Common questions about coronavirus

Information for members about Novel Coronavirus (COVID-19). Updated 27 March 2020

Coronavirus

These FAQs are designed to address the most common questions that the AOP has received around COVID-19. It is not an exhaustive list, but we will be reviewing and updating them as new information becomes available.

1. Should I be wearing a face mask or personal protective equipment (PPE)?

On the 26 March 2020 the Royal College of Ophthalmologists updated their advice to ophthalmologists on PPE.

They now recommend that clinicians should wear standard surgical masks when examining or treating patients at the slit lamp.  Gowns and gloves are not recommended. 

They also recommend that plastic breath shields attached to slit lamps provide some protection, but must be disinfected between patients as studies show that the COVID-19 virus is viable for up to 72 hours on plastic surfaces.

There is a further recommendation that ophthalmologists should avoid speaking at the slit lamp. This means that you should explain at a safe distance that you will point to where you would like the patient to look during slit lamp examination. 

2. Where do I get PPE? Can I access the NHS supply chain?

There is a shortage of PPE on a national level and it is important that those with the greatest need, ie, those treating patients with active disease are prioritised. There are a number of modified breath shields being made. 

A video showing how you can make one can be found at: Making a slit lamp protector.

If members choose to see patients without access to PPE, they should take all practical steps to minimise time spent in close proximity while still delivering suitable patient care. The AOP in conjunction with other sector bodies are raising the issue of PPE with the NHS and government as a matter of urgency.

3. Can I refuse to see patients who are ill or are returning from a high risk area?

Yes. Optical practices should remain open to provide urgent and essential care.

Patients who are symptomatic are being advised to self isolate by the government. Therefore it is reasonable to refuse to see these patients until they have recovered and are no longer considered contagious. If their concern is potentially slight threatening they should be directed to contact the hospital for advice.

4. I'm pregnant. Am I or my baby at greater risk?

The government has advised that pregnant women are in the at risk category and within days will be asked to stay at home for 12 weeks.

For the latest guidance from The Royal College of Obstetricians and Gynaecologists, see: Coronavirus (COVID-19) Infection in Pregnancy

5. Should I close the practice/should we be seeing any patients?

The Welsh, Scottish and Northern Ireland governments have all issued advice on the care that optical practices should continue to provide during the COVID-19 crisis. NHS England has yet to provide guidance on this but is expected to do so very soon.

On 23 March the College of Optometrists, OFNC and the UK optical bodies all issued statements advising optical practices to stop providing routine sight tests and care in the current circumstances. Optical practices should only remain open to provide urgent and essential care. 

Our current view is that:

Urgent or emergency care would include urgent clinical advice or intervention e.g. for red eye, contact lens discomfort, foreign object, sudden change in vision, flashes and floaters which might suggest detachment etc. 

Scottish Government guidance for practices in Scotland states that as is already the case, it is up to the professional judgement of an optometrist or ophthalmic medical practitioner to determine whether or not the circumstances in which a patient presents constitutes an emergency. Professional guidance already exists to help practitioners in this regard, such as the College of Optometrists Guidance for Professional Practice

Essential eye care would include appointments for patients who would not normally be considered to be emergencies, but where, in the practitioner’s professional judgement, a delay in an examination may be detrimental to a patient’s sight or wellbeing.

This definition is from the Scottish Government guidance for practices in Scotland. Optometry Scotland takes the view that a sight test is highly unlikely to meet the definition of essential care. In other parts of the UK, practices may consider a sight test as essential care if for instance a key worker needs a sight test and new spectacle prescription in order to continue to work. Other examples of essential care could include a visually impaired person or child who needs eye care where a delay in care may be detrimental. 


6. I've seen reports that viral conjunctivitis is a presenting symptom. Is that correct?

Viral conjunctivitis does not currently form part of the case definition for COVID-19. However, as with any upper respiratory tract infection patients may develop viral conjunctivitis as a secondary complication of COVID-19. Based upon current information, while it is possible to acquire COVID-19 from the aerosolised tears of someone infected, it is unlikely that someone will present with viral conjunctivitis secondary to COVID-19 without the common symptoms. If the patient has cold, flu or any upper respiratory tract symptoms they should be self-isolating and should not be seen in optometric practice. 

