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Conversations about COVID-19 For Eye Care Professionals Personal Protective Equipment, Therapies, and Contact Lenses Presenting sponsor April 14, 2020

Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

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Page 1: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Conversations about COVID-19 For Eye Care Professionals

Personal Protective Equipment, Therapies, and Contact Lenses

Presenting sponsorApril 14, 2020

Page 2: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,
Page 3: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

For everyone at CooperVision, our values of partnering, and being

inventive, friendly and dedicated do not just apply during the best of

times, they’re even more critical in challenging times like these. Our teams

are examining every area of our business to identify opportunities to

support you, mindful that many of you as small business owners are

seeking additional resources to support your practices and your contact

lens-wearing patients.

CooperVision’s Promise

Page 4: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

• Free shipping for direct-to-patient orders

• Modified consumer rebate policies• Extended payment terms• Continued manufacturing &

shipping

• E-commerce contact lens services• Supporting patient education• CooperVision customer-facing team• Continuous communication

CooperVision’s Resources to Support Eyecare Practices

CooperVision has instituted the following in an effort to support your practices and your contact lens-wearing patients.

For more information, reach out to your sales representative or visit ECP Viewpoints.

https://coopervision.com/practitioner/ecp-viewpoints/eyes-coopervision%E2%80%8C/covid-19-and-save2020eyecare-letter-jerry-warner
Page 5: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Additional Resources

• The U.S. Centers for Disease Control and Prevention (CDC) has issued guidance for contact lens wear and disinfecting. Here’s the link and you’ll find the two relevant tabs toward the bottom of the How to Protect Yourself section: https://www.cdc.gov/coronavirus/2019-ncov/faq.html#How-to-Protect-Yourself

• A new paper published in Contact Lens & Anterior Eye authored by some of the world’s most respected experts concludes that there is no evidence to suggest an increased risk of contracting COVID-19 through contact lens wear compared to wearing prescription spectacles.

• Everyone at CooperVision wants to make sure that unbiased, accurate information is being communicated. With that being said, here are links to additional resources regarding COVID-19 and the safety of contact lens wear here.

https://www.cdc.gov/coronavirus/2019-ncov/faq.html#How-to-Protect-Yourself
https://www.contactlensjournal.com/article/S1367-0484(20)30055-2/fulltext
https://coopervision.com/coronavirus
Page 6: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Conversations about COVID-19 For Eye Care Professionals

Personal Protective Equipment, Therapies, and Contact Lenses

Presenting sponsorApril 14, 2020

Page 7: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Infection Prevention and COVID-19Marlene L. Durand, M.D.

Physician, Division of Infectious Diseases, Massachusetts General HospitalDirector, Infectious Disease Service, Massachusetts Eye and Ear

April 14, 2020

Page 8: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Disclosures

• Stockholder, Pfizer

Page 9: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Coronaviruses

• Enveloped, single-stranded RNA viruses

• “corona” = crown, formed by spikes of glycoproteins on the envelope

• These spikes allow viral entry into cells

• Coronaviruses can cause mild illnesses such as the common cold or severe illnesses such as MERS, SARS, or COVID-19

• COVID-19 (illness) is caused by SARS-CoV-2 (virus)

From NIAID

Page 10: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Coronavirus = enveloped RNA virus

Image credit: Scientific Animations

Page 11: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Viruses: non-enveloped vs enveloped, RNA vs DNA

ENVELOPED VIRUSNON-ENVELOPED VIRUS

P

Modified from Reddy, Sansom, researchgate.net; creative commons

membraneglycoprotein

RNA virus examples: rhinovirus, norovirusDNA virus examples: adenovirus

RNA virus examples: influenza virus, coronavirus, HIV, hepatitis CDNA virus examples: herpes simplex virus, herpes zoster virus

Non-enveloped viruses are more resistant to environmental degradation.

