If you decide to stay open, the following would be reasonable things to do.
- Significantly increase sanitation efforts in the office, which everyone has likely already done. Disinfect after all encounters.
- You are taking precautions, make your customers/patients do the same. Nothing wrong with screening their temperature before entering your facility and certainly nothing wrong with making them wash their hands upon entry. Handwashing is very effective and you are likely to eventually run out of sanitizers without rationed use.
- Triage better – make sure you are asking the patient why they need to come in to determine the element of “essential”.
- Do not let sick people in your office – period. If they are sick and have a serious enough ocular emergency that they must be seen, send them to the hospital. Too many are trying to play emergency room. We are not equipped to deal with high risk individuals – period.
- Deliver glasses and contact lenses to their cars or offer to mail them. Adjusting glasses doesn’t seem essential and poses a high contact situation.
- Limit your schedule – try to keep to a minimal the number of patients in the office for professional care at one time. I heard one recommendation of one patient an hour – exam and whatever optical needs can be easily managed in that time frame. Likely you can do more.
- Ask patients to not bring family and friends with them to the office. Limit scheduling of more than one member of a family at the same time.
- Have people wait outside – call them in through their cell phones like restaurants do when your table is ready.
- Other than the elements of care that do not allow it, practice social distancing. This also includes things like not talking to patients behind the slit lamp, overall limiting the amount of discussions to essential elements.
- Glove up – transmission is predominately fomite. Gloves are likely far more effective in limiting transmission than masks. Gloves are likely in shortage from traditional sources – look in hardware stores.
- Don’t worry so much about contact lenses right now. Extend Rxs generously.
- If glasses are needed have opticians limit number of try ons – don’t let people roam the optical and handle everything. Have patient select only the ones they are REALLY interested in because you need to clean all the ones they try on. And a point – glasses can certainly be essential for people or lose them or whatever and cannot function without them.
- Consider limiting hours of operation and reducing number of staff in the office at the same time – NOT with a goal of cramming more patients into a tighter schedule but to enhance social distancing.
- Alternate staff “teams”. This decreases everyone’s hours but also decreases exposure potentials.
- Give people the choice. You can tell them your office has gone over and above recommended precautions and if people want to be seen it’s their choice. People who are assuring patients they are taking all reasonable precautions are finding a good number of people want to be seen. Anyone that shows up can be screened. Simply seeing if they have a fever is an effective screening metric. We know they have the virus and CAN spread it before onset of fever or any symptoms, but the risk of transmission is way higher once signs and symptoms set in.
- Do consider significantly limiting care to at risk populations…which is definitely anyone over 80 and somewhat anyone over 60.
- While you’re at it, screen your staff every day.
