Ophthalmologic evidence against the interpersonal transmission of 2019 novel coronavirus through conjunctiva

Zhou, Yunyun; Zeng, Yuyang; Tong, Yongqing; Chen, Changzheng

doi:10.1101/2020.02.11.20021956

Cited by 168 publications

(260 citation statements)

References 16 publications

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“…The laboratory test revealed that the nasopharyngeal swab was positive while the conjunctival swab was negative. 5 On the contrary, our case All rights reserved. No reuse allowed without permission.…”

Section: Discussioncontrasting

confidence: 60%

“…A recent research has demonstrated that SARS-COV-2 can be detected in the conjunctival sac of patients with COVID-19 patients or suspected. 5 However, none of these patients had ocular symptoms. We therefore conducted a study to describe the clinical spectrum of ocular symptoms and laboratory test in conjunctival swab samples, we found a rare case of nosocomial SARS-COV-2 infection with conjunctivitis in a nurse, which suggests that ocular transmission may be a potential route of nosocomial transmission of the SARS-COV-2.…”

Section: Introductionmentioning

confidence: 92%

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The infection evidence of SARS-COV-2 in ocular surface: a single-center cross-sectional study

Zhang

Chen

et al. 2020

Preprint

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Purpose: The aim of this study was to identify whether SARS-COV-2 infected in ocular surface. Methods: Cross-sectional study of patients presenting for who received a COVID-19 diagnosis, from December 30, 2019 to February 7, 2020, at Tongji hospital, Tongji medical college, Huazhong University of Science and Technology. Demographics, temperature was recorded, blood routine test (Rt), chest Computed Tomography (CT) were took intermittently, and SARS-COV-2 real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay were arranged for the nasopharyngeal and conjunctival swab samples. Results: A total of 102 patients (48 Male [50%] and 54 Female [50%]) with clinical symptoms, Rt, and chest Computed Tomography (CT) abnormalities were identified with a clinical diagnosis of COVID-19. Patients had a mean [SD] gestational age of 57.63 [14.90] years. Of a total of 102 patients identified, 72 patients (36 men [50%] and 36 women [50%]; mean [SD] age, 58.68 [14.81] years) confirmed by laboratory diagnosis with SARS-COV-2 RT-PCR assay. Only two patients (2.78%) with conjunctivitis was identified from 72 patients with a laboratory confirmed COVID-19. However, SARS-COV-2 RNA fragments was found in ocular discharges by SARS-COV-2 RT-PCR only in one patient with conjunctivitis. Conclusions: Although we suspect the incidence of SARS-COV-2 infection through the ocular surface is extremely low, the nosocomial infection of SARS-CoV-2 through the eyes after occupational exposure is a potential route. The inefficient diagnostic method and the sampling time lag may contribute to the lower positive rate of conjunctival swab samples of SARS-COV-2. Therefore, to lower the SARS-COV-2 nosocomial infection, the protective goggles should be wore in all the health care workers.

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Section: Discussioncontrasting

confidence: 60%

Section: Introductionmentioning

confidence: 92%

The infection evidence of SARS-COV-2 in ocular surface: a single-center cross-sectional study

Zhang

Chen

et al. 2020

Preprint

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“…There were anecdotal reports suggesting that individuals may be infected by patients with subclinical infection [11], either by droplets or by direct contact with secretions from infected cases followed by subsequent inoculation into mucous membranes. Anecdotal reports suggested that when no eye protection was worn, the virus could also possibly be transmitted by aerosol contact with conjunctiva and cause infection [12][13][14]. Hence the close proximity between ophthalmologists and patients during slit lamp examination and direct ophthalmoscopy may pose an infectious risk to ophthalmologists.…”

Section: The Risks Of Covid-19 To Ophthalmologists and Patientsmentioning

confidence: 99%

“…Hence the close proximity between ophthalmologists and patients during slit lamp examination and direct ophthalmoscopy may pose an infectious risk to ophthalmologists. Ophthalmologists may also be caught off guard as conjunctivitis, though uncommon, could be the first presenting symptom of COVID-19, before the appearance of other symptoms such as cough and fever [12,13]. The American Academy of Ophthalmology has issued an alert advising ophthalmologists to wear masks and eye protection when seeing conjunctivitis patients with respiratory symptoms and history of international travel [14].…”

Section: The Risks Of Covid-19 To Ophthalmologists and Patientsmentioning

confidence: 99%

Stepping up infection control measures in ophthalmology during the novel coronavirus outbreak: an experience from Hong Kong