Enveloped viruses have a “greasy” lipid bilayerenvelope that can be destroyed by soap and water

Both enveloped and non-envelopedviruses have protein “shells” or “capsids”

Page 12: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Infection Control and viruses• Non-enveloped viruses (compared with enveloped viruses): generally

harder to kill and survive longer in the environment

Page 13: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Non-enveloped viruses

• Example • Norovirus = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations, 800

deaths• highly contagious (requires <100 viral particles), spread by direct contact

with infected person, eating/drinking contaminated food/liquids, or hand-mouth contact with infected surfaces (fomite transmission)

• Infected person contagious during symptoms but ALSO for several days after symptoms resolve

• Wash your hands with soap and water• Norovirus survives on surfaces for weeks (CDC.gov/norovirus) without disinfection• Relatively hard to disinfect: use dilute (1000-5000ppm) bleach solution (CDC: e.g. 5-

25 Tbsp household bleach/gallon water) or other norovirus-approved disinfectants (see CDC list)

Page 14: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Enveloped viruses

• Example • SARS-CoV-2 (COVID-19 virus). Per CDC, the major mode of

transmission is via close contact (within 6 feet) of infected person due to respiratory droplets (>5 μm) landing on face/mouth/nose/eyes. Fomite transmission (touch infected surface then touch face, mouth, nose, eyes) may also play a role but is thought to be less important

• Hand hygiene essential – all surfaces and between fingers• Can survive on surfaces for up to hours to 3 days: 4 hrs copper, 24 hrs

cardboard, 2-3 days plastic or stainless steel (van Doremalen, NEJM 3/2020)• Disinfect: EPA-registered disinfectant for SARS-CoV-2 (370 listed, see EPA), or

dilute bleach (per CDC, 5 Tbsp household bleach per gallon water) – see CDC.gov/coronavirus/2019-ncov

Page 15: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Quiz: Do you think this virus is enveloped or non-enveloped?

• Originally isolated from adenoids (1953)

• Can survive on surfaces several weeks to 2 months (e.g. doorknobs x 2 months)

Transmission EM, Getty Images

Page 16: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Adenovirus: non-enveloped

• Non-enveloped, dsDNA• Broad range of infections,

mild to severe• Examples: upper respiratory

tract infections, conjunctivitis (and keratoconjunctivitis), bronchiolitis, pneumonia –which can be very severe

• Outbreaks from failure to follow infection control practices

3 images above from Creative Commons, CC-BY-SA-4.0

From Cha et al, Korean J Radiol 2016;17:940-949

Page 17: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,
Page 18: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

EKC (epidemic keratoconjunctivitis)

• Usually adenovirus serotypes 8, 19, 37 but also others (most large outbreaks have been caused by type 8)

• Eye pain, redness; corneal findings can persist for months and affect vision

Page 19: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

A news article you do NOT want about your clinical eye practice

From Review of Optometry

Page 20: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

From Review of Optometry, Feb 11, 2020

Page 21: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

EKC – major modes of transmission in eye clinics

• Hands of healthcare providers (HCP)• in half of reported outbreaks, a HCP has become infected• adenovirus can be recovered from the hands of 50% of EKC patients so hands

of HCPs can also serve as source of transmission• Per CDC, person is contagious from a few days prior to symptom onset to 14

days after onset

• Ophthalmic instruments (tonometer tips, slit lamps)• Ophthalmic solutions from multidose vials• Environmental surfaces

Page 22: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Infection Control – the goal is to prevent transmission of ALL infections (not just COVID-19)

“An ounce of prevention is worth a pound of cure”.

• Benjamin Franklin, 1736

1706-1790

Page 23: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Infection Control in office practice

• Follow CDC guidance for Infection Control. Have a written clinic policy and follow Standard Precautions for ALL patients, transmission-based precautions for those with particular infections

• Standard Precautions – for all patients• Transmission-based Precautions – use as 2nd tier in addition to

Standard Precautions• Contact precautions (e.g. for MRSA) – gown and gloves• Droplet precautions (e.g. for the flu) – single room, door closed, mask on

patient, HCP wears mask. Droplet precautions for COVID-19 also includes eye protection.

• Airborne precautions (e.g. TB) – negative pressure room, patient wears surgical mask outside of room, HCP wears N95 mask

Page 24: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

CDC: Standard Precautions

Page 25: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Hand Hygiene is very effective in preventing infection transmission

Images from CDC

Page 26: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Hand hygiene

• Very important in preventing transmission of infections, including COVID-19

• Hand hygiene (soap and water x 20 seconds, or alcohol-based hand sanitizer).

