Evaluation of SARS-CoV-2 in Tears of Patients with Moderate to Severe COVID-19

Arora, Ritu; Goel, Ruchi; Kumar, Sumit; Chhabra, Mohit; Saxena, Sonal; Manchanda, Vikas; Pumma, Palak

doi:10.1016/j.ophtha.2020.08.029

Cited by 97 publications

(121 citation statements)

References 27 publications

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“…Subsequent studies confirmed that coronavirus infection is rarely associated with conjunctivitis, with occasional cases reported in patients with established COVID-19 infection, along with isolated cases of conjunctivitis as a presenting sign. 19 20 On the contrary, Arora et al 21 reported the presence of viral RNA in tears of one-fourth of patients with moderate to severe COVID-19 without conjunctivitis.…”

Section: Discussionmentioning

confidence: 99%

One threat, different answers: the impact of COVID-19 pandemic on cornea donation and donor selection across Europe

et al. 2020

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ObjectivesTo assess to which extent the COVID-19 pandemic affected corneal transplantation by virtue of donor selection algorithms in different European countries.DesignSurvey.Setting110 eye banks in 26 European countries.Participants64 eye banks covering 95% of European corneal transplantation activity.InterventionsA questionnaire listing the number of corneas procured and distributed from February to May 2018–2020 was circulated to eye banks.Main outcome measuresThe primary outcome was the number of corneal procurements. Additional outcomes were national algorithms for donor selection, classified according to their stringency (donors with COVID-19 history, suspected for COVID-19, asymptomatic, PCR testing) and the pandemic severity in each country. We calculated Spearman’s correlation coefficient to determine, two by two, the relationship between the 3-month decline in eye banking activity (procurement), the stringency of donor selection algorithm and the grading of pandemic severity (cases and deaths). A partial correlation was run to determine the relationship between decline and stringency while controlling for pandemic severity.ResultsProcurements decreased by 38%, 68% and 41%, respectively, in March, April and May 2020 compared with the mean of the previous 2 years, while grafts decreased, respectively, by 28%, 68% and 56% corresponding to 3866 untreated patients in 3 months. Significant disparities between countries and the decrease in activity correlated with stringency in donor selection independent of pandemic severity.ConclusionsOur data demonstrate significant differences between countries regarding donor screening algorithms based on precautionary principles and, consequently, a decrease in the donor pool, already constrained by a long list of contraindications. Fundamental studies are needed to determine the risk of SARS-CoV-2 transmission by corneal transplantation and guide evidence-based recommendations for donor selection to justify their substantial medical and economic impact.

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Section: Discussionmentioning

confidence: 99%

One threat, different answers: the impact of COVID-19 pandemic on cornea donation and donor selection across Europe

et al. 2020

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“…The ocular mucosa and the nasopharynx are connected by the nasolacrimal duct. When splashes reach the cornea or conjunctiva, they can penetrate the nasolacrimal duct and be transported to the nasopharynx and trachea [ 44 , 45 ]. Ocular manifestations seem frequent, and high-frequency hand–eye contact correlates with conjunctival congestion [ 46 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

Experimental Efficacy of the Face Shield and the Mask against Emitted and Potentially Received Particles

Wendling¹,

Fabacher²,

Pébaÿ³

et al. 2021

IJERPH

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There is currently not sufficient evidence to support the effectiveness of face shields for source control. In order to evaluate the comparative barrier performance effect of face masks and face shields, we used an aerosol generator and a particle counter to evaluate the performance of the various devices in comparable situations. We tested different configurations in an experimental setup with manikin heads wearing masks (surgical type I), face shields (22.5 cm high with overhang under the chin of 7 cm and circumference of 35 cm) on an emitter or a receiver manikin head, or both. The manikins were face to face, 25 cm apart, with an intense particle emission (52.5 L/min) for 30 s. The particle counter calculated the total cumulative particles aspirated on a volume of 1.416 L In our experimental conditions, when the receiver alone wore a protection, the face shield was more effective (reduction factor = 54.8%), while reduction was lower with a mask (reduction factor = 21.8%) (p = 0.002). The wearing of a protective device by the emitter alone reduced the level of received particles by 96.8% for both the mask and face shield (p = NS). When both the emitter and receiver manikin heads wore a face shield, the protection allowed for better results in our experimental conditions: 98% reduction for the face shields versus 97.3% for the masks (p = 0.01). Face shields offered an even better barrier effect than the mask against small inhaled particles (<0.3 µm–0.3 to 0.5 µm–0.5 to 1 µm) in all configurations. Therefore, it would be interesting to include face shields as used in our experimental study as part of strategies to reduce transmission within the community setting.

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“…When liquid splashes occur at eye, it can be partially absorbed by the cornea and conjunctiva but also get into the nasal cavity through the nasolacrimal duct, be transported toward the nasopharynx and trachea, and at this point swallowed into the gastrointestinal tract. So logically viruses contained in the liquid splashes to which the eye is exposed can be transported to the nasopharynx and respiratory tract mucosa [34,35]. Ocular manifestations seem frequent, and high-frequency hand-eye contact was correlated with conjunctival congestion [36,37].…”

Section: Discussionmentioning

confidence: 99%

Experimental efficacy of the face shield and the mask against emitted and potentially received particles

Wendling

Fabacher

Pebay³

et al. 2020

Preprint

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The aim of this study was to evaluate the comparative performance of masks and face shields in different experimental configurations. An experimental setup with two mannequin heads positioned at 1.70m high and at 25 cm each other was used. A fogger generated a particle’s airflow with a speed of 5m/sec from the emitter to the receiver head mannequin. Our aerosol generator produced 3 000 times more particles than a physiological cough situation. A particle counter allowed us to evaluate the number of particles received on a mannequin head located at a very short distance of 25 cm. The amount of all particles up to the selected particle sizes were counted with an optical particle counter on channels 0.3 µm, 0.5 µm, 1 µm, 2.5 µm, 5 µm and 10 µm. The reduction factors with a protection worn by the receiver alone, by the emitter alone and then the double protection of emitter and receiver were calculated. When the receiver alone wore a face shield, the amount of total particles was reduced (54.8%), while the reduction was less when the receiver alone wore a mask (21.8%) (p = 0.003). Wearing a protection by the emitter alone reduced much more the level of particles received by 96.8% for both mask and face shield. The double protection allowed for even better results, but close to the protection of the emitter alone: 98% reduction for the face shields and 97.3% for the masks (p=0.022). Even with small particle size emission (≤0.3µm), results were of the same order. Considering our results, protection of the emitter alone or double protection is much more effective than protection of the receiver only. Validated face shield should be included as part of strategies to safely and significantly reduce transmission in the community setting, in addition to masks or for people with disabilities or medical intolerance to masks.

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Evaluation of SARS-CoV-2 in Tears of Patients with Moderate to Severe COVID-19

Cited by 97 publications

References 27 publications

One threat, different answers: the impact of COVID-19 pandemic on cornea donation and donor selection across Europe

One threat, different answers: the impact of COVID-19 pandemic on cornea donation and donor selection across Europe

Experimental Efficacy of the Face Shield and the Mask against Emitted and Potentially Received Particles

Experimental efficacy of the face shield and the mask against emitted and potentially received particles

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