Protecting ophthalmology - EuroTimes

Protecting ophthalmology

Oliver Findl MD, PhD

Oliver Findl MD, PhD, Chief of the Department of Ophthalmology at Vienna Hanusch Hospital, Austria, spoke with EuroTimes contributing editor Dermot McGrath, on measures currently being taken in Austria to deal with the COVID-19 pandemic.

What is the current situation in Austria?
Like most other countries in Europe we are in shutdown mode here in Austriha. All schools and universities are closed, as are cafes and restaurants, theatres, shops and so forth. Only supermarkets and essential services such as banks and post offices remain open. The request to limit social contact seems to have been respected by the vast majority of the population. It is quite strict, as needs to be the case to contain the virus, and you need to have a valid reason to be outside and can only do so in the company of your immediate family members living in the same household. The police will intervene if they see groups gathering in public places and fines are in place for any breach of the regulations concerning confinement and social distancing. The duration of the confinement measures was supposed to last for at least four weeks in total, but that could change depending how the situation evolves.

What about your hospital and the health services in general? What measures have been put in place to deal with the epidemic?
At the moment there are still relatively few cases of COVID-19 in Austria.

Our hospital has set up two separate triage stations: one for personnel and one for patients. Everyone who comes to the hospital answers a series of questions relating to possible COVID-19 infection and has their temperature taken. It is only once they have passed screening that they are allowed on to the hospital premises.

In terms of ophthalmic care, all elective surgery has been cancelled and we only see patients in the outpatient setting who require emergency treatment such as retinal detachment, trauma and so forth. We have stepped up protective measures in our clinics, all of which have now been fitted with plexiglass shields on the slit lamp. There is greater use of masks as well but there is still some debate about the utility of using them in all situations.

We try to keep at least two metres’ distance between personnel and not to stay in the same room with a colleague for more than 15 minutes at a time. This is a precaution in case one of the personnel turns out to be infected with COVID-19. If we keep those rules then the personnel who have been in contact with the infected staff member are defined as category 3 risk and not category 1 and 2. Personnel who fall into the latter categories 1 and 2 need to go into quarantine for two weeks, whereas the measures are less stringent for category 3 and allows the hospital to maintain staff levels high at a time when they are needed most.

Since last week we have split up into three teams, two of which work from home offices at any given time while the other team is in the hospital. Each team has a set number of doctors, nurses, orthoptic staff and secretaries and we rotate shifts to ensure that there is rolling coverage at all times. It was rather challenging to organise all medical professions into these teams, but after a constructive discussion the process was implemented swiftly.

What about patients who require intravitreal injections?
For the first week we stopped doing intravitreal injections but this week we are starting to see patients again in order to administer their injections. We have, however, considerably reduced the volume from around 60 patients a day before the coronavirus crisis to around 25 a day in the current circumstances. We have gone through the patient records and are seeing those who require treatment the most. We are not seeing the patients in our hospital here in Vienna but are using a centre off site where our staff go to administer the injections. The idea is to protect the hospital here as much as possible.

How are resident ophthalmologists being managed during the crisis?
Training has been severely restricted of course given the exceptional circumstances that the entire medical profession is facing. But the residents who are working from home have been given work packages with particular assignments that they can complete during this period, whether it is writing up studies for peer-review publications or other work. They have also been asked to research COVID-19 and become familiar with this particular family of viruses. The next step will probably be to have them refresh their knowledge of emergency and intensive care treatment in case they are called into action at a future point.

Is Austria ready to deal with this epidemic?
We had a very vivid exchange with all of the chiefs of departments of ophthalmology in Austria over recent days to discuss ideas, strategies and best practices. At our department we have written a Standard Operating Procedure (SOP) document now for COVID-19 for everyone in our department and have made it available for everyone to have access. The IT department in our hospital has also worked hard to enable everyone to access their work emails from their home offices and to facilitate communication. So that all helps us to prepare for what is coming and it all went smoothly and efficiently.

We have all the structures and teams in place to tackle this crisis and are on a war footing. It is a little bit surreal as everything is ready but there are very few patients for the moment. It is the calm before the storm. There are not yet so many COVID-19 positive patients in Austria and very few currently need hospitalisation. But as we have seen elsewhere, this can change very quickly and we need to be ready for every eventuality.

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