Low risk of SARS‐CoV‐2 transmission through the ocular surface

Deng, Chaohua; Yang, Yang; Chen, Huawen; Chen, Wei; Chen, Zhiqi; Ma, Ke; Wang, Junming

doi:10.1111/aos.14471

Cited by 16 publications

(11 citation statements)

References 5 publications

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“…For the ophthalmologist facing viral conjunctivitis-like patients without any systemic manifestation but high risk of being infected with SARS-CoV-2, it is reasonable if the tears specimen for PCR testing could be obtained in a repeated manner or in combination with the nasopharyngeal swab. Performing routine PCR testing for SARS-CoV-2 among patients with COVID-19 without ocular manifestation may yield a very low positivity rate, as previously reported by Deng et al 41 Eye protection and mask should be worn in managing patients with red eyes in daily clinical practice. A recent systematic review found that using eye protection or face mask, in addition to physical distancing and using respirators, could further reduce the risk of being infected by SARS-CoV-2.…”

Section: Discussionmentioning

confidence: 84%

“…Performing routine PCR testing for SARS-CoV-2 among patients with COVID-19 without ocular manifestation may yield a very low positivity rate, as previously reported by Deng et al . 41 Eye protection and mask should be worn in managing patients with red eyes in daily clinical practice. A recent systematic review found that using eye protection or face mask, in addition to physical distancing and using respirators, could further reduce the risk of being infected by SARS-CoV-2.…”

Section: Discussionmentioning

confidence: 99%

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Are eyes the windows to COVID-19? Systematic review and meta-analysis

et al. 2020

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ObjectiveTo review and critically appraise the ocular manifestation and the presence of SARS-CoV-2 through PCR positivity from ocular samples in COVID-19-related patients. Moreover, to evaluate the time and severity association of ocular manifestation to systemic disease of COVID-19.Methods and analysisA systematic literature search from PubMed, ScienceDirect and Google Scholar databases was performed using standardised Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Selected keywords were related to COVID-19, ocular manifestation and PCR testing of SARS-CoV-2. Studies were assessed for their validity, and the data were extracted by two independent reviewers. Observational, case series and case report studies were included if they met the selection criteria. Meta-analysis was performed to estimate the pooled prevalence of ocular manifestations and PCR positivity from tears.ResultsThirty-one articles were qualitatively reviewed, and 14 studies were included in the meta-analysis. The pooled prevalence of ocular manifestation among COVID-19-related patients was 0.05 (95% CI 0.02% to 0.08). The overall PCR from tears samples positivity rate from COVID-19-related patients presenting with ocular manifestation was 0.38 (95% CI 0.14% to 0.65). Ocular manifestation could precede systemic manifestation in about 0.28 (95% CI 0.05% to 0.58) of COVID-19-related patients with ocular manifestations. Besides, ocular manifestation was not associated with a severe form of COVID-19.ConclusionAlthough the overall number of ocular manifestation and SARS-CoV-2 PCR positivity rate from ocular samples was very low, around a quarter of COVID-19-related patients with ocular manifestation presented their ocular manifestation earlier than the systemic manifestation regardless of the severity. Interestingly, SARS-CoV-2 PCR was positive from one-third of ocular samples, which could potentially be the source of infection to the respiratory tract and the environment, although the infectivity is yet to be determined.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Are eyes the windows to COVID-19? Systematic review and meta-analysis

et al. 2020

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“…Several studies have demonstrated angiotensin-converting enzyme 2 (ACE2) expression in various tissues, including the lung, brain, and kidney. Although the ocular lens was reported as the target of the SARS-CoV-2 infection [ 31 ], whether the retina is also an infection target for SARS-CoV-2 remains unclear. To investigate whether the retina expresses endogenous ACE2 and is susceptible to SARS-CoV-2 infection, we first attempted to examine the ACE2 expression on human induced pluripotent stem cell (hiPSC)-derived retinal organoids and monolayer cultures derived from dissociated retinal organoids ( Figure 1 A).…”

Section: Resultsmentioning

confidence: 99%

Expression of Endogenous Angiotensin-Converting Enzyme 2 in Human Induced Pluripotent Stem Cell-Derived Retinal Organoids

