The American Academy of Ophthalmology 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 initiative are principally authored by James Chodosh, MD, MPH. Dr. Chodosh is the David G. Cogan Professor of Ophthalmology at Harvard Medical School’s Department of Ophthalmology, a member of Harvard’s PhD program in virology and a world-recognized cornea and external disease expert. The Academy thanks Dr. Chodosh for making his scientific and clinical expertise available to his colleagues.
On March 11, COVID-19 was officially declared a pandemic by the World Health Organization. Countries with documented ongoing widespread or sustained community transmission include China, Iran, Italy, Japan, and South Korea. The 2 countries with the highest number of cases, China and South Korea, have shown consecutive multi-day declines in new cases.
Currently, U.S. COVID-19 cases include imported cases in travelers, cases among close contacts of a known case and community-acquired cases where the source of the infection is unknown. Based on the Johns Hopkins University COVID-19 interactive map, the states with the highest number of confirmed cases are Washington (281), New York (212), California (175) and Massachusetts (92)
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; conjunctivitis has also 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. 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. Viral RNA has also been found in stool samples from infected patients, raising the possibility of transmission through the fecal/oral route.
Currently, federal officials are trying to determine if there is asymptomatic transmission. A Feb. 21 report in JAMA details a case of an asymptomatic carrier who possibly infected 5 family members despite having normal chest computed tomography (CT) findings. In addition, Li Wenliang, MD, the whistleblower ophthalmologist who sounded the initial alarms on the coronavirus, said he was infected by an asymptomatic glaucoma patient. These reports, however, are preliminary.
Two recent reports suggest the virus can cause conjunctivitis. Thus, it is possible that SARS-CoV-2 is transmitted by aerosol contact with the conjunctiva.
While it appears 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 when caring for patients potentially infected with COVID-19. In addition, slit-lamp breath shields are helpful for protecting both health care workers and patients from respiratory illness.