Coronavirus May Reproduce in Eyes for Weeks

By | May 8, 2020

Information about the SARS-CoV-2 virus continues to unfold. Since this virus has never been seen before, researchers are scrambling to understand the infection and mortality rates, how it spreads and how it can be treated.

Engineers from Johns Hopkins1 created an online digital database that gets updated every day with the number of confirmed cases, deaths and the total number of tests conducted for reporting countries. The mortality rate can be found by taking the total number of deaths and dividing by the total number of confirmed cases.

This has been the percentage of deaths reported in the news. However, the number is not accurate because states have not had the resources for mass COVID-19 testing.2 Most of those tested have also presented with symptoms, so it’s unknown how many may have had and recovered from COVID-19, but were unaware when they had mild or no symptoms of infection.

From late March to early April 2020, all pregnant women entering New York–Presbyterian Allen Hospital and Columbia University Irving Medical Center to deliver their babies were screened for SARS-CoV-2.3 The results revealed that 87.9% who tested positive had no symptoms.

Results from a separate round of testing4 at a homeless shelter in Boston showed that 36% tested positive but, of those, only 7.5% had a cough, 1.4% had shortness of breath and 0.7% had a fever. If the percentage of people in the general population who are infected without symptoms is just half of the 87.9% tested in New York, it significantly reduces the mortality rate, since it increases the number who will test positive.

This would mean that the published mortality rates are far from accurate, as most of the testing now is on people who have symptoms, which artificially elevates the rate and skews the statistics.

SARS-CoV-2 Found One Week After Infection Cleared

Researchers know most human-to-human transmission has been through respiratory droplets. However, other routes are still under investigation, including exposure to feces and blood.5 While some patients with COVID-19 present with conjunctivitis, data on viral replication in eye samples has been sparse.

During the SARS-CoV-1 pandemic, exposure to eye fluid was associated with an increased risk of transmission and infection. A new case study published in the journal Annals of Internal Medicine6 indicates that coronavirus may live in eye fluid long after the infection appears to have cleared.

Researchers used data gathered from a 65-year-old woman who had traveled from Wuhan, China, to Italy in late January and was the first confirmed case in Italy.7 She was admitted to the hospital six days after arriving in the country.

Doctors report that she had conjunctivitis on the day of admission to the Roman hospital, Lazzaro Spallanzani National Institute for Infectious Diseases.8 After the third day her eye was swabbed because the condition was not improving. Samples were collected almost daily after SARS-CoV-2 was detected in the fluid. The conjunctivitis appeared to have improved by Day 15 and resolved by Day 20.

The testing showed declining concentration of the virus through Day 21. By Day 22 the virus was not detectable. Yet, five days later it was again found in a sample from her eyes. The lab values suggest the virus continued replicating in the conjunctiva. Further testing revealed it was infectious and could represent a source for infecting others.

Conjunctivitis — One Symptom of COVID-19

Symptoms of conjunctivitis have “occasionally been reported”9 with COVID-19, in much the same way other types of coronaviruses are associated with conjunctivitis.10 However, it was not associated with SARS-CoV or MERS-CoV.

Viral conjunctivitis is extremely contagious and often self-limiting. The condition may develop after exposure to someone with an upper respiratory infection such as COVID-19, or it may develop after a virus spreads throughout the body along mucus membranes connecting the lungs, nose, throat and tear ducts.11

There is no treatment for viral conjunctivitis, which usually runs its course in two to three weeks. Antibiotics, ointments and drops are not effective, as the condition is caused by a virus rather than bacteria. Cold compresses and artificial tear solutions may help relieve the symptoms.

Speaking to a reporter from The Washington Post, infectious disease specialist W. David Hardy pointed out most people don’t always remember the connection between the nose and eyes.12

Symptoms of COVID-19 have included cough and shortness of breath.13 You should seek medical attention if you’re having trouble breathing or if you’re having persistent pain or pressure in your chest. If your lips or face are blue call 911. It’s also an emergency if someone has new confusion or if you’re unable to arouse them.

