key: cord-280518-2tl0mtb8 authors: Xia, Jianhua; Tong, Jianping; Liu, Mengyun; Shen, Ye; Guo, Dongyu title: Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS‐CoV‐2 infection date: 2020-03-12 journal: J Med Virol DOI: 10.1002/jmv.25725 sha: doc_id: 280518 cord_uid: 2tl0mtb8 OBJECTIVE: This study aimed to assess the presence of novel coronavirus in tears and conjunctival secretions of SARS–CoV‐2‐infected patients. METHODS: A prospective interventional case series study was performed, and 30 confirmed novel coronavirus pneumonia (NCP) patients were selected at the First Affiliated Hospital of Zhejiang University from 26 January 2020 to 9 February 2020. At an interval of 2 to 3 days, tear and conjunctival secretions were collected twice with disposable sampling swabs for reverse‐transcription polymerase chain reaction (RT‐PCR) assay. RESULTS: Twenty‐one common‐type and nine severe‐type NCP patients were enrolled. Two samples of tear and conjunctival secretions were obtained from the only one patient with conjunctivitis yielded positive RT‐PCR results. Fifty‐eight samples from other patents were all negative. CONCLUSION: We speculate that SARS‐CoV‐2 may be detected in the tears and conjunctival secretions in NCP patients with conjunctivitis. In December 2019, 41 cases of unexplained pneumonia were clustered in Wuhan, Hubei Province, China. Most of the infected people were confirmed to be related to the South China Seafood Market. On 7 January 2020, the Chinese Center for Disease Control and Prevention isolated and confirmed this pathogen as a novel type of coronavirus through a throat swab. This coronavirus was then named 2019-nCoV by the World Health Organization (WHO). 1 The origin of the virus remains unknown, and the virus-host is suspected to be a species of bat. 2 On 25 January 2020, the WHO confirmed that the virus was spread via human-to-human transmission and family-aggregated infections and is less contagious to healthcare professionals, unlike severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome-related coronavirus. 3 On 31 January 2020, the WHO characterized the outbreak as a public health emergency of international concern. 4 At the close of day (on 18 February 2020 at 24:00:00), the cumulative number of infected people worldwide was 73 332, and the cumulative number of infected people in China was 72 528. The virus had spread to 25 other countries globally, with 1873 deaths worldwide. 5 At present, the mortality rate in China is about 2.58%, and the number of infected and dead people continues to increase. On 11 February 2020, the WHO officially named infection due to the virus as coronavirus disease 2019 (COVID- 19) 5 Study Group of the International Committee on Taxonomy of Viruses named 2019-nCoV severe acute respiratory syndrome-related coronavirus 2, or SARS-CoV-2. 6 At present, COVID-19 poses a huge threat to China and the world. COVID-19 is highly infectious and transmitted mainly through respiratory droplets and contact with infected persons. The possibility of feco-oral and aerosol transmission remains to be further studied. 7 In 2004, some researchers found that the tears of SARS patients tested positive for viral nucleic acid, some patients only showed positive results with tear samples, 8 and the chromosome of SARS-CoV-2 was 82% similar to that of SARS-CoV. 9 A previous study reported the case of a clinician who was infected while working with only his eyes unprotected. 10 Lu et al 11 reported that the disease can be transmitted through the mucous membranes, including the conjunctiva. There have been many case reports in which many ophthalmologists were found to be infected through routine diagnosis and treatment. 11 Considering that the virus is present in the body fluids of patients, tear fluid is a type of body fluid, and SARS-CoV-2 is similar to SARS-CoV, it is speculated that there may be a risk of tear and conjunctival transmission. Therefore, this is a focus of the current research to understand whether COVID-19 is transmitted via other routes and reduce further spread of the epidemic. In the present study, the tear and conjunctival secretions of A prospective interventional case series study was designed. We RT-PCR protocol: 1. The collected specimen was shaken for 30 seconds. We pipetted 1 to 2 mL of the specimen and stored it in an Eppendorf tube. 2. The tube was then centrifuged at 12 000 r/min for 5 minutes and 300 µL of the supernatant was pipetted and added to the prepared deep well plate. Then, we added 20 µL of proteinase K and 6 µL of settling agent to extract the nucleic acid. The extraction was completed after about 22 minutes. Then, the nucleic acid was stored in a new Eppendorf tube. Altogether, 21 patients with common-type and 9 patients with severe-type were included, with an average age of 54.50 ± 14.17 years and a male/female ratio of 7/3. By the time of first collection of tear and conjunctival secretions, the mean time of onset was 7.33 ± 3.82 days. The average body temperature of the patients was 37.09°C ± 0.69°C at the time of sampling. Details of the characteristics of the study participants are provided in Table 1 . Two conjunctival swab samples from the only one common-type patients with conjunctivitis (patient No. 21) yielded positive RT-PCR results and his sputum samples were also positive. Fifty-eight conjunctival swab samples from 20 common-type patients and 9 severe-type patients were all negative. Currently, it is difficult to screen for NCP. Some patients have no obvious fever or respiratory manifestations, or even obvious symptoms in the early stages of the disease. 13 During clinical diagnosis and treatment, particularly at the outpatient clinic, it is difficult to quickly screen patients with early-stage disease or carriers of the virus. According to recent reports, a large number of ophthalmologists involved in the diagnosis and treatment of the disease on a daily basis accidentally acquired NCP. Thus, many doctors suspect that it is related to contact with tears or conjunctival secretions of patients. 11 In the study of this small sample, we used conjunctival test paper to obtain tears and con- We speculate that SARS-CoV-2 may be detected in the tears and conjunctival secretions in NCP patients with conjunctivitis. Further high-volume studies are warranted to evaluate this issue. Outbreak of pneumonia of unknown etiology In Wuhan, China: the mystery and the miracle Origin and evolution of the 2019 novel coronavirus Novel coronavirus (2019-nCoV) situation report-3 Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). Geneva, Switzerland: World Health Organization Novel Coronavirus (2019-nCoV) Situation Report-29 Christening of new coronavirus and its disease name create confusion Office of State Administration of Traditional Chinese Medicine. Notice on the issuance of a programme for the diagnosis and treatment of novel coronavirus (2019-nCoV) infected pneumonia (trial The severe acute respiratory syndrome coronavirus in tears Genomic characterization of the 2019 novel human-pathogenic coronavirus isolated from a patient with atypical pneumonia after visiting Wuhan Peking University Hospital Wang Guangfa disclosed treatment status on Weibo and suspected infection without wearing goggles. Beijing News 2019-nCoV transmission through the ocular surface must not be ignored Office of State Administration of Traditional Chinese Medicine. Notice on the issuance of a programme for the diagnosis and treatment of novel coronavirus (2019-nCoV) infected pneumonia (trial Clinical features of patients infected with 2019 novel coronavirus in Wuhan Potential maternal and infant outcomes from (Wuhan) coronavirus 2019-nCoV infecting pregnant women: lessons from SARS, MERS, and other human coronavirus infections Infection control guidelines for optometrists 2016 Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study A meta-analysis to evaluate the effectiveness of real-time PCR for diagnosing novel coronavirus infections Tears and conjunctival scrapings for coronavirus in patients with SARS Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection The authors declare that there are no conflict of interests. JHX took part in sample collection. JT and ML took part in data collection and interpretation. YS and DG designed the study, analysis and interpretation of the data, and wrote the manuscript. http://orcid.org/0000-0003-2962-1161