English translation:

[Image Subtitle] Viral conjunctivitis can precede general symptoms such as fever, cough or muscle pain in the case of COVID-19 disease - Image source: wikipedia

Dear friends of freedom and peace,
Dear friends of love and happiness,
Dear readers,

In the following paragraphs, I would like to deal in several sections with the specific case of the COVID-19 risk situation when visiting an ophthalmologist in a clinic or practice. These sections will be based on the recommendations of the ophthalmologists in Hong Kong, which were published a few days ago. Because of the high relevance for the health of the old and multimorbid (suffering frequent or chronic illnesses) patients, and thus particularly vulnerable patients and ophthalmologists, this article will be a bit extensive.

Background on SARS-CoV-2 or COVID-19 disease

The experience of the ophthalmologists at the eye clinics in Hong Kong, together with the local epidemic experts, worked out recommendations for ophthalmological care that focus on avoiding infection risks for patients and ophthalmologists.

A three-stage infection control system was established in the knowledge that ophthalmologists who work without personal protective equipment, as persons in risk class 1, with more than 15 minutes of contact with infected people, are highly at risk of being infected even by asymptomatic or symptomatic virus eliminators when performing their work and caring for patients.

The virus, now officially known as SARS-CoV-2, is capable of severe disease courses
with massive damage to the lungs and consecutive lung failure in the form of acute respiratory distress syndrome (ARDS), which leads to death from multi-organ failure in a large number of such patients (around half of the cases).

Because of the severity of the illness, around 30 percent of the patients admitted to a hospital require intensive medical treatment, which, in addition to the direct virus-related damage to the patient, can also result in secondary and consequential damage such as paralysis, etc. in the case of such serious illnesses.

The incubation period for COVID-19 is 2-14 days - in rare cases up to 24 days. Doctors and medical personnel who - even unknowingly - had unprotected handling of SARS-infected patients have to be quarantined at home for 14 days and are no longer available for health care and are absent for at least two weeks, even possibly becoming ill themselves and suffering the consequences of a SARS infection as well.

Common symptoms in the run-up to such a severe course of the disease are fever, cough, runny nose, fatigue, muscle and body aches, shortness of breath as well as diarrhea and possible heart problems as a result of viral involvement of the heart muscle. The average mortality rate is stated at 2.3 percent, but has so far been 4.3 percent in Wuhan.

The likelihood of dying from infection with the new SARS virus COVID-19 increases significantly with age. The mortality of infected people increases significantly, particularly from the age of 40 and is around 1-2 percent among the group of over 50 year olds, between 3.8 and 8 percent for over 60 year olds and over 8 percent for over 70 year olds

From the age of 80, more than 15 percent of all infected COVID-19 patients die.

The threat situation and the risk of the uncontrolled spread of the new corona virus from person to person continues to increase

In the coming weeks and months, a further increase in the threat and risk situation is expected worldwide, which is associated with considerable risks for the health of both patients and doctors.

Ophthalmologists and patients are particularly affected by such a heightened risk of the threat situation, since, as a rule, due to the close visual examination by the ophthalmologist, the safety distance between patient and ophthalmologist drops to a few centimeters and thus a direct transmission of the highly contagious SARS virus to the doctor (or vice versa to a patient) is likely.

In addition, ophthalmologists in particular often serve a largely elderly clientele, who belong to the risk group for a fatal outcome of the SARS-CoV-2 infection, since they not only are older, but also often exhibit a variety of existing illnesses. However, since young people can also die from a COVID-19 disease, and the risk of a fatal outcome is also significantly increased for cancer patients, diabetics and lung patients, a maximum reduction in the risk of infection is essential.

Human-to-human transmission of the new corona virus occurs through droplet infection, smear infection or contaminated areas in in cases of self-infection (auto-infection). Therefore, all measures must be taken to prevent such infection chains, as effectively as possible.

By February 14, 2020, 1,716 health care workers in China were infected, 6 of whom have since died. The first of these was the ophthalmologist Dr. Li Wenliang, who at the time of his infection contracted the SARS-CoV-2 virus in the control of an asymptomatic glaucoma patient and died at the end of January of the effects of Covid-19.

