Update April 7, 2020
“Hanging in there.” It’s what we’re all saying these days when asked, “How are you?”
So far, I personally know five people infected with the novel coronavirus. One is a former co-worker. One is a fellow veterinarian who, out of the goodness of her heart, allowed a client to be present during euthanasia of her pet, despite a strict social distancing policy at her hospital. Three are my clients, one of which needed her cat seen for a descemetocele. I was happy to help this cat, even though she is in a household with a COVID-positive human. Never would I have thought that I would gown up to see a cat out of precaution for a human virus.
This is real.
We all face the dilemma of economic stability versus adherence to self-isolation. There are no easy answers. I choose to do what’s best at my hospital so I can sleep (better) at night. I may worry about money when I fall asleep, but if my staff or family became infected due to my own negligence, I would have nightmares.
I am hopeful that the promises of the Paycheck Protection Program will bolster us in the short-term. I’ve been pleased with my credit card companies and our veterinary vendors for deferring payments and waiving fees: in some cases, for several months. I’m also glad to defer my federal student loans, the bane of a millennial veterinarian’s budget! If you’re facing financial turmoil, please reach out to your colleagues and your financial advisors to help: you’re not the only one struggling.
A few recommendations have been questioned since my first update with you. Wearing masks when interacting with the public is encouraged, if only to prevent asymptomatic carriers from spreading the virus. It may also make sense to wear them among your co-workers. But it is not a substitute for basic infectious disease control: social distancing and quality hand-washing. Also, accelerated hydrogen peroxide comes in many different formulations, and while it’s a relatively safe compound, use your clinical judgement with products not approved for application directly to an animal.
I worry about the increase in reports of animals infected with COVID-19. It’s still seemingly rare, but will we face something like the dog flu epidemic again? I hope nothing comes of it. Cats certainly have too many respiratory afflictions as it is!
Be safe, be well, and remember to wash your hands.
Amanda Perkins, DVM
Update March 24, 2020
A Message from Your LVMA President
‘We, the Board of Directors of the LVMA, have been discussing your concerns with the COVID-19 pandemic as Louisiana veterinarians. I have also been talking to Dr. Mike Strain, our Commissioner of the Department of Agriculture and Forestry. As more coherent guidelines and mandates have come to light, we will do our absolute best to help you during these uncertain times, knowing that the recommendations could all change tomorrow.
Firstly, please follow the leadership of your local, state, and federal government. There are legal implications of following orders based on the advice of public health officials. Also, we recommend the guidelines set forth by the AVMA and the CDC.
Secondly, do not make rash decisions out of fear. The population of China is starting to see no new cases due to successful enactment of strict regulations with social distancing after a few months. There is a light at the end of this tunnel.
We need to watch the Families First Coronavirus Response Act, an emergency federal legislation that requires up to 12 weeks of paid leave under some circumstances to employees. We do not yet know of any exemptions for businesses under 50 employees. This is changing on a daily basis. As of now, I do not recommend staff changes based solely on this pending legislation. Again, do not act with haste.
Small Business Administration loans and grants may be available to us as well. As a business owner, payroll is my biggest priority. Do what you can to protect your employees.
Keep your business open, if you are willing and able. If you choose to close your business, that is also acceptable. The World Organization for Animal Health and the World Veterinary Association advocate for the specific activities of Veterinary Services to be considered as essential businesses. We have a key role in disease prevention and management, including those transmissible to humans, and to ensure food safety for the populations.
Governor Edwards has specifically advised people that they may bring their pet to the veterinarian if necessary. There is an expectation for us to be available.
However, we have the responsibility to safeguard our health, the health of those we work with, and our clients’ health. Hence, we must ensure that appropriate levels of biosecurity are implemented, that our personnel are protected with the necessary equipment, and that animal owners are informed of precautionary measures in place. It is the responsibility of each individual to ensure that appropriate behaviors are respected in the framework of these activities, to avoid further spread of COVID-19.
The following information for clinic guidelines is adapted from a recent online presentation by Scott Weese, DVM, DVSc, DACVIM (LAIM) at the Ontario Veterinary College.
