Impact of the SARS-CoV-2 pandemic on ophthalmic care in Germany <span class="so-article-trans-title" dir="auto"> Translated title: Auswirkungen der SARS-CoV-2-Pandemie auf die ophthalmologische Versorgung in Deutschland </span>

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Abstract

Background

Survey by the commission for cross-sectoral ophthalmology, as a joint commission of the German Ophthalmological Society (DOG) and the Professional Association of German Ophthalmologists (BVA) on the effects of the SARS-CoV‑2 pandemic on ophthalmological patient care in Germany.

Methods

Online-based survey.

Results

A total of 1190 questionnaires were (partly) answered. With respect to outpatient care and consultations from 15 March to 15 April 2020, a total of 69 (5.8%) participants indicated unlimited, 756 (63.5%) reduced and 330 (27.7%) emergency care only, independent of the type of institution. Outpatient surgery was restricted to emergency surgery in 68% of clinics, 42.0% of inpatient wards, 45.0% of surgical medical care centers and group practices and 33.0% of private practices. Inpatient procedures were limited to emergency care in 75.0% of inpatient wards and in 71.0% of clinics. With the exception of endophthalmitis (+8.2%), the number of urgent indications and emergencies declined: retinal detachment (−34.8%), perforating eyeball injuries (−7.3%), acute glaucoma (−17.8%), central retinal artery occlusion and anterior ischemic optic neuropathy (−31.0%), others (−30.9%), penetrating keratoplasty and amniotic membrane transplantation (−59.1%). Institutional or professional policy requirements (76.0%) and appointment cancellation by patients (84.0%) were the most common reasons for limitations in ophthalmic patient care.

Conclusion

The initial phase of the pandemic was characterized by a massive reduction in non-urgent conservative and surgical treatment that affected all areas of ophthalmology. Due to intensive care capacities required for COVID-19 patients, inpatient treatment was largely restricted to emergencies. Treatment of ophthalmological patients, including ocular emergencies and urgent treatment, was maintained across all sectors with a (considerable) decrease in the number of cases even in these groups.

Translated abstract

Hintergrund

Umfrage der „Kommission Sektorenübergreifende Augenheilkunde“ als gemeinsame Kommission der Deutschen Ophthalmologischen Gesellschaft (DOG) und des Berufsverbandes der Augenärzte Deutschlands (BVA) zu den Auswirkungen der SARS-CoV-2-Pandemie auf die ophthalmologische Versorgung in Deutschland.

Methoden

Online-basierte Umfrage.

Ergebnisse

Insgesamt wurden 1190 Fragebögen (teilweise) beantwortet. Die Ambulanz- bzw. Sprechstundentätigkeit in der Zeit vom 15.03. bis 15.04.2020 gaben 69 (5,8 %) Teilnehmer mit „uneingeschränkt“, 756 (63,5 %) mit „reduziert“ und 330 (27,7 %) als „ausschließliche Notfallversorgung“ an, unabhängig von der Art der Einrichtung. Ambulante Operationen waren in 68,0 % der Hauptabteilungen, 42,0 % der Belegabteilungen, 45,0 % der operativen MVZ und Gemeinschaftspraxen und 33,0 % der operativen Einzelpraxen notfallchirurgischen Eingriffen vorbehalten. Stationäre Eingriffe waren in 75,0 % der Belegabteilungen und in 71,0 % der Hauptabteilungen auf die Versorgung von Notfällen beschränkt. Die Fallzahlen dringlicher Indikationen und Notfälle waren mit Ausnahme der Endophthalmitis (+8,2 %) rückläufig: Amotio retinae (−34,8 %), Bulbusperforation (−7,3 %), Glaukomanfall (−17,8 %), ZAV und AION (−31 %), Sonstige (−30,9 %), perforierende Keratoplastik und Amnionmembrantransplantation (−59,1 %). Institutionelle oder berufspolitische Vorgaben (76,0 %) sowie Terminabsagen durch Patienten (84,0 %) waren der häufigste Grund für eine Einschränkung der ophthalmologischen Versorgung.

Schlussfolgerung

Während der Pandemie kam es initial zu einer erheblichen Reduzierung nichtdringlicher konservativer und chirurgischer Behandlungen, von der alle Bereiche der Augenheilkunde betroffen waren. Aufgrund der für COVID-19-Patienten benötigten Intensivkapazitäten waren insbesondere stationäre Behandlungen weitgehend auf Notfälle beschränkt. Die Versorgung ophthalmologischer Patienten einschließlich Notfällen und dringlicher Behandlungen konnte sektorübergreifend aufrechterhalten werden, wobei für beide Gruppen ein (deutlicher) Rückgang der Fallzahlen beobachtet wurde.

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Most cited references 38

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Clinical Characteristics of Coronavirus Disease 2019 in China

Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)

Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)

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Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility

Melissa M. Arons, Kelly Hatfield, Sujan Reddy … (2020)

