COVID-19
Shivan

Shivan

COVID-19 Alert Level 2: A Week so far in the Optometry Clinic

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Moving into alert level 3 from level 4 was arguable the best news Kiwis have received in the last few weeks during the COVID-19 pandemic. Possibly better was what happened at 11:59 pm on the 13th of May 2020, when New Zealand moved from alert level 3 down to level 2. 

This saw major restrictions lifted, notably, the opening of many physical businesses such as retail.

The majority of optometry clinics had been running at alert level 3. Albeit, this is with very restricted measures as I cover this in a previously published post. Only urgent cases could be seen and great attempts were made to reduce the contact time with patients.

Alert level 2 sees the return of full routine eye examinations for the majority of the public. Although guidelines are not as restrictive, measures were still being taken to reduce the spread of the disease.

COVID19
Table of summarises alert levels. Original from Unite Against COVID-19

As a disclaimer, these are not strict rules and I am only speaking from my own experiences. Please perform your own research to assess the risk of COVID-19.

Goodbye Work Bubbles

In alert level 3, teams were split into work bubbles in order to reduce the spread of the disease.

With the reduction in alert levels and the diseased contained, teams are now merged as one single unit.

Team members are still advised to maintain a 1-metre social distance as there is still a possibility of transmission within the community.

Our Door is Always Open

Instead of keeping the door locked and talking to patients over the phone, while they remain outside before entry, the door is now left open.

Patients are allowed to enter the premise. Great care is taken to limit the numbers who enter.

A maximum of ten persons is allowed in the space including staff. However depending on the size of the practice, this may be less. With limited floor space, the 1-metre social distancing cannot be maintained with a certain number and this may be less than ten.

Door Signage

Information provided on door signage is vital as it will explain the procedures required when entering the practice. This includes:

  • Signing the contact tracing form
  • Maintaining a 1-metre social distance
  • Sanitising hands
  • Advising not enter the practice if they have flu-like symptoms, have been in touch with anyone with flu-like symptoms or tested positive for COVID-19, or have themselves tested positive for COVID-19 or are awaiting a test for confirmation.

The Routine Eye Examination Returns

Alert level 3 entailed reduced testing time and condensed examination. For example, if someone broke their only glasses and needed this for their essential work, then only a glasses prescription check would be performed, and the eye health portion of the test deferred to a later time.

Patients had to be triaged to make sure they had no COVID-19 related symptoms. 

Additionally, only urgent cases such as eye threatening symptoms and those who have broken their only pair of glasses that they require to perform their day-to-day task were allowed to be seen immediately. Everyone else had to be deferred until the alert levels reduced.

Now in alert level 2, routine examination are now back in the game. Measures are still being undertaken to keep everyone safe.

Patients are still being asked if they have any flu-like symptoms or if they have been in touch with anyone with COVID-19 with a phone questionnaire. This same questionnaire is asked right before their eye examination.

They are also asked if they have common co-morbidities like breathing problems, diabetes, heart problems and so on as these seem to be present in the majority who have died from COVID-191.

For the majority of the fit and healthy population, they are now able to have their eyes examined routinely and for less urgent reasons.

This means that they can get new glasses or try contact lenses. More can be done for patients in alert level 2 than could be done in alert level 3, similar to what could be provided pre-COVID times.

Contact Tracing

Optometry is in an interesting position where there is a combination of both health and retail.

There are two categories that optometry will be classed under based on the WorkSafe website.

  1. Close contact and proximity business and services: all individuals who are subjected to this must be contact traced.
  2. Retail: contact tracing does not have to be performed on customers, but 1-metre social distancing must be maintained. Workers, however, must be contract traced.

Individuals who have their eyes examined or glasses measured for a dispense fall under the close contact category and must be contact traced.

For those who simply come and browse frames or come in to purchase an off-the-shelf product like eye drops, then this would be classified as a retail service. They would not have to be traced as long as 1-metre social distancing is maintained in store.

Questionnaires

Before patients are booked in for an appointment, a series of questions are asked to ensure the safety of the practice and everyone who visits. This includes asking:

  • if they have any flu-like symptoms or that anyone they have been in touch with has flu-like symptoms
  • if they have had a positive COVID-19 test or are awaiting results, or if they have been in touch with anyone with COVID-19

They are also asked if they have any co-morbidities to assess their risk level, as discussed before.

As an optometrist a judgment call is made if a patient is seen and that they have answered positively to having COVID19 or if they have any of the co-morbidities putting them in the high-risk category.

A decision is made based on the risks to the patient and the benefit they made from coming in and getting their eyes examined.

If a person has tested positive for COVID-19, it might be worth delaying their appointment further to allow for recovery and to ensure they will not spread the disease. In the case of urgency, then they are referred directly to the district health board.

The Exam Room

Similar to alert level 3, the exam room is kept in a minimal state.

This reduces the number of items that need to be cleaned in between patients.

Extra time is given between appointments to allow for thorough cleaning of the examination room.

Personal Protective Equipment

I generally wear a mask and gloves with patients for all eye examinations. 

This helps reduce the spread of the disease but also it installs confidence in myself and patients that I am doing the best to reduce to spread of COVID-19.

Conclusion

Moving from alert level 3 to alert level 2 is welcoming and shows New Zealand is moving in the right direction for this COVID-19 pandemic.

With the reduction in restriction, level 2 allows optometrists to help the community more than what could be done in level 3. We are able to help people out do much more now.

Despite this, vigilance and precautions are still in place to reduce the spread of COVID-19.

References
  1. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis[]

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