The risk of transmission from the average client to you or your staff is low. However, ask your clients to stay home if they are ill with respiratory disease. Their pets should also stay home. Although there is no evidence of pet-to-person transmission, minimize the risk. If a potentially exposed pet must be treated, you may minimize fomite transmission by wiping the pet with an accelerated hydrogen peroxide wipe, bathing, or using an antimicrobial mousse. Staff should wear PPE (gloves, face shield) during decontamination and wash their hands up to their elbows afterward. Avoid exposure to aerosol from the pet (dog panting, dental procedures). Animals belonging to infected owners may need to board at your facility in isolation wards, and this is totally feasible with routine infectious disease control.
Although SARS-CoV-2 PCR testing is available for animals, there is little indication for it at this time. If there is “reason” to test, there is reason to assume the animal is infectious and to treat it as such, regardless of any test result. Also, please remember that canine and feline coronaviruses, as well as human “common cold” coronaviruses, are NOT the same as SARS-CoV-2 and do not grant anyone immunity to the novel virus. This must be explained to your clients as well.
Many clinics are strictly using curbside service. Less busy clinics may be allowing clients inside but directing immediately into an exam room and communicating via phone (this is what I am doing as a very low-traffic cat-only clinic). Some are limiting hours to keep staff at home. Some are dividing teams to work on certain days in case an employee affected with COVID-19 necessitates that an entire team self-quarantine for 14 days.
Do whatever you can to protect yourself and your staff and to limit the spread of this virus. Reach out to your colleagues to see what others are doing and if it makes sense for you. Again, there is no mandatory protocol. Be prudent, practical, and take this seriously. Ensure your staff is practicing social distancing outside of work.
Use PPE wisely due to the shortage of face masks and gloves on the human side. As an alternative to sterile surgical gloves, you may don high quality exam gloves and use Avagard or a similar antimicrobial agent to safely perform sterile procedures. Reuse face masks, as long as they are intact. Do not attempt to autoclave or otherwise sterilize these items, as you may compromise their integrity.
No one has to be wearing face masks all day: this is uncomfortable and does not adequately protect people from contracting viruses (that requires eye protection as well), although it may prevent face touching. If someone is sick and wants to wear a mask to protect others, then they need to be at home. The same goes for exam gloves: if they are kept on all day, they must be disinfected as often as one would wash or sanitize their hands, so it may be best just to do frequent hand-washing. Make sure you and your staff are trained on properly removing PPE as well. The CDC has excellent graphics for training.
Always wash hands properly or use hand sanitizer properly after any and all contact with people and pets.
Coronavirus is easily killed by common disinfectants and by desiccation in the environment. Accelerated hydrogen peroxide is a good choice.
All clinics should be limiting their services to what is immediately and urgently needed. If you have valid, established veterinarian-client-patient relationships, then you may use telemedicine via phone, text, email, or video calls to diagnose and treat a patient remotely, within the context of the state license(s) you hold. Remember: you cannot establish a VCPR via telemedicine. Encourage clients to use your branded online pharmacies, or even offer your staff to drop off medications and food to self-isolating clients, if this is within your comfort zone with liability. Have owners pre-order and pre-pay for items for easy curbside service.
Vaccination is an important part of our public health duty. However, decide which of your patients need vaccination today versus who can wait. For example, our puppies need their parvo boosters. But an indoor-only cat with eight rabies vaccinations in her lifetime can probably wait a few months.
Use electronic payments only, such as credit card numbers over the phone. Limit the need for signatures or aggressively disinfect pens (or ask the client to use their own pen). Create online forms (like Google Forms) for owners to provide history so there is no need for exchange of paper.
I hope this practical insight is helpful to you. Please don’t hesitate to reach out to our office with any questions or concerns. Other excellent resources for specific public health questions include Drs. Brent Robbins (225) 925-3980 and Gary Balsamo (504) 568-8315, our state veterinarians.
Be kind and wash your hands,
Amanda Perkins, DVM