• Always perform hand hygiene immediately before and immediatelyafter contact with the patient.

Page 27: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

From CDC (Centers for Disease Control and Prevention)

Page 28: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

PPE -- Glove use

• Use gloves for patients with conjunctivitis or other infections (e.g. MRSA, COVID-19), but use gloves FOR ONE PATIENT ONLY.

• Perform hand hygiene before putting gloves on and after taking gloves off.

• Why? Exam gloves are “leaky” and you cannot disinfect them.• They become even more leaky with application of alcohol-based hand rub –

never try to “disinfect” your gloved hands, always remove them after use on a single patient.

Page 29: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Examination gloves are “leaky” including to viruses

• 1990 study of virus penetration polyethylene and polyvinyl gloves had failure rates of 40% and 22%, respectively. Following exposure to 70% alcohol, failure rates increased to 94% and 56%. Latex gloves are better but rarely used due to latex allergies in HCPs and patients. (Klein et al, Biotechniques 1990; 9:196-199.)

• 2004 study of viral (bacteriophage φ174) penetration of gloves: When 2 brands of non-latex (e.g. nitrile) examination gloves were “stressed” (e.g. after handling instruments) then tested, virus penetrated 29% and 36% of the gloves (O’Connell et al, Clin Micro Infect 2004;10:322-326)

Page 30: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Office disinfection – disinfect all pathogens, not only COVID-19 • Tonometer tips (prisms)• Disinfection of surfaces

Page 31: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Tonometer tips (prisms)

• Follow manufacturer recommendations for disinfection or reusable tonometer prisms, and in accordance with CDC guidance

• Example: 5-10 minute (timed) soak in dilute bleach solution followed by prolonged rinsing in water – but follow manufacturer IFU (instructions for use) EXACTLY

• Alternative: single use, disposable tonometer prisms

Page 32: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

AAO Recommendations – do not use alcohol wipes

Ophthalmology 2017;124:1867-1875.

Page 33: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Disinfect surfaces – example of spread of EKC due to inadequate eye clinic disinfection• 2016 EKC outbreak on U.S. Virgin Islands related to 2 eyecare clinics –

78 people affected. CDC investigated (MMWR Aug 4, 2017)• CDC took samples from these 2 clinics, PCR testing• Positive samples for adenovirus:

• Door knob• eye occlude• Refractor• examination light• bathroom faucet• surface of multiuse eye drop bottle• waiting room chair.

Page 34: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Disinfect surfaces

• Adenovirus: use same disinfectants as for norovirus (see CDC list, under Adenovirus section)

• For SARS-CoV-2 (COVID-19 virus) – CDC says:

Page 35: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Infection Control for seeing COVID-positive in outpatient setting (see CDC.gov)• Defer appointment if possible (unless urgent)• Patient should wear a surgical mask; do not let patient wait in waiting

room; place in a single exam room and the close door. After patient leaves, keep door to room closed to allow air exchange (e.g. 1 hour).

• To enter room, HCP wears gown, gloves, N95 mask, eye protection (face shield or goggles; glasses alone are NOT sufficient). Surgical mask may be used in place of N95 if N95 is not available and if no aerosol-generating procedures (AGPs, e.g. intubation, endoscopy) will be performed. AGPs should be performed in negative pressure room if available.

• N95 mask must be fit-tested to be effective

Page 36: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

See CDC website for details

Page 37: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,
Page 38: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

N95 masks (“respirators”): you first need to be fit-tested• OSHA requires “respiratory clearance”

before fit-testing – list of questions, medical clearance by Occupational Health, records maintained for 30 years. Some people cannot wear an N95 mask due to medical conditions.

• Fit-testing: a mask that fits prevents the wearer from smelling the test substance (e.g. sweet or bitter).

• Without the appropriate fit and seal, leakage around sides of an N95 mask can occur and the mask will not perform as “N95”.

