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MARCH 26, 2020 -- Healthcare professionals, like everyone else, have been thrown into a new world dominated by fear and uncertainty. We are wondering what we can do to confront this pandemic. As ophthalmologists, the answers aren't always clear.
I can confidently say that I have no business or knowledge in managing a patient with acute respiratory distress. I do not believe that ophthalmologists will ever be needed to "man a vent," but you never know—these are unprecedented times.
Issues surrounding the supply chain raise yet more questions: Will we have enough personal protective equipment? Does it make sense to conserve supplies until we get a better handle on the pandemic? Should we be closing our clinics to help prevent the spread of the virus? Elective cases are already being suspended in many hospitals across the country; should we now convert those operating rooms into makeshift ICUs?
By now, we have all learned the term "flattening the curve" and, hopefully, understand its necessity. The more we can decrease the rate of transmission and spread out the rate of infection, the better chance we have as a healthcare community to manage and care for potential patients. It will also allow us to conserve our supplies if we experience a wave of COVID-19–positive patients.
Even if we can agree on the goals, we will struggle to identify the best means of achieving them. The policies at my institution are constantly in flux. Yesterday we were practicing social distancing and only allowing essential staff members to be in the clinic. Medical students were present but in a limited role. But today we have opted to essentially close our clinics and postpone all elective surgeries, while continuing to treat patients with urgent ophthalmic problems only and follow up on those with postoperative appointments.
These methods will differ depending on your practice type (eg, solo or group practice, hospital or academic based), where you operate (eg, ambulatory surgery center, hospital), and which state you practice in.
I practice at a teaching institution, where we also have a responsibility to our residents. Currently, they are still helping to triage, examine, and treat patients, but their clinical and surgical volume has been decimated. So far, everyone is taking it in stride. For our third-year residents in particular, this could have a big impact on their surgical experience. I am not sure what the remedy is, given that we do not really have a choice in the matter. But even if they do not get another surgical case this year, I am confident that they have received solid training thus far.
The impact on our ophthalmic patients is another story. Depending on your specialty, your patient population may have more acute need for care. Personally, I have canceled all nonurgent patients and delayed all elective surgery. My patients have been very understanding of the situation, especially in light of the mandatory quarantine in my area. We are still seeing patients with acute issues and those who could suffer vision loss with delayed care.
I wonder what will happen if we are forced to shut down our practices for a protracted period of time. The longer this goes on, elective patients may turn into acute patients. It will be important for us to establish contingency plans to allow for scaling up as soon as we are able to in a safe and ethical manner.
We must all ask ourselves these questions now, while we still have sufficient time to act on them. For all intents and purposes, we are about 10-14 days behind Italy, where the number of infected patients has overwhelmed the healthcare system and they are rationing supplies and care.
One thing has been made clear by this crisis: We are all in this together. Hopefully it won't be for too long.
Sumit (Sam) Garg, MD, is vice chair of clinical ophthalmology and an associate professor in the Department of Ophthalmology at the Gavin Herbert Eye Institute, University of California, in Irvine. He specializes in corneal and cataract surgery as well as laser refractive surgery.
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