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

VOSH/International recently consulted its US and International Chapters about the feasibility and timing to restart our humanitarian clinics. While the vaccination process continues with different levels of success depending on availability and acceptance, it is evident that vaccine inequity and the availability and reliability of data in several countries are issues we need to consider.

Even if already vaccinated, our chapters are still concerned about the wellbeing of our volunteers and patients.  Some chapters, are organizing clinics locally where they are better able to comply with the existing safety requirements and respective state/country regulations.

The COVID-19 pandemic is being experienced quite differently depending on state, region, country, vaccine availability, vaccine acceptance, and the spread of SARS-COV-2 variants. Most VOSH chapters are not holding clinics or traveling internationally in 2021.

Thus, VOSH/International is slightly moderating its overall guidance against clinics and travel issued in late March 2020 and renewed in January 2021. This will be reviewed and communicated on a quarterly basis.

If a VOSH Chapter choses to hold a clinic or travel internationally, we highly recommend that the chapter performs due diligence to comply fully with the requirements established by the visited country, ensures all VOSH volunteers are aware of and follow strict safety guidelines and all existing protocols and regulations of the country, and keeps the principle of “do no harm” embedded in all its decision making. As always, the wellbeing and 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. VOSH chapters in specific countries are using protocols that need to be considered as well. You can download VOSH/International clinic guidelines here.

*VOSH/International is formed by autonomous US and international chapters that are fully and only responsible for their activities, fundraising and decision-making.  VOSH/International can only provide recommendations based on our best knowledge and information at the time.

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 hard work and dedication to improving vision and eye health throughout the world.

John Daniel Twelker, OD, PhD, FAAO, FVI

President, VOSH/International

July 2021