”), which indicates that one infected person can affect so many others without any intervention. For any disease to get eradicated, the R0 has to be less than one. If it is more than one, it will go on spreading in a geometric progression manner. As per the World Health Organization, the R0 of COVID-19 ranges between 1.4 and 2.5; however, there are some reports with even higher ranges than this figure.[4] After certain pharmaceutical interventions, such as medicines or vaccines, as well as certain nonpharmaceutical interventions, such as screening and lockdown measures, R0 can be reduced. The reduced R0 number after various measures at any given time is known as Rt. Hence, with all the interventions available, the efforts are to bring down Rt to less than one.

What are the complexities about COVID-19? The disease is a new entity, and all facts are not known. We have still to know which of the various systems of the human body are affected by this virus. Earlier, we thought that it affects only the respiratory system; however, now, with various anecdotal reports appearing, we can see that there is involvement of other systems, as well. Neurologists say that they are noticing a different type of stroke.[5] Further, there are a lot of uncertainties about this disease. We are yet to know for how long does the infectivity last? Whether the antibody developed in the body can give protection in the future and for how long? We are ignorant about the immunity aspect of this infection, because there were reports from China saying that a few cases which got infected again after recovery.[6] Therefore, we cannot be sure of the development of “herd immunity” that many of us are optimistically waiting to come to our rescue. We are also not sure that how long will this “herd immunity” last if at all it becomes a reality? Any vaccine development takes time and that is another ray of hope in the next 6 months or so, if we are lucky to keep getting positive reports from different countries and companies regarding the development of vaccine in the near future. One such research group from Oxford University is pretty sure about the successful outcome of their project of vaccine development. It has been successful on monkeys and already undertaking trials on human beings, which is the next phase of vaccine development in progress. The researchers are extremely confident and have already negotiated with various companies to start manufacturing these vaccines so that once the human trials turn out to be successful, it can immediately start using it for the population at large without any lag period after the trial. One such company from Pune, India, has started the process of manufacturing this vaccine and has put a lot of money at stake, for the benefit of humanity. Another complexity about this disease is that the enemy is invisible and the organism can be present anywhere and everywhere. Infected asymptomatic persons are also known to spread the infection. Hence, we have to be always “suspicious” and “cautious.” Although the mortality rate of this disease is said to be between 3% and 4%, in reality, it appears to be higher, based on the data available from different countries. The mortality rate in some countries is turning out to be as high as 15%. People with comorbidities, children <10 years, and elderly more than 65 years of age are under “higher risk” category, as far as mortality is concerned.

How does the ophthalmologist start their professional activity as healthcare workers? Life has to go on – with this in mind, we need to understand that ophthalmologists are healthcare workers who are more at a risk compared to that of the general population. In addition, because they fall midway among the healthcare professionals, they are open to infection because they are in very proximity to the dangerous areas such as eyes, nose, and mouth during the course of examinations, apart from the fact that eyes may be the route and source of infection.

How do we decide our future course of action? Any action regarding starting practice should be an individual's own decision, as everyone has the right to protect themselves. I will discuss certain aspects which will help us take appropriate decision in this regard. “Physical survival” should be the top most priority for everyone without any compromise. “Financial sustenance” with bare minimum requirements should be the next in the priority list. The optimal balance between these two factors and the risk-taking profile of each ophthalmologist shall decide how, when, and to what extent they should start their practice? The other factors such as how to spend time fruitfully at home, how to handle anxiety and psychological issues, and how to handle the stress which is likely to come from a desire to earn more for luxuries in life are not essential and basically are “secondary,” at present. This situation needs that we restrain ourselves and understand and accept that things are not going to be what they were. We need to acknowledge our priorities and work accordingly. They can be handled later and differently based on the changed scenario. Most importantly, one should desist from taking undue risk at present.

What precautions do we take while practicing? Whatever is your decision regarding the starting of the practice based on the discussions earlier in this Editorial should be a personal decision. Those who start their practice should follow the safety measures diligently. The purpose should be to protect yourselves and others, as far as possible. Various guidelines have been published by various journals and medical societies.[3] Study them thoroughly and implement whatever is applicable in your practice and your working conditions. Absolutely, no compromise should be made as far as the safety measures are concerned. Four pillars which should be strictly upheld are hygiene, social distancing, using masks, and regular screening for symptoms. The recommended personal protective equipment (PPEs) must be used. Since the PPEs are in short supply, we should not overuse them, this being a scarce but essential commodity. We should also arrange for its proper reuse and disposal as per the recommendations issued by the concerned authorities from time to time.

I am sure that this Editorial will help everyone in deciding the future course of action in their professional career. We should keep in mind that the last word is not out yet and will never be out in the ever-changing disease scenario. There are many uncertainties looming around us which we all are facing first time in our lifetime.

Take care and stay safe.

References

1Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.
2Yu, et al. A comprehensive Chinese experience against SARS-CoV-2 in ophthalmology. Eye Vis 2020;7:19.
3Romano MR, Montericcio A, Montalbano C, Raimondi R, Allegrini D, Ricciardelli G, et al. Facing COVID-19 in ophthalmology department. Curr Eye Res 2020;45:653-58.
4Viceconte G, Petrosillo N. COVID-19 R0: Magic number or conundrum? Infect Dis Rep 2020;12:8516.
5Das G, Mukherjee N, Ghosh S. Neurological insights of COVID-19 pandemic. ACS Chem Nerosci 2020;11:1206-9. [doi: 10.1021/acschemneuro. 0c00201].
6Xing Y, Mo P, Xiao Y, Zhao O, Zhang Y, Wang F. Post-discharge surveillance and positive virus detection in two medical staff recovered from coronavirus disease 2019 (COVID-19), China, January to February 2020. Euro Surveill 2020;25:2000191.