Nurse Jackie Vargas puts on her N95 mask using a plastic food container while getting ready to assist a COVID-19 patient at St. Jude Medical Center in Fullerton, Calif., Tuesday, July 7, 2020. Vargas wears her glasses instead of contacts so she doesn't have to touch her eyes. She swaps her sneakers out for glittery black clogs so she doesn't have to handle shoelaces. She seals her N95 mask in a Tupperware-like container between patients so it's stored away from germs in the air. Credit: Jae C. Hong / AP

Jonathan Shenkin is a pediatric dentist in Augusta. He is a faculty member in Health Policy and Pediatric Dentistry at the Boston University School of Dental Medicine. Daniela Bacherini is a faculty member in Ophthalmology at the University of Florence, Italy.

Maine has been witnessing an acceleration in the number of new cases of COVID-19, yet we are still the state with the second lowest per capita number of infections in the U.S. This disparity between the low per capita number of COVID-19 infections in Maine and the increase in new cases creates an opportunity for change in how we reduce the risk of infection beyond a mask mandate. An unexplored public health intervention for the general public is the concept of wearing eye protection when in public spaces with high traffic, like a supermarket, or when face masks aren’t being worn, like in a restaurant.

While eye protection may seem far-fetched, it may be one of the reasons why there has not been a single reported case of COVID-19 transmission in a dental office between patients and dental staff in the world. Dentists and their clinical staff have been wearing eye protection for decades. That eye protection has traditionally been safety glasses, but now also includes face shields and goggles. In health care settings, eye protection is an important part of personal protective equipment (PPE) recommended for health care personnel who come into close and prolonged contact with patients infected with SARS-CoV-2.

Maine hospitals now require all employees, whether they are clinical or non-clinical employees, to wear eye protection when working near patients. The scientific basis for now requiring eye protection is based on the knowledge that coronaviruses can be transmitted from oral secretions from one person through the mucosa of the eye of another individual. Recent studies suggest that SARS-CoV-2 may cause conjunctivitis and nearly 1 percent to 12 percent of patients with COVID-19 have ocular manifestations. Furthermore, SARS-CoV-2 was detected in tears or the conjunctival sacs of patients with COVID-19. Therefore, the eyes are considered a potential transmission route for SARS-CoV-2.

A provocative study published earlier this year found that 30 percent of the population in a region of China is near-sighted and wears eyeglasses at all times, yet near-sighted individuals made up only 6 percent of cases of patients who had contracted COVID-19. A disproportionately small percentage of hospitalized patients with COVID-19 wore eyeglasses, and the authors hypothesized that eyeglasses prevent or discourage wearers from touching their eyes, thus avoiding transferring the virus from the hands to the eyes.

However, wearing eyeglasses could increase the risk of touching the eyes more frequently and potentially contaminating them when removing, replacing or adjusting the eye protection, especially if a person is not used to wearing them. Therefore, it is important to pay attention to preventive measures parallel to the use of glasses, such as frequent hand washing and avoiding touching the eyes.

The current mandate to wear a face mask in Maine is based on the knowledge that a mask has two modes of protection. It protects the person who is wearing the mask, but also potentially protects the person who is near a masked infected individual. As we know, masks are not perfect in preventing infection with SARS-CoV-2, and protecting the eye from the virus could be a missing link in a more comprehensive approach to reducing the public’s risk for infection. As winter approaches and Mainers retreat to the warmth of the indoors, we need to implement greater personal protection against viral transmission.

Protective eyewear may be an added layer of defense for frontline workers in a variety of non-healthcare industries who are in direct contact with the general public. It may also be a suitable suggestion for high-risk populations or the elderly. If Maine hospitals feel it is in their employee’s best interest to be wearing eye protection when interacting with the public, why would this not benefit a supermarket employee stocking shelves or a waiter, or your grandmother?

Maine has an opportunity to maintain one of the lowest rates of infection in the U.S., but this will require us to be prudent and to follow the best available science. Maine could lead the nation by adding another recommendation to our arsenal: protect your eyes.