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can spread rapidly within skilled nursing facilities. After identification of a case of Covid-19 in a skilled nursing facility, we assessed transmission and evaluated the adequacy of symptom-based screening to identify infections in residents. Methods We conducted two serial point-prevalence surveys, 1 week apart, in which assenting residents of the facility underwent nasopharyngeal and oropharyngeal testing for SARS-CoV-2, including real-time reverse-transcriptase polymerase chain reaction (rRT-PCR), viral culture, and sequencing. Symptoms that had been present during the preceding 14 days were recorded. Asymptomatic residents who tested positive were reassessed 7 days later. Residents with SARS-CoV-2 infection were categorized as symptomatic with typical symptoms (fever, cough, or shortness of breath), symptomatic with only atypical symptoms, presymptomatic, or asymptomatic. Results Twenty-three days after the first positive test result in a resident at this skilled nursing facility, 57 of 89 residents (64%) tested positive for SARS-CoV-2. Among 76 residents who participated in point-prevalence surveys, 48 (63%) tested positive. Of these 48 residents, 27 (56%) were asymptomatic at the time of testing; 24 subsequently developed symptoms (median time to onset, 4 days). Samples from these 24 presymptomatic residents had a median rRT-PCR cycle threshold value of 23.1, and viable virus was recovered from 17 residents. As of April 3, of the 57 residents with SARS-CoV-2 infection, 11 had been hospitalized (3 in the intensive care unit) and 15 had died (mortality, 26%). Of the 34 residents whose specimens were sequenced, 27 (79%) had sequences that fit into two clusters with a difference of one nucleotide. Conclusions Rapid and widespread transmission of SARS-CoV-2 was demonstrated in this skilled nursing facility. More than half of residents with positive test results were asymptomatic at the time of testing and most likely contributed to transmission. Infection-control strategies focused solely on symptomatic residents were not sufficient to prevent transmission after SARS-CoV-2 introduction into this facility.

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Elective surgery cancellations due to the COVID ‐19 pandemic: global predictive modelling to inform surgical recovery plans

Dmitri Nepogodiev, Aneel Bhangu, Savino Spadaro … (2020)

Background The COVID‐19 pandemic has disrupted routine hospital services globally. This study estimated the total number of adult elective operations that would be cancelled worldwide during the 12 weeks of peak disruption due to COVID‐19. Methods A global expert‐response study was conducted to elicit projections for the proportion of elective surgery that would be cancelled or postponed during the 12 weeks of peak disruption. A Bayesian beta‐regression model was used to estimate 12‐week cancellation rates for 190 countries. Elective surgical case‐mix data, stratified by specialty and indication (cancer versus benign surgery), was determined. This case‐mix was applied to country‐level surgical volumes. The 12‐week cancellation rates were then applied to these figures to calculate total cancelled operations. Results The best estimate was that 28,404,603 operations would be cancelled or postponed during the peak 12 weeks of disruption due to COVID‐19 (2,367,050 operations per week). Most would be operations for benign disease (90.2%, 25,638,922/28,404,603). The overall 12‐week cancellation rate would be 72.3%. Globally, 81.7% (25,638,921/31,378,062) of benign surgery, 37.7% (2,324,069/6,162,311) of cancer surgery, and 25.4% (441,611/1,735,483) of elective Caesarean sections would be cancelled or postponed. If countries increase their normal surgical volume by 20% post‐pandemic, it would take a median 45 weeks to clear the backlog of operations resulting from COVID‐19 disruption. Conclusions A very large number of operations will be cancelled or postponed due to disruption caused by COVID‐19. Governments should mitigate against this major burden on patients by developing recovery plans and implementing strategies to safely restore surgical activity. This article is protected by copyright. All rights reserved.

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Author and article information

Contributors

Lars-Olof Hattenbach: hattenbach.LO@klilu.de , hattenbach@me.com

Journal

Journal ID (nlm-ta): Ophthalmologe

Journal ID (iso-abbrev): Ophthalmologe

Title: Der Ophthalmologe

Publisher: Springer Medizin (Heidelberg )

ISSN (Print): 0941-293X

ISSN (Electronic): 1433-0423

Publication date (Electronic): 4 June 2021

Pages: 1-10

Affiliations

[1 ]Commission for Cross-Sectoral Ophthalmology of the DOG (German Ophthalmological Society e. V.) and BVA (Professional Association of German Ophthalmologists), Munich/Düsseldorf, Germany

[2 ]Eye Clinic, Ludwigshafen Hospital, Bremserstr. 79, 67063 Ludwigshafen, Germany

[3 ]Ophthalmology practice, Dr. Peter Heinz, Schlüsselfeld, Germany

[4 ]GRID grid.411984.1, ISNI 0000 0001 0482 5331, Eye Clinic, , University Hospital Göttingen, ; Göttingen, Germany

[5 ]GRID grid.411088.4, ISNI 0000 0004 0578 8220, Eye Clinic, , University Hospital Frankfurt/Main, ; Frankfurt/Main, Germany

[6 ]GRID grid.5252.0, ISNI 0000 0004 1936 973X, Eye Clinic, , Ludwig Maximilian University Munich, ; Munich, Germany

[7 ]ReVis Eye Clinic Aschaffenburg, Aschaffenburg, Germany

[8 ]Aurich Ophthalmological Care Center, Aurich, Germany

[9 ]University Eye Hospital Münster, Münster, Germany

[10 ]GRID grid.7708.8, ISNI 0000 0000 9428 7911, Department of Ophthalmology, , University Hospital Freiburg, ; Freiburg, Germany

Article

Publisher ID: 1411

DOI: 10.1007/s00347-021-01411-7

PMC ID: 8176275

PubMed ID: 34086070

SO-VID: 3f95ac21-820c-4776-a253-d1598eb3515b

License:

This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

Impact of the SARS-CoV-2 pandemic on ophthalmic care in Germany Translated title: Auswirkungen der SARS-CoV-2-Pandemie auf die ophthalmologische Versorgung in Deutschland

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Abstract

Background

Methods

Results

Conclusion

Translated abstract

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Novel Coronavirus Disease COVID-19

Most cited references 38

Clinical Characteristics of Coronavirus Disease 2019 in China

Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility

Elective surgery cancellations due to the COVID ‐19 pandemic: global predictive modelling to inform surgical recovery plans

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