US Ophthalmologists Respond to COVID-19 Outbreak
Eyewire News contacted several ophthalmologists across the United States to ask what preparations they are making for COVID-19 and how the outbreak is affecting their practices.
According to the Centers for Disease Control (CDC), Massachusetts had reported 164 cases of COVID-19 as of March 17, 2020. Sarwat Salim, MD, FACS, is a professor of ophthalmology, vice chair of clinical and academic affairs, and director of the Glaucoma Service at Tufts University School of Medicine in Boston. “While we continue to learn more about this virus and its range of symptoms in afflicted individuals, increase our testing capabilities, develop future plans and strategies for management, and [determine] the impact of this on our infrastructure and global economy, the health care providers around the world are at the forefront of the crisis and may be the most vulnerable,” Dr. Salim said.
“Tufts Medical Center [TMC] was one of the first institutions in the country to restrict all domestic and international travel for business for 2 months in an effort to curb this outbreak,” she said. “The critical decision to postpone all elective surgery was made to conserve vital resources.”
Dr. Salim added that TMC is consolidating clinics and downsizing operations at its main campus and satellite offices but remains open for emergency visits. To control flow into the clinic, access has been limited to specific entrances, and TMC has imposed restrictions on the number and type of visitors permitted. Employees are receiving discount parking to encourage them to avoid public transportation, administrative staff is working from home, and all meetings and conferences are occurring by phone or video. TMC is also providing confidential counseling services to employees who need support. Dr. Salim added that TMC is training physicians and support staff on telemedicine and is looking at nontraditional spaces within the institution to create more ICU beds.
New York had reported 669 cases of COVID-19 to the CDC as of March 17. Marguerite B. McDonald, MD, FACS, a cornea and refractive surgery specialist at Ophthalmic Consultants of Long Island (OCLI) in Long Island, New York, told Eyewire News, “This is a very fluid situation. We change our habits as we get new information, especially from the CDC, AAO, and ASCRS. We have cancelled all but emergency surgeries.”
OCLI has also reduced office hours, with the last patient seen at 2 PM. The practice is booking fewer patients so that the waiting room is not crowded. The staff regularly wipes down all surfaces, disposes of magazines, and changes any materials (business cards at the front desk, etc.) that patients might have touched.
“We screen all patients with questions about fever, cough, travel history, and the travel history of family members,” Dr. McDonald said. “Patients may have only one visitor with them. The other friends or family must wait in the car.”
The significant decrease in surgical volume and office visits will have a major economic impact on OCLI, Dr. McDonald said.
Missouri had reported one to five cases of COVID-19 to the CDC as of March 17. John F. Doane, MD, stated that Discover Vision Centers in Kansas City, Missouri, has positioned a sentry at the door to screen patients prior to entry. The visits of those who are sick, have a cough or fever, have been exposed to COVID-19, or have recently traveled outside the United States are rescheduled. Anyone accompanying a patient is asked to remain outside the building and is contacted by text message when the patient departs. Chairs in the waiting room have been positioned 6 feet apart from each other, and scheduling has been adjusted to minimize the number of patients in the office at a given time. Any employee or doctor who is healthy but feels uncomfortable about reporting to work is permitted to stay home.
Dr. Doane stated that approximately 15% of visits were cancelled on March 16, a percentage he expects to rise if the number of new COVID-19 cases increases significantly. He added that the practice expects to lose 40% of its work staff if public schools are closed in response to the outbreak.
Illinois had reported 93 cases of COVID-19 to the CDC as of March 17. Lisa M. Nijm, MD, JD, is the medical director and founder of Warrenville EyeCare and LASIK in Warrenville, Illinois, and assistant professor of ophthalmology at the University of Illinois Eye and Ear Infirmary in Chicago. She told Eyewire News that her practice is following the precautions posted on the AAO’s website. They are rescheduling routine patient visits, postponing elective surgeries, decreasing the number of patients in the waiting room, and regularly disinfecting surfaces. All staff members are wearing masks and gloves, and patients are asked to wash their hands immediately upon arrival.
Dr. Nijm said, “It’s this critical 2-week time bloc that we’re all trying to work together to blunt the curve.“ She continued, “I think that, for the safety of our patients and our staff and our community, we really need to take all actions possible to minimize the threat of the virus.”
Asked about the financial impact of COVID-19, Dr. Nijm acknowledged that it is a concern for many practices—“how to minimize overhead during this time but at the same time obviously to be cognizant of our staff. For the moment, we’re hoping it’s a 2-week bloc.”
North Carolina had reported 33 cases of COVID-19 to the CDC as of March 17. Karl G. Stonecipher, MD, is the director of refractive surgery for TLC in Greensboro, North Carolina. He said they have asked all patients over the age of 60 without urgent ocular problems and those with cold, flu, and allergy symptoms to stay at home. Patients and staff members with a temperature above 99.5º are referred to their primary care providers. Magazines and the beverage area have been removed from the waiting room, and the number of patients permitted in the waiting room at one time has been reduced.
“SARS we got through, and we’re going to get through this as well,” Dr. Stonecipher said.