Lai

Chou

Chien

et al. 2021

IJMS

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Angiotensin-converting enzyme 2 (ACE2) was identified as the main host cell receptor for the entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its subsequent infection. In some coronavirus disease 2019 (COVID-19) patients, it has been reported that the nervous tissues and the eyes were also affected. However, evidence supporting that the retina is a target tissue for SARS-CoV-2 infection is still lacking. This present study aimed to investigate whether ACE2 expression plays a role in human retinal neurons during SARS-CoV-2 infection. Human induced pluripotent stem cell (hiPSC)-derived retinal organoids and monolayer cultures derived from dissociated retinal organoids were generated. To validate the potential entry of SARS-CoV-2 infection in the retina, we showed that hiPSC-derived retinal organoids and monolayer cultures endogenously express ACE2 and transmembrane serine protease 2 (TMPRSS2) on the mRNA level. Immunofluorescence staining confirmed the protein expression of ACE2 and TMPRSS2 in retinal organoids and monolayer cultures. Furthermore, using the SARS-CoV-2 pseudovirus spike protein with GFP expression system, we found that retinal organoids and monolayer cultures can potentially be infected by the SARS-CoV-2 pseudovirus. Collectively, our findings highlighted the potential of iPSC-derived retinal organoids as the models for ACE2 receptor-based SARS-CoV-2 infection.

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“…Assuming a worst case human feco-oral infectious dose of 10 3 gc/person, this would necessitate that levels of infectious SARS-CoV-2 greater than 3.3 × 10 4 gc/l would be needed to cause concern. It should also be noted that while the eyes are often in contact with water during recreational activities, this route of SARS-CoV-2 entry into the body is thought to be minimal, particularly in comparison to ingestion of water and oral/nasopharanyx mucosal exposure(C. Bin (Deng et al, 2020).…”

Section: Amount and Persistence Of Sars-cov-2 In The Wider Environmentmentioning

confidence: 99%

Fecal Shedding of SARS-CoV-2 and Its Potential Role in Person-To-Person Transmission and the Environment-Based Spread of COVID-19

Jones¹,

Quintela-Baluja²,

Graham³

et al. 2020

Preprint

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The recent detection of SARS-CoV-2 RNA in feces has led to speculation that it can be transmitted via the fecal-oral/ocular route. This review aims to critically evaluate the incidence of gastrointestinal (GI) symptoms, the quantity and infectivity of SARS-CoV-2 in feces and urine, and whether these pose an infection risk in sanitary settings, sewage networks, wastewater treatment plants, and the wider environment (e.g. rivers, lakes and marine waters). Overall, severe GI dysfunction is only evident in a small number of COVID-19 cases, with 11 ± 2% exhibiting diarrhea and 12 ± 3% exhibiting vomiting and nausea. In addition to these cases, SARS-CoV-2 RNA can be detected in feces from some asymptomatic, mildly- and pre-symptomatic individuals. Fecal shedding of the virus peaks in the symptomatic period and can persist for several weeks, but with declining abundances in the post-symptomatic phase. SARS-CoV-2 RNA is occasionally detected in urine, but reports in fecal samples are more frequent. The abundance of the virus genetic material in both urine (ca. 102-105 gc/ml) and feces (ca. 102-107 gc/ml) is much lower than in nasopharyngeal fluids (ca. 105-1011 gc/ml). There is strong evidence of multiplication of SARS-CoV-2 in the GI tract and infectious virus has occasionally been recovered from both urine and stool samples. The level and infectious capability of SARS-CoV-2 in vomit remain unknown. In comparison to enteric viruses transmitted via the fecal-oral route (e.g. norovirus, adenovirus), the likelihood of SARS-CoV-2 being transmitted via feces or urine appears lower due to the lower relative amounts of virus present in feces/urine. The biggest risk of transmission will occur in clinical and care home settings where secondary handling of people and urine/fecal matter occurs. In addition, while SARS-CoV-2 RNA genetic material can be detected by in wastewater, this signal is greatly reduced by conventional treatment. Our analysis also suggests the likelihood of infection due to contact with sewage-contaminated water (e.g. swimming, surfing, angling) or food (e.g. salads, shellfish) is extremely low or negligible based on very low predicted abundances and limited environmental survival of SARS-CoV-2. These conclusions are corroborated by the fact that over eight million global cases of COVID-19 have occurred, but exposure to feces or wastewater has never been implicated as a transmission vector.

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Low risk of SARS‐CoV‐2 transmission through the ocular surface

Cited by 16 publications

References 5 publications

Are eyes the windows to COVID-19? Systematic review and meta-analysis

Are eyes the windows to COVID-19? Systematic review and meta-analysis

Expression of Endogenous Angiotensin-Converting Enzyme 2 in Human Induced Pluripotent Stem Cell-Derived Retinal Organoids

Fecal Shedding of SARS-CoV-2 and Its Potential Role in Person-To-Person Transmission and the Environment-Based Spread of COVID-19

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