Page 39: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Fit-testing an N95 mask: there are several brands/styles, and a person may fit only one style

YouTube 3M video

Page 40: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Carefully remove PPE so you do not contaminate yourself (see CDC guidelines)

Page 41: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

COVID-19: U.S. hospitalizations through 4/4/2020

From CDC

65+

50-64

18-49

Overall

Page 42: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Percentage of visits to ED for COVID-19 and influenza-like illness (from CDC)

COVID-like illness

Influenza-like illness

Page 43: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Thank you

Page 44: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Conversations about COVID-19 for Eye Care Professionals:Personal Protective Equipment, Therapies, and Contact Lenses

Page 45: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Corona Hot Topics Samir Melki MD, PhD

No Financial Interest

Page 46: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Financial DisclosuresNone

Page 47: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Corona Hot Topics

•Testing soup•Miracle cures?

•Vaccine Saviors?•How does it end?

Page 48: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Testing Soup

Page 49: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Testing SoupApril 14th 2020

25 approved molecular tests1 Saliva Molecular test (yesterday)

0 Viral antigen tests1 approved antibody test (Cellex)

Page 50: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Singapore – Case Tracing

Page 51: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

US – Case Tracing?

Page 52: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Testing Soup

Page 53: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Testing Soup

Page 54: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Testing Soup

Will Antibodies be protective?What exposure level is protective?

How long do Antibodies last?

Page 55: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Are antibodies protective?

Page 56: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Are antibodies protective?

Page 57: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Therapies

HydroxychloroquineRemdesivir

Actemra (Tocilizumab)Anticoagulants

Page 58: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

How does it kill you?

Page 59: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

How does it kill you?

Page 60: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

How does it kill you?

Page 61: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Therapies

Hydroxychloroquine - VariousRemdesivir - Antiviral

Actemra (Tocilizumab) – Anti IL-6Anticoagulants - Antithrombotic

Page 62: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

TherapiesHydroxychloroquine Mechanism of actionIs it a miracle drug?

Retina toxicityProphylaxis?

Page 63: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

TherapiesHydroxychloroquine

1- Raises pH level of endosomes - entry2- Increases intracellular Zinc - replication

3-Immunomodulator4- Antithrombotic

Page 64: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

TherapiesHydroxychloroquine

1- No Randomized Clinical trial2- Risks of Arrythmias w Azithromycin

3- Shortage4- Retina Toxicity

Page 65: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Hydroxychloroquine

Malaria Covid-19

Page 66: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Therapies

Hydroxychloroquine - VariousRemdesivir - Antiviral

Actemra (Tocilizumab) – Anti IL-6Anticoagulants - Antithrombotic

Page 67: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Vaccines – The Savior?

Page 68: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Vaccines

Page 69: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Vaccines

Page 70: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Vaccines – The Savior?HIVZika

EbolaSARSMERS

No corona viruses vaccines on market

Page 71: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Vaccines

Page 72: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Vaccines

Page 73: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

How does it end?• Better drugs/protocols

• Extensive testing/tracing• Better PPE/Hospital capacity

• Social distancing• Vaccines

• Herd Immunity

Page 74: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

How does it end?

• https://youtu.be/o4PnSYAqQHU

Page 75: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

How does it end?• Better drugs/protocols

• Extensive testing/tracing• Better PPE/Hospital capacity

• Social Distancing• Vaccines

• Herd Immunity

•Respect – Not fear

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Samir Melki MD, [email protected]

Thank You!

mailto:[email protected]
Page 77: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Conversations about COVID-19 for Eye Care Professionals:Personal Protective Equipment, Therapies, and Contact Lenses

Page 78: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

COVID-19 & CONTACT LENSES

Anita Gulmiri, OD, FAAO

Page 79: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Disclosures: None

Page 80: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

COVID-19& Contact Lenses

• Conflicting and controversial information

• Ocular transmission of SARS-CoV-2 through tearsSun et. al (2020): “The eye is rarely involved by human CoV infection, nor is it a preferred gateway of entry for human CoVs to infect the respiratory tract” Jun et al (2020): “The results from this study suggests that the risk of SARS-CoV-2 transmission through tears is low”

• To date, there have been no lab studies reported on the ability of coronaviruses to adhere to contact lenses

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Contact Lens UseDuring a PandemicContact lens use during this time is SAFE for healthy individuals• Proper hand-washing must be conducted

