Perspective of ophthalmologists providing direct care to COVID-19 positive patients at JIPMER, Puducherry

Abstract

Dear Editor: Over the past 4 months, coronavirus disease-2019 (COVID-19) cases have been rising exponentially in India.[1] The preparations to tackle the situation had necessitated the recruitment of clinicians from various specialities including ophthalmologists for providing direct care to patients with COVID positive at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry. As ophthalmologists, we were initially a little perturbed and uncertain about our role in dispensing duties at the COVID-19 designated hospital of our institute. However, a 1-day workshop on various aspects of evaluation, care, and management of COVID; video-based demonstrations, hands-on training on personal protective equipment (PPE) kit donning and doffing; and post-workshop certification test had eased out most of the initial anxiety, and instilled a sense of self-confidence in us. Since then, we have been performing regular duties as frontline health care workers (HCWs) in the management of COVID positive patients under the supervision of the specialists from the core branches of Medicine and Anaesthesiology. Various responsibilities and duties for Ophthalmologists in the COVID hospital include the screening of patients with symptoms of influenza-like illness (ILI) or severe acute respiratory infection (SARI), eliciting a detailed history of travel and contact as per ICMR guidelines,[2] oropharyngeal and nasal swab collection, transport to lab in viral transport medium (VTM); segregation of patients for admission into intensive care units (ICU), suspect or positive wards; daily monitoring of vitals and treatment charts of the patients; regular counseling of the patients; coordination with the Department of Community Medicine for contact tracing, advice on home quarantine post-discharge and ensuring strict adherence to the quarantine guidelines.[3] We also need to perform fundus evaluation of COVID positive patients admitted with other systemic co-morbidities like cerebral venous thrombosis (CVT), and head injury to rule out papilledema. Universal precautions are being followed by us at all instances of potential exposure. We, infact, cannot afford to let our guard down at any point of time. Entry into the COVID wards is allowed only after proper donning of PPE kit performed under the observation of another HCW. Doffing is also done following all steps of the guidelines in a sequential manner. However, as the routine protocols for PPE donning/doffing do not account for handling of ophthalmic instruments, we had to make small modifications to conduct safe fundus evaluation using indirect ophthalmoscope (IO). We use three layers of gloves instead of two, use goggles instead of face shield after PPE donning to minimize fogging, and cover the IO and its wirings with plastic cling film. After performing the examination, the first layer of gloves are removed and 20 D lens is cleaned with soap and water, disinfection of the IO is performed with 95% isopropyl alcohol as per VRSI guidelines.[4] Routine sequence of PPE kit doffing is then performed in sequence with the remaining two layers of gloves. There is no scope for allowing any PPE breach while performing our role as frontline HCWs. In case any breach is noted, we are advised to doff immediately, report to the institute HCW helpline and do exposure risk assessment. Few instances of PPE breach that we noted in our fellow HCWs were mostly related to improper fitting of n95 masks. To conclude, these new responsibilities do come with some degree of stress owing to the exponentially increasing new case load; fear of potential exposure; deprivation from surgical training for the residents; depleted academics and clinical training; and prolonged social distancing. To mitigate this stress, regular counseling of the residents, involvement in virtual classrooms, and wet lab practice is being advocated and followed at our institute. Our stint and experience at COVID hospital, however, provides us with a unique opportunity to actively participate in the fight against the COVID pandemic, apart from performing our routine duties as Ophthalmologists. The pandemic is here to stay and therefore, our role as frontline warriors at COVID hospital will continue. In times to come, Ophthalmologists and other non-core branch specialists in other institutes as well will have to play a major role in fighting the pandemic apart from managing their respective speciality cases. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.