Coronavirus | 2019-nCoV & Eye Disease

The new coronavirus recently discovered may cause eye symptoms in infected individuals.  This article is meant to highlight the information made available to the public as health agencies such as AAO (The American Academy of Ophthalmology,  AOA (American Optometric Association), WHO (World Health Organization), and the CDC (Centers for Disease Control) who are collecting and dispersing information as we learn more about this global outbreak.

Coronaviruses are not new.  While several variants cause mild infections, they are also responsible for the SARS, MERS and the present novel coronavirus outbreaks where infections can be deadly.  The novel Coronavirus (dubbed 2019-nCoV) has not been identified previous to December 2019 where it initially was reported to have infected six patients in Wuhan City, Hubei Province, China.

There are 7 known coronaviruses.  This family of viruses are zoonotic, that is, they are capable of infecting both animals and humans.  The SARS coronavirus was found to be transmitted from civet cats to humans. The MERS coronavirus can be transmitted between dromedary camels and humans. 

Based on genomic sequencing for the virus, the origin of 2019-nCoV is suspected to be bats.  Another technical name for the novel coronavirus is SARS-CoV-2 and is closely related to SARS-CoV-1, the virus responsible for SARS.  SARS-CoV-1 also finds its origins in bats.  

The coronavirus is known to be at least as infectious as the influenza virus.  It is believed to be transmitted principally by aerosolized germs and/or direct contact.  

The disease causes respiratory symptoms:  cough, shortness of breath and pneumonia 

2019-nCoV (Coronavirus)

2019-nCoV is the name of the novel coronavirus.

There are seven known coronaviruses that infect humans.  Coronaviruses were first described in the 1960s.

Four viruses cause mild disease: HKU1, NL63, OC43 and 229E.

Three can cause deadly disease: SARS CoV-1, MERS, and SARS-CoV-2.

Coronaviruses cause similar symptoms to a cold are flu and are largely believed to spread from person to person via aerosolized respiratory droplets released when a person coughs or sneezes.  

Symptoms of COVID-19

The official name of the disease caused by coronavirus 2019-nCoV is called COVID-19.  COVID-19 stands for COronaVIrus Disease 2019.  

2019-nCoV causes COVID-19. 

Symptoms of coronavirus are similar to the flu:

• Runny nose
• Sore throat
• Headache
• Fever
• Cough
• Malaise
• Shortness of breath

Coronaviruses can also cause pneumonia and bronchitis, but occurs more often in people with cardiopulmonary disease, compromised immune systems, infants and the elderly. 

Conjunctivitis 

The viral infection may cause conjunctivitis.  Symptoms include redness, discharge, photophobia and irritation.  Patients who have symptoms of conjunctivitis and respiratory symptoms (cough, shortness of breath, others?) and who have travelled recently to China (or who have been exposed to  may be carriers. 

Conjunctivitis caused by the virus is thought to be self-limited and not known to cause any damage to the eye. 

Transmission

This recently identified coronavirus is similar to the SARS (Severe Acute Respiratory Syndrome) coronavirus and the MERS (Middle East Respiratory Syndrome) coronavirus.  As of this writing, it may be more contagious and has already caused more fatalities than the SARS outbreak. Starting in 2002, 8098 cases of SARS were reported including 774 deaths.  

The exact mechanism of transmission is not known, but person-to-person contact seems to be the predominant way the virus is spread.  Because some patients have conjunctivitis, health officials recommend protecting the eyes as a precaution to prevent spread, that is, it may be possible to contract the disease by getting droplets splashed or rubbed into the eyes.

Current recommendations also include thorough handwashing, covering your mouth and nose when sneezing (actually sneezing into your arm/elbow and not your hands is recommended) and avoid close contact with someone who may be ill.  Close contact is defined as being within 6 feet of an individual.

The virus seems to be very contagious.  The virus may have an incubation time of at least 14 days, perhaps longer.  Incubation time is defined as the time between contracting the virus and showing the first symptoms of disease.  It is likely that patients can be “carriers” (spreading the disease) during the incubation period.  

Healthcare Providers – PUI

The following resource from the CDC explains best practices for evaluating and reporting persons under investigation (PUI). 

Healthcare providers are requested to take a detailed travelled history when contacting patients with fever and signs of lower respiratory illness (cough, shortness of breath).  Those patients seen with symptoms of conjunctivitis should also be evaluated for fever and respiratory illness. 

Travel history is conducted to identify patients with a travel to mainland China, especially Hubei Province, China OR who have had close contact with a confirmed 2019 nCoV patient within the past 14 days of onset of symptoms should be further evaluated.

Healthcare providers are urged to contact state and local health agencies.