Changes in the Clinical Practice of Ophthalmology during the Coronavirus Disease 2019 (COVID-19) Outbreak: an Experience from Daegu, Korea

Clinical operational considerations and responses to lockdown and reopening in the Covid-19 pandemic: experience of a tertiary ophthalmology centre in Singapore

Background

Much has been written on infection control and clinical measures for ophthalmic institutions and departments to cope with the COVID-19 pandemic. However, few articles have detailed implementation plans to manage lockdowns and subsequent re-openings. In this article, specific operational responses and their outcomes in a large tertiary ophthalmology centre are described.

Method

Through a concerted effort led by a dedicated task force, the Singapore National Eye Centre (SNEC) planned and executed an operational transformation to respond to the restrictions imposed on healthcare delivery during a national lock down. A carefully calibrated re-starting of services was carried out with the subsequent phased reopening of the country, taking into consideration unique constraints faced at that time. Strategies for operating in the new normal environment were also developed.

Results

Outpatient attendances were safely and expediently reduced by 70% (8749 vs. 29,311) and 82% (5164 vs. 29,342) in April and May 2020, respectively, compared to the corresponding months in 2019. A correspondingly large reduction in surgical load was also achieved through a similar triaging and prioritization system. Through optimizing the center’s use of space and time, as well as expanding on new models of care, a return to pre-pandemic patient load was achieved 3 months into the phased reopening of the country, and subsequently exceeded in the following months.

Conclusion

The lessons gleaned from SNEC’s experience may be useful for institutions currently facing the same challenges, and for future responses to COVID-19 resurgences or other pandemics.

One Year on: An Overview of Singapore's Response to COVID-19-What We Did, How We Fared, How We Can Move Forward

Background-One year has passed since the first COVID-19 case in Singapore. This scoping review commemorates Singaporean researchers that have expanded the knowledge on this novel virus. We aim to provide an overview of healthcare-related articles published in peer-reviewed journals, authored by the Singapore research community about COVID-19 during the first year of the pandemic. Methods-This was reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) protocol. It included healthcare-related articles about COVID-19 published between 23 January 2020 and 22 January 2021 with a Singapore-affiliated author. MEDLINE, Embase, Scopus, Web of Science, CINAHL, PsycINFO, Google Scholar, and local journals were searched. The articles were screened independently by two reviewers. Results-The review included 504 articles. Most of the articles narrated the changes to hospital practice (210), while articles on COVID-19 pathology (94) formed most of the non-narrative papers. Publications on public health (61) and the indirect impacts to clinical outcomes (45) were other major themes explored by the research community. The remaining articles detailed the psychological impact of the pandemic (35), adaptations of medical education (30), and narratives of events (14). Conclusion-Amidst a resurgence of community cases involving variant COVID-19 strains, the resources from the research community will provide valuable guidance to navigate these uncertain times.

Risk and prevention of COVID-19 in ophthalmic practice

The ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported in China in December 2019. Recent reports have confirmed that SARS-CoV-2 is primarily transmitted through secretions of the respiratory tract; however, it remains controversial whether or not COVID-19 affects the eye. This study presents a review of current evidence related to ocular transmission of SARS-CoV-2 for gaining a better understanding of the ocular manifestations of patients with COVID-19. The study also summarizes appropriate measures to be taken to protect healthcare providers in the ophthalmology department from being exposed to infected tears or conjunctival secretions. Some studies reported that SARS-CoV-2 can be transmitted through infected tears and conjunctival secretions of patients with COVID-19. Ocular manifestations such as injection, increased discharge, or epiphora, which are consistent with those of viral conjunctivitis, are more commonly reported. Therefore, during the ongoing COVID-19 pandemic, personnel working in the ophthalmology department should be provided with adequate and appropriate personal protection equipment. The exact mechanism and pathophysiology of ocular transmission of SARS-CoV-2 remain unclear, thus warranting further studies.