The ophthalmologist Dr Li Wenliang became famous worldwide because he was the first to publicize the suspicion of a new SARS virus and report it to the WHO, dying shortly afterwards due the consequences of the infection.

His wife, who is pregnant with his second child, and his son, as well as his parents, survived the SARS infection they got. His tragic death exhorts us even more than ophthalmologists and patients, as well as citizens, to pay more attention than ever to the basic tenets of infection protection for the well-being of patients and the general interest for fellow human beings, as well as for our own life.

Nobody is helped if a doctor who does not protect himself is infected with COVID-19, like Dr. Li Wenliang, and possibly passes this virus on to other patients unnoticed during his work.

The new corona virus can also, in the form of an aerosol, infect a person's conjunctiva as part of a droplet infection and in this way trigger the potentially fatal COVID-19 disease, especially for older people over 50 years of age.

According to reports from Hong Kong, COVID-19 disease can manifest itself clinically as solitary conjunctivitis (conjunctivitis) before symptoms such as fever, cough, and symptoms appear before symptoms such as fever or cough become apparent. There is currently no therapy for viral conjunctivitis initiated by the SARS-CoV-2 virus - although in my opinion the topical administration of gamma interferon in the form of eye drops can be discussed for unofficial use- though it is currently not possible due to the lack of such a preparation.

Clinically asymptomatic virus carriers are particularly capable of infecting ophthalmologists

There is increasing evidence that doctors and medical staff have also contracted the new Coronavirus from undiagnosed and asymptomatic patients.

Several scientific papers indicate that an infection with the new corona virus was caused by air transmission, through contact with contaminated aerosols with the surface of the eye if full protective glasses were not worn with the personal protective equipment and further measures to protect against infection have been taken.

Because of this situation, the AAO - the American association of ophthalmologists - has recently been forced to issue an alarm and an instruction for ophthalmologists in America, which will affect ALL PATIENTS with conjunctivitis and / or suspected COVID-19 disease. Use of personal protective equipment including full safety glasses.

Basically, patients with suspected COVID-19 conjunctivitis should only be examined by ophthalmologists after the disease has healed in order to keep the risk for fellow patients in the clinic and practice, as well as for the medical staff on site, as low as possible and thus to maintain the health care of other patients.

It is now certain that the new coronavirus is also infectious via a person's tear fluid and can therefore be transmitted via direct contact with the patient. Therefore, all direct manipulations such as eye pressure measurements, and contact glass examinations should be avoided if possible. This also includes the contactless measurement of the eye pressure, since micro-aerosols with infectious SARS viruses can be released into the environment by the measuring mechanism.

A complete ophthalmological examination is often associated with time-consuming additional examinations – often including pupil dilation. In the case of the COVID-19 pandemic, this constitutes an increased risk of infection of the SARS-CoV-2 pathogen.

Language barriers, old age, and limited mobility of patients simply make matters worse. Because of the additional time and complexity involved, these factors can all further increase the risk of infection of people in the immediate vicinity of an infected person, especially if the person is not wearing a face mask or protective equipment.
The risk of cross-transmission of the new coronavirus is therefore significantly increased in ophthalmological practices and treatment centers as well as eye clinics with particularly long waiting times compared to other medical disciplines.

In the context of a SARS pandemic, the number of doctor-patient interactions must be limited to the absolutely minimum in order to protect patients and medical personnel, and normal routine examinations and illnesses that do not require urgent clarification should be postponed to a later date - especially when it comes to routine checkups of no urgency.

The basic requirement is that every patient – for their own safety - must wear respiratory protection when visiting a clinic, doctor's office, or emergency center in order to reduce the risk of infection for others.

** Patients with proven contact with SARS / COVID-19 patients should also not go to a clinic or a practice without consulting a doctor. This is all the more true if they show clinical signs such as conjunctivitis, fever, cough, runny nose, etc. and an outbreak of COVID-19 disease is therefore likely.

In this case, hotline 116117 should be called outside of normal office hours in Germany, or sick patients should first call their doctor or contact the local health office immediately to rule out the presence of SARS-CoV-2 disease and the like to discuss therapeutic diagnostic procedures ...

Part 2 to follow ...