Lai

Tang

Chau

et al. 2020

Graefes Arch Clin Exp Ophthalmol

343

394

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Purpose Coronavirus disease has rapidly emerged as a global health threat. The purpose of this article is to share our local experience of stepping up infection control measures in ophthalmology to minimise COVID-19 infection of both healthcare workers and patients. Methods Infection control measures implemented in our ophthalmology clinic are discussed. The measures are based on detailed risk assessment by both local ophthalmologists and infection control experts. Results A three-level hierarchy of control measures was adopted. First, for administrative control, in order to lower patient attendance, text messages with an enquiry phone number were sent to patients to reschedule appointments or arrange drug refill. In order to minimise cross-infection of COVID-19, a triage system was set up to identify patients with fever, respiratory symptoms, acute conjunctivitis or recent travel to outbreak areas and to encourage these individuals to postpone their appointments for at least 14 days. Micro-aerosol generating procedures, such as noncontact tonometry and operations under general anaesthesia were avoided. Nasal endoscopy was avoided as it may provoke sneezing and cause generation of droplets. All elective clinical services were suspended. Infection control training was provided to all clinical staff. Second, for environmental control, to reduce droplet transmission of COVID-19, installation of protective shields on slit lamps, frequent disinfection of equipment, and provision of eye protection to staff were implemented. All staff were advised to measure their own body temperatures before work and promptly report any symptoms of upper respiratory tract infection, vomiting or diarrhoea. Third, universal masking, hand hygiene, and appropriate use of personal protective equipment (PPE) were promoted. Conclusion We hope our initial experience in stepping up infection control measures for COVID-19 infection in ophthalmology can help ophthalmologists globally to prepare for the potential community outbreak or pandemic. In order to minimise transmission of COVID-19, ophthalmologists should work closely with local infection control teams to implement infection control measures that are appropriate for their own clinical settings.

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“…12 Latest investigation reveals that although SARS-CoV-2 (1 of 67 cases) was tested positive in the conjunctival sac of NCIP patients, the hypothesis is not supported. 13 Nevertheless, goggle is necessary to protect eyes for all medical workers.…”

Section: Vertical Transmission Is Another Important Mode Of Concernmentioning

confidence: 99%

Uncertainties about the transmission routes of 2019 novel coronavirus

Han

Lin

et al. 2020

Influenza Resp Viruses

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The 2019 novel coronavirus (now named as SARS-CoV-2) caused an outbreak of SARS-like illness in the late of December 2019. At present, the origin, susceptible population, and infection sources already have been clear. 1,2 However, the transmission routes, a key step to the epidemic control, have not yet been fully ascertained. Here, we focus on the potential transmission routes that have been investigated in the SARS-CoV-2 epidemic recently. SARS-CoV-2, similar to SARS and MERS, is predominantly spread via respiratory tract with high infectivity. It is commonly recognized that droplet transmission is the main route. Spread by aerosol is suspected to be another important route of transmission but unestablished now. Epidemiological experts, as well as the WHO, consider more evidence is needed to confirm. 3 Besides, there are other routes except respiratory transmission. The previous study indicated that different human coronaviruses, such as SARS-CoV and MERS-CoV, can maintain infectious for a different time on inanimate surfaces. 4Meanwhile, it was reported that SARS-CoV-2 was also founded on the surface of the door handles, cell phones, and other items in the residential sites of confirmed cases. 5 Therefore, individuals will be probably infected if they touch the nose, mouth, or eyes after contacting the contaminated items.Currently, the existing of live SARS-CoV-2 in the stool has been confirmed because researchers at two independent state key laboratories isolated this live virus from the stool specimens of cases with novel coronavirus-infected pneumonia (NCIP). 6 This phenomenon is coincident with that of SARS-CoV as a result of ACE2 highly expressing in epithelia of the small intestine. 7,8 Furthermore, retrospecting the transmissibility of the SARS-CoV in the 2002-2003 pandemic, a shocking news reported that a major outbreak of SARS-CoV involving 321 patients occurred in a high-rise housing estate in Hong Kong. 9 Sewage is considered to play a definite role in this transmission. In summary, fecal-oral or fecal-droplet mode of transmission may be one of the several routes and cannot be ignored.Vertical transmission is another important mode of concern.A new retrospective study reviewed for nine pregnant women developing NCIP in late pregnancy at Zhongnan Hospital of Wuhan University suggests that no evidence is found for vertical transmission. 10 Moreover, no SARS-CoV-2 was detected in breast milk, indicating that the virus may not be transmitted through breastfeeding neither. 10 However, two newborns were confirmed in Wuhan women and children's healthcare center, one of whom was 30-hour-old, suggesting that the transmission via mothers to infants should not be ignored. 11Additionally, some researchers propose a hypothesis about the transmission through the ocular surface. 12 Latest investigation reveals that although SARS-CoV-2 (1 of 67 cases) was tested positive in the conjunctival sac of NCIP patients, the hypothesis is not supported. 13 Nevertheless, goggle is necessary to protect eyes for all medical wo...

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Ophthalmologic evidence against the interpersonal transmission of 2019 novel coronavirus through conjunctiva

Abstract: 1 Background: The emerging 2019 novel coronavirus (2019-nCoV) has pushed several 2 countries into state of emergency all over the world. The possible transmission of

Cited by 168 publications

References 16 publications

The infection evidence of SARS-COV-2 in ocular surface: a single-center cross-sectional study

The infection evidence of SARS-COV-2 in ocular surface: a single-center cross-sectional study

Stepping up infection control measures in ophthalmology during the novel coronavirus outbreak: an experience from Hong Kong

Uncertainties about the transmission routes of 2019 novel coronavirus

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