Our experience as ophthalmologist working with COVID-19 patients’ health care

The health crisis caused by SARS-CoV-2 has led to social changes of enormous magnitude and as yet unknown consequences. This pandemic is causing considerable unrest in civil society and the health sector, largely because it is lasting longer than expected and the poor evidence about the effectiveness of the unpopular legislative measures imposed on the population for reducing the incidence of COVID-19 disease.

In this second stage of the pandemic, November 2020, some hospitals have collapsed to the same level (or even more) than when this public health problem began. Faced with this situation, which can be defined as a health catastrophe, the authorities have had to reorganize the healthcare model and it has been necessary to modify legal regulations in order to apply exceptional measures to health professionals, such as imposing the forced recruitment of specialist doctors to help their colleagues who are treating patients with COVID-19, which are the Internal Medicine, Pneumology and Intensive Care Units (ICU) services.

This forced recruitment of medical specialists could be questioned by some of us, with the argument that we lack the professional skills needed to care for patients with COVID-19.¹ Given this reasoning, we consider it important to recall the regulations of the Code of Medical Ethics (CDM),² Chapter II, General Principles:

Article 6

2.- The doctor will not abandon any patient who needs his/her care, even in situations of catastrophe or epidemic, unless obliged to do so by the competent authority or evidence of an imminent and unavoidable vital risk for his/her person. He/she will voluntarily present him/herself to collaborate in the tasks of health assistance.

In addition to the CDM regulations, there is legislation, at least in the Community of Castile and Leon,³ that empowers the health authorities to force the mobilisation of health professionals, as well as the possibility of cancelling vacation leaves, etc.

In this reorganization of healthcare activity, some ophthalmologists have collaborated in the care of patients with COVID-19 and we think it is appropriate to share this experience. The first thing is to comment that the change in the assistance routine generates vertigo and makes it essential to have a significant dose of humility to recognize that our specialty is very far from usual medical assistance. Thus, our first perception when starting this new work is to confirm our intuition that our knowledge is very circumscribed to the sense of vision and we hardly have knowledge to make global assessments of patients. However, the ophthalmologists who have participated in the care of patients with COVID-19 perceived it as an opportunity to grow personally and professionally.

Our work at the Hospital Universitario de Burgos in the so-called COVID-19 care groups has largely been that of qualified assistants with the willingness to take on tasks such as writing in the medical record what our colleagues in protective equipment dictated, informing relatives by phone, requesting analyses and tests as well as preparing developments in the computerized medical record. Despite being considered as administrative work, it can be done only by doctors, so it is a necessary task and our colleagues have thanked us for it. Also, it seems interesting to comment that after a few days of work, it is possible to acquire the competence to make the first clinical assessments of COVID-19 patients, and even to guide or at least suggest treatments.

It seems appropriate to present four important (and common) problems in public health that ophthalmologists are not familiar with:

To face the difficult situation that implies for the doctor not to have hospitalization beds (or in the ICU) and, therefore, the necessary professional (and ethical) commitment to select patients, either to discharge them from hospital, assuming certain risks, and thus be able to distribute limited health resources, or to have to decide which patients are admitted to the ICU.

The conflicts between different medical specialties to decide who has to assume the care of patients, serve as an example: patients with polymerase chain reaction (PCR)+ but without clinical COVID-19 being admitted to hospital for another pathology.

On many occasions, it is difficult to discharge hospital patients who are elderly and dependent, suffer from dementia or have multiple illnesses. There are families who are very reluctant to assume the discharge of these patients and demand they remain in hospital.

The difficulty of communicating bad news, even more so by phone. It is difficult to inform the relatives that a patient is in the terminal phase or has died, with the added difficulty that visits to patients are highly restricted in COVID-19 hospitalization plants.

Current clinical assistance involves working most of the time on the computer, with visits to patients with COVID-19 being quite short and less frequent. Also, we have been surprised by the great capacity of work of our colleagues without hardly considering the schedules, as well as the mutual help between colleagues to cover the assistance work. However, this new job also has pleasant aspects such as not having to make decisions or the cordial relationship with other medical colleagues that we hadn’t met before despite having worked for years in the same hospital.

As you can see, we have not mentioned the fears caused by providing medical care to patients with COVID-19 because the ophthalmologists of the Ophthalmology Dept. of the University Hospital of Burgos know that you are intelligent readers and we need not comment the obvious.

To conclude this editorial, we suggest our fellow ophthalmologists to regret less our burden of care and congratulate ourselves for having chosen this specialty. Our greatest wish and hope is to have, as soon as possible, an effective vaccine for COVID-19.