President Dan Twelker, OD discusses the Role of VOSH Volunteers in Identifying and Preventing COVID-19

To date, some of VOSH/International’s programs have been affected by the COVID-19 outbreak. We have two VOSH Corps optometrists, Bob Molter, OD, and Kim Molter, OD teaching at the Pham Ngoc Thach Medical University in Ho Chi Minh City who advised us that “Our Vietnam phones have gotten texts from the Vietnamese government asking everyone to wear masks in public places and in crowded environments like on public buses.  The biggest impact on our lives has been the delay in starting the second semester of the school year.  Our time here is limited. This has compressed the courses we are to present and that makes for a lot of stress with the scheduling.” In addition, a VOSH/International Ambassador, Dr. Bruce Moore, has had to delay a teaching trip to Hanoi Medical University Optometry Program.

One of the most important functions of an optometrist, ophthalmologist, or VOSH volunteer is to prevent COVID-19 spread.  COVID-19, previously referred to as “2019-nCoV” or the “Wuhan coronavirus,” is a novel coronavirus that started in Wuhan City, Hubei Province, China. Its origin appears to be from bats but there may be an intermediate host such as pangolins which in some regions of the world are used as food or medicine. Once transmitted to humans person-to-person transmission is clearly occurring inside and outside of China.

In general, close contact is necessary for transmission, mainly through respiratory droplets that are produced when an infected person coughs or sneezes. It is not clear if a person can become infected by touching a surface that has virus on it and then touching their mouth, nose, or possibly their eyes. Study is ongoing on COVID-19 regarding how long the virus can live outside the body. It is possible that the virus could be spread through fecal material in diarrhea, but abdominal symptoms are not common in most infected persons.

When infected some people remain asymptomatic or show mild symptoms similar to a common cold. Patients can present with respiratory illness, including fever, cough, shortness of breath and conjunctivitis. Severe complications include pneumonia. These can appear as soon as two days or as long as 14 days after exposure.

There is no vaccine or cure for COVID-19 at this time, so treatment includes supportive care such as rest, hydration, and the use of a clean humidifier or cool mist vaporizer. Acetaminophen, ibuprofen, or naproxen can reduce pain and fever. Some patients may present with severe shortness of breath and require respiratory support and/or intravenous fluids. While most patients recover, the death rate is on the order of 2%.

As a VOSH volunteer in the US and abroad, it is important to know that patients could present to an office, clinic, or hospital with a conjunctivitis. Because the outbreak is relatively new and centered in Hubei Province, take a travel history to see if the patient or close contacts have traveled recently to Hubei Province, China or have symptoms of cough, fever, or shortness of breath.

The World Health Organization (WHO) as the United States Center for Disease Control (CDC) “always recommends everyday preventive actions to help prevent the spread of respiratory viruses, including:

  • Avoid close contact with people who are sick.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Stay home when you are sick.
  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
  • Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.
  • Follow CDC’s recommendations for using facemask.
    • CDC does not recommend that people who are well wear facemask to protect themselves from respiratory viruses, including 2019-nCoV.
    • Facemask should be used by people who show symptoms of 2019 novel coronavirus, in order to protect others from the risk of getting infected. The use of facemasks is also crucial for health care workers and people who are taking care of someone in close settings (at home or in a health care facility).
  • Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
    • If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.”

If you suspect a patient has COVID-19, ask the patient to use a facemask. Wash your hands and put on gloves, respiratory protection, and eye protection. Avoid touching your mouth, nose, or eyes.

At this time, the best place for further diagnostic testing usually is not an eye clinic or office, rather a clinic or hospital prepared to diagnose and care for patients with COVID-19. Further diagnostic testing could include real-time polymerase chain reaction (PCR) testing or a chest computerized tomography (CT) scan.

The WHO Health Emergencies Programme has developed and published an online course available in their learning platform, OpenWHO.org. The materials are available in several languages and include information materials and videos.

As time goes it will be important for optometrists, ophthalmologists, and VOSH volunteers to keep up with the most recent information on the outbreak, its detection, diagnosis, and treatment and above all stay safe to keep serving your patients.

For more information, please see:

https://www.who.int/emergencies/diseases/novel-coronavirus-2019

https://www.aaopt.org/detail/news/2020/02/07/2019-novel-coronavirus-update-and-recommendations

https://www.cdc.gov/coronavirus/2019-ncov/about/transmission.html

https://www.aoa.org/documents/HPI/HPI%20CoronaVirus%20Statement%201-30-20.pdf

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Updated COVID-19 and VOSH Humanitarian Clinics Advice

Due to an unprecedented surge in COVID-19 infections, a new variant that is more contagious, and these being early days in the vaccination distribution, VOSH/International DOES NOT recommend that chapters participate in domestic or international eye and vision clinics at this time.

We reiterate that at a time when the coronavirus continues to spread quickly in many parts of the world and vaccinations are not yet available to local populations, the risk of close contact with patients in a crowded outpatient environment remains high.

If a VOSH Chapter or VOSH volunteer chooses to hold a clinic against our best guidance, this is done at your own risk, by your own decision and should be in line with current local/national government rules.  VOSH/International would like to reiterate that safety for VOSH volunteers and our patients is of utmost importance and central to any decision-making process.

We have published our updated clinic guidelines with best practices to be observed in this new context.  You can download VOSH/International clinic guidelines here

Also please keep checking the following sites with official and most recent updates:

World Health Organisation: https://www.who.int/emergencies/diseases/novel-coronavirus-2019

US CDC: https://www.cdc.gov/coronavirus/2019-ncov/travelers/when-to-delay-travel.html

US Government Travel Advise: https://travel.state.gov/content/travel/en/traveladvisories/COVID-19-Country-Specific-Information.html

Thank you for your patience in these unprecedented times, hard work and dedication to improving vision and eye health throughout the world.

John Daniel Twelker, OD, PhD, FAAO, FVI

President, VOSH/International

January 2021