Recently, the Center for Disease Control and Prevention added six more conditions that may appear with SARS CoV-2.14 The symptoms of coughing and shortness of breath may appear within two to 14 days after having been exposed to the virus. The CDC said that people with these two symptoms or those who have at least two of the following may have COVID-19:15

Fever

Repeated shaking with chills

Chills

Muscle pain

Headache

Sore throat

New loss of taste or smell

What Is Conjunctivitis?

There is a thin layer of tissue lining the inner surface of the eyelid and the white part of the eyes. This is called the conjunctiva. When it becomes inflamed or swollen the condition is called conjunctivitis, which you may know as pink eye. It’s especially common in children but can happen in adults.16 Conjunctivitis can be caused by a virus, bacteria or chemical irritant and symptoms include:

  • A gritty feeling, itching or burning in the affected eye
  • Excessive tearing and discharge
  • Swollen eyelids
  • An increase in light sensitivity

The name “pink eye” comes from the final symptom, which is a pink discoloration in the affected eye, including the whites of the eye. Adults and children who have allergic reactions to pollen, smoke, chlorine or ingredients in cosmetics may also have symptoms of conjunctivitis after exposure.

Allergic conjunctivitis will happen more commonly if you suffer from seasonal allergies. The condition develops when the allergic protein contacts the eye. Chemical conjunctivitis may be triggered by exposure to noxious chemicals or airborne pollutants.

If you frequent chlorinated swimming pools, the chlorine can sometimes trigger chemical conjunctivitis. If you wear contact lenses, you need to temporarily stop wearing them and possibly switch to a different type of disinfection solution.

As conjunctivitis is highly contagious, it’s important to keep your hands away from your eyes since you can spread the infection to other people. Wash your hands thoroughly and frequently and change your towels daily. Throw out any eye makeup and never share eye makeup with others.

New Information Has Implications for Preventing the Spread

Several others have also found the SARS coronavirus can live in eye fluid. However, as Hardy noted, the area more frequently affected is the throat and lungs, where it can cause serious damage. Hardy told a reporter from The Washington Post:17

“The cells that are inside the eye are similar but not the same. When it gets into the eye, it doesn’t cause nearly the same amount of destruction as it does to cells in the respiratory system.

The whole message that is important here is that you don’t touch your face until you get home, wash your hands and make sure your hands are clean before touching your face. You have to be extra vigilant and assume that everything out there could’ve been contaminated with fresh covid virus.”

The findings also have implications for health care workers. While it’s not necessary for the general public to use face shields, Aaron Glatt, from Mount Sinai South Nassau and spokesperson for the Infectious Diseases Society of America, told The Washington Post these findings may affect public health procedures.

However, he also believes more research is needed to gauge how many others can retain the virus in their eye fluid. The information also highlights the importance of avoiding touching your eyes, nose and mouth, as well as frequently washing your hands using a good technique.18 Roman researchers concluded:19

“A related implication is the importance of appropriate use of personal protective equipment for ophthalmologists during clinical examination, because ocular mucosa may be not only a site of virus entry but also a source of contagion.

Furthermore, we observed that ocular involvement of SARS-CoV-2 may occur early in the COVID-19 course, suggesting that measures to prevent transmission via this route must be implemented as early as possible.”

Prevent the Spread of Viruses and Protect Your Health

One study indicated that proper hand-washing helped reduce the spread of respiratory illnesses in incoming Navy recruits by 45%, demonstrating the power of keeping your hands clean.20 Research has shown that diligently washing your hands helps stave off infections, including respiratory illnesses.

So, the best thing to do is to be sure to follow the CDC’s advice and make good hand-washing a regular practice. Compare your hand-washing habits to the recommended techniques in “The Impact of Effective Hand-Washing Against Infection.”

In the past months I’ve covered several strategies you can use to help prevent getting infected or spreading the virus to others, including social distancing and keeping your hands away from your face. The CDC now recommends wearing cloth masks in public to avoid infecting others in case you are unknowingly carrying the virus.21

Additional steps you can take to protect your health can be found on my Coronavirus Resource Page, including combatting the virus by supporting your immune system and addressing your vitamin D levels. You can also find information about increasing your vitamin C, quercetin and zinc levels to help recover from influenza and SARS-CoV-2.


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