Covid-19 in NZ: What about our patients?
Dr Richard Hart preparing to operate in Auckland during the Covid-19 pandemic

Covid-19 in NZ: What about our patients?

April 7, 2020 Louise Wood

In a very short space of time we have plunged into the unknown. Overnight our daily vocabulary has transformed to include Covid-19, PPE, ‘flattening the curve’, infection spikes, contamination, lockdown, quarantine… and more.

 

During the lockdown period, ophthalmology and optometry are classified as essential services. What does that mean for clinicians and our patients? Those in lockdown with children at home are possibly thrilled with the news they can now escape the house for short periods. Others are naturally going to feel anxious about being exposed to SARS-Cov-2 (Covid-19).

 

Safe practice guidelines

 

Guidelines emerged quickly about how to approach this unfamiliar territory. The Ministry of Health (MoH), the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) and the Optometrists and Dispensing Opticians board (ODOB) issued safe practice protocols for us to adhere to. The underlying message is we are available to help others in acute need but must maintain safe practice.

 

On 18 March 2020, the American Association of Ophthalmologists recommended that ophthalmologists should cease all treatments with the exclusion of acute care. On Friday 27 March 2020, RANZCO released a set of subspecialty specific guidelines splitting patients into three categories: 1) those with acute conditions that require care within two weeks; 2) those with moderate conditions that can be managed with telemedicine and reviewed in three months; and 3) everyone else with non-urgent conditions and can be seen after four months.

All elective ophthalmic surgeries have been canceled in the private and public sector. Acute cases falling into category one may include but are not limited to, patients requiring regular anti-VEGF treatments, post-operative care, sudden loss of vision, eye infections, uveitis and trauma.

 

With the number of do-it-yourself projects about to explode exponentially across New Zealand those patients with paint splashes in the eye or on the receiving end of a misfired nail gun will still be cared for.

 

The lockdown’s effect on private and public eye care services?

 

In the lead up to the lockdown, each practice had to make a decision about whether they would open their doors to patients. Dr Richard Hart of City Eye Specialists, Auckland said, “We are seeing a severe reduction in the number of patients and a corresponding reduction in revenue during the lockdown period because private ophthalmology practices predominantly provide elective consultations and services. Guidelines published by RANZCO on 27 March 2020 provide clear guidance for practitioners about which patients can be seen and urgent indication for surgery during the crisis. In the public sector, the effects are similar – care for urgent and acute or vision threatening conditions, or potentially life-threatening conditions will continue but all elective clinics and surgeries have been cancelled. There will be no lacrimal surgery. Patients with acute dacryocystitis will be managed medically and have their DCR surgery deferred due to the increased contamination risk with surgeries involving the nasopharynx.”

 

This will likely result in a huge unsustainable backlog in the public sector when the lock down is lifted.

 

Running a clinic during lockdown

 

As this is an evolving pandemic and research into Covid-19 is ongoing, it is difficult to accurately determine contamination risk, but all available advice focuses on maintaining clinician and patient safety. The MoH has advised any patient exhibiting Covid-19 symptoms, or who has recently travelled overseas or been in close contact with a Covid-19 patient, needs to be referred directly to a testing station and should not be seen in the private sector.

 

At City Eye Specialists, patients are being triaged on the phone by medical staff and then asked to wait in their car upon arrival. Limiting exposure time and distance to each other is an important part of lockdown but is not always practical in a clinical setting. City Eye has installed slit lamp guards to try and limit contamination when social distancing is not practical.

 

 

Slit lamp shield at City Eye Specialists during Covid-19 pandemic

 

 

Currently, personal protective equipment (PPE) is only advised when seeing patients who are at risk of Covid-19 exposure and should be seen in hospital. “PPE is not being worn in the eye department at the hospital but is available for use during procedures and only for consultations if you are in contact with a Covid-19 patient,” said Dr Hart.

 

A study published on 10 March in the Annals of Internal Medicine found that the mean incubation period for SARS-CoV-2 is five to seven days¹. A 21 February report in JAMA found a case where a family of five possibly became infected by an asymptomatic member who had travelled from Wuhan². In addition, emerging research indicates SARS-CoV-2 can survive 24 hours on cardboard and two to three days on plastic and stainless steel³.

 

At present, in private clinics thorough cleaning of all surfaces between each patient with alcohol-based disinfectants should be practiced*. Guidelines will likely change as ongoing research into Covid-19 emerges.

 

What next?

 

In this uncertain time, we are unsure of the long-term repercussions of the lockdown. Our public hospitals already practice at capacity and have significant waiting lists for elective eye surgeries. We may see ophthalmology patients from the public hospital system being triaged into the private sector to cope with the backlog. This leaves the eye departments free for Covid-19 patients as capacity is stretched.

 

We fill a valuable role in helping our patients in whatever way we can. Staying safe and protected is of primary importance for both patients and clinicians.

 

* For more on disinfection advice, see: http://eyeonoptics.co.nz/articles/archive/disinfection-advice-for-optoms/.

 

 

References:

 

  1. Lauer SA, Grantz KH, Bi Q, et al. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med. 2020

 

  1. Bai Yan, Yao Lingsheng et al. Presumed Asymptomatic Carrier Transmission of COVID-19. Published online February 21, 2020

 

  1. van Doremalen N, Morris D et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J of March 17, 2020

 

  1. health.govt.nz/system/files/documents/pages/covid19-ppe-community-care_providers-27mar20.pdf

 

 

Louise Wood is a therapeutically qualified optometrist working at City Eye Specialists in Auckland, New Zealand.

 

 

For all New Zealand related Covid-19 announcements, go to: http://eyeonoptics.co.nz/articlesearchresults?searchstring=COVID19