In late July, Dr. Anthony Fauci, the nation’s top infectious disease expert, told ABC News that he thinks Americans should consider wearing goggles or a face shield in order to prevent spreading or catching the novel coronavirus, the cause of COVID-19.
“If you have goggles or an eye shield, you should use it,” Fauci said, adding that, at some point, this might become a concrete recommendation, like wearing a face mask, washing your hands frequently and practicing social distancing. At this point, goggles and eye or face shields are “not universally recommended,” he said, “but if you really want to be complete, you should probably use it if you can.”
The reason: The virus is primarily transmitted through mucosa, the watery mucus membranes that cover many parts of the body. “You have mucosa in the nose, mucosa in the mouth, but you also have mucosa in the eye,” said Fauci, the director of the National Institute of Allergy and Infectious Diseases. “Theoretically, you should protect all the mucosal surfaces. So, if you have goggles or an eye shield, you should use it.”
The mucus membrane in the eye is connected with the membranes of the nose, mouth and throat, according to Dr. Thomas Steinemann, a private practice ophthalmologist, professor of ophthalmology at MetroHealth Medical Center in Cleveland, Ohio, and a spokesperson for the American Academy of Ophthalmology. Most parents likely know this eye membrane well. It is called the conjunctiva, and when it is infected, the result is conjunctivitis — or pink eye, a fairly common childhood affliction.
Eye Infections and COVID
The reason eye protection is not currently universally recommended is in part because it is unclear just how readily the virus can infect the eye and, then, the rest of the body.
“The eye is really good at protecting itself,” says Dr. Lyndon Jones, director of the Centre for Ocular Research and Education at the University of Waterloo in Canada. “You have to really be unlucky to get an infection of the ocular surface from bacteria or a virus, and viral infections of the eye are extraordinarily rare. Even the most contagious viruses, like herpes, pose very low risk on the eye.”
Research has not yet been able to prove conclusively whether the novel coronavirus is one of the risky ones or not. “The first issue is, if it is able to bind to the ocular surface — and that is controversial. Some papers say there are receptors there, others are not able to show that,” Jones says. “So, there is some controversy whether it can bind to the ocular surface anyway.” Further, he says, only about 3% of all COVID-positive patients have had the virus isolated from the surface of the eye or in their tears. “My guess is, it will be lower than that if you add all the asymptomatic cases,” he says.
A second issue, Jones says, is that, even if the virus can bind to the eye surface, it needs to get to the nose and mouth and then on to the lungs. “That is a pretty circuitous path,” he says. “You can get it from the nose, breathed in — there is zero controversy there. But there is some controversy if goggles would provide protection.”
Jones admits that he and other experts in the field “were surprised when Fauci said this,” and pointed out that Fauci later clarified his position by saying that covering every orifice in your body is the only way to be 100% protected. That’s not practical, of course, so the question remains: Is eye protection a good idea?
Again, the research is limited. “The only paper I have seen that analyzed health care workers in COVID-19 hospital wards showed a 10% protective effect” from eye coverage, Jones says. “So, if you are in a place where people are sick, yes you should be protected. But it gives only a 10% protective effect.”
However, for daily living during the cornavirus pandemic — going to the grocery store, for example — the chance of coming across this virus in high-enough concentrations for the 15 minutes of contact time thought to be needed for infection is “extraordinarily low,” Jones says. “For evidence in normal life, I haven’t seen one paper yet showing that goggles would be protective. It could happen, but no one has showed it to be the case, as it is through (protecting) the nose and lungs.”
Based upon all evidence available at the moment, Jones says, the bottom line is protective eyewear may help in some high-risk situations, but research has not yet shown a need for it in normal life.
“If someone in your family has COVID or you are working in a hospital situation, I would recommend protective eyewear, though the risk is incredibly low,” he says. “That environment could have a higher level of coronavirus than you would like, and if I was that person, I would err on the side of caution. In normal life, the evidence is simply not there for wearing goggles. Just wear a mask, wash your hands often and don’t touch your face with unwashed hands. I don’t see how wearing goggles would reduce risk any more that that, based on the evidence we have at this time.”
One interesting caveat, Jones notes, is with teachers returning to classrooms. “That is going to be fascinating,” he says. Children, even asymptomatic kids, do transmit the virus. “So now it’s a public policy question of how many kids in a classroom and what that does to the environment of kids and teachers. We just don’t know, but will find out pretty soon.” He still believes that if teachers follow the mask-wearing, handwashing and face-touching rules, “I think those measures are sufficiently good enough to reduce risk.”
Still, if you want to be extra cautious, Jones recommends wearing goggles that fit tightly around the eyes, with no gaps. “Evidence from (the Centers for Disease Control and Prevention) data in high-contamination environments says spectacles do not provide the protection you need, because of the gaps on the sides. My sense is that it would be no better with a face shield. “If you truly wish to seal the eyes off, you have to have goggles.”
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