• If soap & water not available, use a hand sanitizer with at least 60% alcohol• Clinicians can suggest patients use disposable gloves, ethanol or alcohol wipes to

disinfect their fingers before lens handling as an extra precaution

• Proper wear & care• Disinfect every evening or dispose daily lenses

• Avoid touching face, mouth, nose, and eyes with unwashed hands

• Discontinue contact lens wear if sick

Page 82: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Contact Lens Disinfection• Hydrogen Peroxide Solutions

CDC: “Hydrogen peroxide-based systems for cleaning, disinfecting, and storing contact lenses should be effective against the virus that causes COVID-19”

• Multipurpose Solutions/Ultrasonic CleanersCDC: “Not enough scientific evidence to determine efficacy against the virus”

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In-Office Disinfection

Page 84: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Eyeglass UseDuring a Pandemic• Eyeglasses safer that contact lens use?

CDC: “There is no evidence to suggest contact lens wearers are more at risk for acquiring COVID-19 than eyeglass wearers.”

• Do Eyeglasses offer protection against coronavirus transmission?AOA: “There is no scientific evidence that wearing spectacles or glasses provides protection against COVID-19 or other viral transmissions”CDC: “Goggles or disposable face shields for eye protection” for any HCP caring for patients suspected to have COVID-19. Personal eyeglasses are NOT considered adequate eye protection”

• Recommend frequent disinfection of eyeglasses

Presenter
Presentation Notes
Touching your face wearing glasses vs. glasses
Page 85: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Contact Lens RenewalsDuring a Pandemic• Fairness to Contact Lens Consumers Act

AOA: “No federal laws related to the Contact Lens Rule prescription verification process have been suspended or waived.”

• Continue supplying your patients with contact lensesOrdering through your practice whether online or phone

• Reach out to patients who are due for renewal

• Telehealth Evaluations

Presenter
Presentation Notes
Law around extending CL RX? Video or phone
Page 86: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Telehealth CL Evaluations• Contact lens evaluations

• Emergency or Triage for CL wearers

• Photo and video consultations

– High resolution photos• Back camera• Lighting

Page 87: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

Further Research• COVID-19 & contact lens materials

• SiHY vs. Hydrogel• GP materials

• Disinfecting systems

• Tear film & transmission

Page 88: Personal Protective Equipment, Therapies, and Contact Lenses · = most common cause of acute gastroenteritis in U.S. • Each year in U.S.: 20 million cases, 56,000-71,000 hospitalizations,

References• Fonn D, Jones L. Hand hygiene is linked to microbial keratitis and corneal inflammatory events. Contact Lens Anterior Eye.

2019;42:132-35.• C. Sun, Y. Wang, G. Liu, Z. Liu, Role of the Eye in Transmitting Human Coronavirus: What We Know and What We Do Not

Know, Preprints In press (2020).• Jun I., Anderson D.E., Kang A.E., Wang L.-F., Rao P., Young B.E., Lye D.C., Agrawal R. Assessing Viral Shedding and Infectivity

of Tears in Coronavirus Disease 2019 (COVID-19) Patients. Ophthalmology In press. 2020• Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with

biocidal agents. D Hosp Infect. 2020;104:246-51.• Jones, Lyndon, et al. “The COVID-19 Pandemic: Important Considerations for Contact Lens Practitioners.” Contact Lens and

Anterior Eye, 2020, doi:10.1016/j.clae.2020.03.012.• World Health Organization. Coronavirus disease (COVID-19) advice for the

public. www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public.• Centers for Disease Control. How Covid-19 Spreads: “Frequently Asked Questions.” Centers for Disease Control and

Prevention, Centers for Disease Control and Prevention, 8 Apr. 2020, www.cdc.gov/coronavirus/2019-ncov/faq.html#How-COVID-19-Spreads.

• American Optometric Association “AOA Guide to Telehealth-Based Care during COVID-19.” AOA Guide to Telehealth Based Care During COVID-19 - American Optometric Assciation (AOA), www.aoa.org/coronavirus/aoa-guide-to-telehealth-based-care-during-covid-19.

• Walsh K. COVID-19 and contact lens wear: what do eye care practitioners and patients need to know? Contact lens Update. March 16, 2020.

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Conversations about COVID-19 for Eye Care Professionals:Personal Protective Equipment, Therapies, and Contact Lenses

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