As we all enter the amber phase of post-lockdown, there are many excellent resources to be accessed from the AOP (check out their new pre-reg job site which aims to match up those who are currently out of work with suitable supervision), LOCSU and the College of Optometrists. LOCSU send a regular email update and, of the many points of interest they highlight, a recent email summarised the findings of their survey into how our profession is coping with delivering urgent and emergency care during the pandemic. Of the 474 responses received, 81% of consultations were managed by optical practice, 42% managed by the practice remotely, and just 13% were referred to hospital services. The remainder referred to a GP or higher qualified optometrist. This reflects well on the profession. Less impressive is the fact that still some CCGs are yet to commission a CUES or MECS service.
From the College site, I have copied the children’s poster in the hope of softening the sight of me in full PPE. That said, an ophthalmologist recently pointed out that ‘kids will just have to get used to it.’ A fair point.
Viral Conjunctivitis
The CoO’s Clinical Management Guidelines (CMGs) are evidence-based guidance on the diagnosis and management of a range of common and rare, but important, eye conditions that present with varying frequency in primary and first contact care. I am sure most of you use these CMGs already. The viral conjunctivitis CMG has just been updated to reflect the fact that SARS-CoV-2 has been linked with ocular infection and may, albeit rarely, present as a viral conjunctivitis. For further information on this topic, see Optician 22.05.20.
Immunity
I have said before that when an effective vaccine against Covid-19 is developed, it is likely to be well into 2021 before it is proven safe and made widely available. That time limit was predicted to be somewhat shorter recently with the progress made by J&J with their vaccine programme. Their scientists were mentioning the end of this year as a possible date for roll out on a recent news report. In the meantime, there has been understandable interest in the likelihood or otherwise of immunity being conferred by having recovered from the disease. A very well written review of this subject appeared last week in JAMA.1 The reviewers stated, ‘existing limited data on antibody responses to SARS-CoV-2 and related coronaviruses, as well as one small animal model study, suggest that recovery from COVID-19 might confer immunity against reinfection, at least temporarily. However, the immune response to COVID-19 is not yet fully understood and definitive data on post-infection immunity are lacking.’ Even temporary immunity is a positive if a vaccine is on the horizon.
Shields and Masks
I strongly recommend a new paper currently made available online from the American Academy of Ophthalmology which takes a look at the effectiveness of face masks and slit lamp breath shields in protecting the patient and practitioner from infection with the SARS-CoV-2 virus.2 The paper describes a study where a mannequin is used to represent the clinician and a spray is used to produce an aerosol to simulate that which might be produced from the respiratory output of patient and practitioner alike. Using impressive video footage, the study shows some, if limited, protection offered by the breath shields at a slit lamp, but strongly recommends they only be used to complement and support the far more effective protection offered by properly fitted face masks – on both the practitioner and the patient.
Local Spikes
As most people move out of lockdown, all of us are hoping that a second spike will not occur and, if it does, it may be located quickly and effectively before infection spreads beyond the hot spot of origin. My heart goes out to all those in Leicester. I agree with those who suggest that, had the available data been made available more quickly, a focused response may have been more effective. Perhaps because of such grumblings, the NHS has recently made available (at least in beta-testing mode at the time of writing) a dashboard that clearly shows the infection rates at localities throughout England – go to https://digital.nhs.uk/dashboards/progression. The results are updated daily and, today, it was clear that Leicester is still a hotspot (figure 1), while Bath and North Somerset had a zero infection rate. Well worth keeping an eye on.
And Finally….
Before we get bored with reviews and recriminations, a tory MP on the Today programme the other day actually said, ‘a review should not look backwards.’
References
- DOI:10.1001/jama.2020.7869
- DOI: https://doi.org/10.1016/j.ophtha.2020.06.031