7. Is my employer liable if I catch coronavirus?

Employers have an obligation to take reasonable steps to ensure staff are safe. As long as they do this they would not be liable. In this instance, that would be checking patients do not have symptoms of coronavirus infection. Practices should be asking screening questions when the patient books and reiterating them at any reminder calls. If patients are asymptomatic there is currently no reason not to see them.          

External advice on employment matters can be found on the ACAS site - see Coronavirus (COVID-19): advice for employers and employees

8. Am I liable if I give a patient coronavirus?

If you do not self isolate when required to do so and knowingly place patients at risk, then potentially. However if you were asymptomatic yet contagious, it is unlikely that you would be held responsible.

9. Can I refuse to see patients who are at a high risk of having coronavirus after being around people who have been diagnosed?

Patients without symptoms can be seen. However, if they have been in contact with someone with a confirmed case, it is our advice that they should wait seven days since that contact before attending for a routine appointment.

10. Should we refuse to see at risk groups such as the over 70s for routine appointments?

The Welsh, Scottish and Northern Ireland governments have all issued advice on this as has OFNC for England. NHS England has yet to provide guidance on this but is expected to do so very soon.
 
On 23 March the College of Optometrists, OFNC and the UK optical bodies all issued statements advising optical practices to stop providing routine sight tests and care in the current circumstances. Optical practices should only remain open to provide essential and urgent services.

11. Can I claim a for a home visit (GOS 6) and see the patient at home if they are self-isolating?

Currently well but self-isolating patients would not be a reason for a GOS 6 to be used. The patient should be advised to book an appointment at a later date, or if they need spectacles a telephone consultation may be suitable.

12. Can I supply glasses or contact lenses by post to patients who can’t attend the practice due to risk factors associated with coronavirus?

The GOC has published a statement about this: see General Optical Council (GOC) statement on supply of spectacles and contact lenses during COVID-19 emergency.

They make it clear that as long as it is in the best interests of the patient that you can provide contact lenses or spectacles to an expired specification or prescription.

The AOP has worked with other sector bodies to develop interactive forms for this process, to minimise risk to patients. See: Telephone-based consultancy for replacement glasses and contact lenses - guidance and templates.

13. What do I do if a patient needs referral?

Given the current pressures on secondary care due to coronavirus, it is our view that routine referrals should now be advised that here may be a significant wait to be seen. To avoid patients being lost it may be appropriate to follow up the patient on a shorter recall before referring them. This would only be appropriate for routine referrals, where the risk to the patient is low. 

14. Should I close my practice? What if there is a lockdown?

The Welsh, Scottish and Northern Ireland governments have all issued advice on this as has OFNC for England. NHS England has yet to provide guidance on this but is expected to do so very soon.
 
On 23 March the College of Optometrists, OFNC and the UK optical bodies all issued statements advising optical practices to stop providing routine sight tests and care in the current circumstances. Optical practices should only remain open to provide essential and urgent services.

15. Are optometrists key workers?

In our view all essential optical staff involved in offering urgent and essential care will meet the Government definition of a key worker for the purpose of access to schools and transport. ABDO has published an ‘essential workers’ template letter for optical practices to help their staff demonstrate this to schools. Key workers should only place children in school where absolutely necessary at this time.

16. I have been informed that my practice insurance does not cover business interruption due to coronavirus (COVID-19). Could that be correct?

Yes. As outlined on the Association of British Insurers’ website, almost all practice insurance policies in the market will not have made provisions for this unprecedented COVID-19 outbreak. This principle applies to the Lloyd & Whyte policy for optical practices. 
 
We understand it is unlikely that the government would classify COVID-19 in a way that would force insurance companies to pay claims when the terms of the policy have not been met. But, in light of the unprecedented level of strain the situation is having on businesses, the government has announced that it is reviewing other funding solutions to support small to medium sized businesses as a priority. The AOP team will continue to provide guidance for members as soon as the government announces any updates.

Updated 27 March 2020