dvm360's Chief Veterinary Officer Adam Christman, DVM, MBA, continues his 

 with Beth Davidow, DVM, DACVECC, and Scott Weese, DVM, DVSc, DACVIM, about the what the COVID-19 pandemic means for the veterinary profession now and in the future.

Dr. Davidow, clinical assistant professor of emergency and critical care at Washington State University College of Veterinary Medicine, and Dr. Weese, professor of internal medicine, zoonotic disease, public health and microbiology at the University of Guelph Ontario Veterinary College, share their insight on these important topics: 

How the pandemic has made telemedicine mainstream (

What you may not know about how—and when—you should be washing your hands (

go right to minute 4:17 for a story that really pushes home why it's vital

hit minute 16:03 to learn what we know right now

The many reasons why veterinary medicine is essential (

Elective vs nonelective veterinary procedures (

to learn the difference, listen in at minute 8:10

To listen in on their whole conversation—or just bits and pieces—click on the video below.

Videos

More on the essential work veterinary practices are doing right now and the key role they play in slowing the spread of the virus.

COVID-19: How veterinary practices can help flatten the curve

We all know the story: A dog walks into a bar—ahem—your veterinary practice, and says, “I’m itchy.” You see patchy hair loss and excoriated skin and know that the possibilities are endless. But one rake with a flea comb yields an immediate diagnosis and the news is delivered.

This initial flea diagnosis is where you, super-vet, must sound the alarm. What I tell owners is that in the event of a nuclear war the only survivors will be horseshoe crabs, cockroaches and, you guessed it, fleas! I’m joking, of course, but I want my clients to take the problem seriously because if they don’t act quickly, aggressively and with painstaking rigor, they will be combatting these hardy invaders for a long time. But sometimes clients just don’t get the message the first time around.

and the owner is back in your office because the fleas won’t go away, or the owner “got rid of them and now they are back.” Get real with your client by reviewing with them these facts:

The adult fleas you see on your cat or dog—

 but these buggers are just the tip of the iceberg.

Each female flea lays 10 to 50 eggs a day,

 with a lifetime total of up to several thousand. Fleas reproduce following a blood meal, with a new generation of fleas emerging every few weeks.

The length of flea life stages varies depending on environmental conditions: eggs (3-21 days), larvae (1-2 weeks), pupae (1-3 weeks to one year) and adults (2-7 months).

Your pet’s fleas never really went away. The “new” infestation is likely another generation of the original batch, still thriving because the life cycle was never broken.

You cannot break the flea life cycle without chemicals. Natural remedies (e.g. garlic, coconut oil, borax) won’t put a stop to it.

With rare exception, if one pet in the household has fleas,

 pet has fleas. Surprised because your other pet(s) are not manifesting flea allergy dermatitis and/or pruritus? Don’t be! Flea infestations in some pets are clinically silent.

If your pet has fleas, your home and likely your yard are also infested.

Leaving an infested environment, like a vacation home, does not necessarily make the fleas die. Adult fleas can live for a few months without a food source, and pupae can survive for up to a year in a barren house; adults are triggered to emerge by vibrations, carbon dioxide and warmth.

After reviewing the principles that lay the groundwork for persistent flea infestations, I ask how the initial infestation was managed. Then, together, the client and I identify the smoking guns. The most common oversights are (1) failure treat 

I tell owners, “Let’s turn your pet into a walking exterminator.” By treating the animal immediately with an adulticide, the fleas currently on the pet and those that jump on when the pet goes home will die quickly, before they have a chance to lay eggs. I get an adulticide such as nitenpyram on board before the pet leaves my office, thereby killing any fleas that might leap onto the fur from the cat carrier or the car during the ride home, and bringing the pet immediate relief.

I advise the owner to bathe the pet well, manually removing adult fleas in the process. They can then begin, or resume, using an oral or spot-on insect growth regulator such as lufenuron, methoprene or pyriproxyfen. These must be given monthly—

—in order to dismantle the flea life cycle successfully. At a minimum, they should be continued for at least two months after the last flea is seen, and then ongoing depending on individual risk factors.

 must be treated, right down to the cracks between the floorboards, where flea eggs can drop and safely mature:

Mop floors, then rinse the infected mop immediately under running water so all fleas, larvae and/or eggs are washed down the drain.

Flea eggs, which are dry and fall from the pet’s coat, can sink deeply into carpet. So vacuum all carpets immediately and repeatedly. Put used vacuum bags into sealed bags, and dispose of them in an outdoor trashcan. Then wipe down the bottom of the vacuum cleaner and, for bagless machines, the canister itself with a cloth dampened with water or (even better) an insecticide solution.

Fabric can harbor any of the four flea life stages, particularly pupae, which cling well to fibers. Launder in hot water or dry clean all removable fabric in the home, from pet bedding to human bedding to furniture upholstery to curtains.

Treat hidden spots where fleas can multiply with abandon, such as corners and crevices, beneath furniture, and inside garages and sheds.

Treat your yard, particularly near the entrances to the home.

Vacuum/clean and treat all vehicles and transport devices (i.e. cat carrier) the pet has come in contact with, as fleas in these areas can re-infect treated pets.

Chemical treatment of the home and yard, I tell owners, is sometimes best left to professionals. For a stubborn flea problem, dial an exterminator. Owners wishing to do it DIY-style can use pyrethroid foggers and sprays in home and outdoor areas.

I explain to owners that if all goes according to plan, it will take a couple months to completely eradicate the flea infestation. More commonly, these diehards wax and wane over six to 12 months as adults die and eggs hatch. When my clients are in this position, I help them identify weak links in their flea management plan and assure them that once we revamp the plan the end really will be in sight.

1. Hsu M-H, Hsu T-C, Wu WJ. Distribution of cat fleas (Siphonaptera: Pulicidae) on the cat. 

2. Rinaldi L, Spera G, Musella V, et al. A survey of fleas on dogs in southern Italy.

3. Guzman RF. A survey of cats and dogs for fleas: with particular reference to their role as intermediate hosts of Dipylidium caninum. 

4. Little SE, Starkey LA. Conquering fleas: preventing infestations and limiting disease transmission. 

5. Bowman DD. Arthropods. In: Bowman DD, ed: 

, 9th ed. St. Louis: Saunders Elsevier; 2008:5-83.

Dr. Joan Capuzzi is a small animal veterinarian and journalist based in the Philadelphia area.

Articles

Fleas have a supersonic life cycle and fireball breeding power, but many veterinary clients don’t grasp the behemoth problems these arthropodal dynamos can create. That’s where you come in.

Coaching pet owners through unrelenting flea infestations 

The origin of the novel coronavirus (SARS-CoV-2), the causative agent of COVID-19 disease, is not yet completely understood. It is believed to have originated in bats. Given its zoonotic nature, questions have arisen about whether animals in close contact with humans can become infected with the virus.

Over the past month, there have been several reports of positive COVID-19 test results in animals that were in contact with COVID-19–positive human patients. The 

 reports of infected dogs came from Hong Kong in early and mid-March, respectively. Neither dog showed clinical signs associated with COVID-19. Questions about the implications of these positive test results remain unanswered.

Clinical signs that could be attributed to the virus, including vomiting, diarrhea and respiratory difficulty, were reported in a 

 reportedly tested positive for the virus at the end of March but did not show clinical signs. Most recently, a 

 that was sick with respiratory signs tested positive after exposure to an infected zookeeper. Six other tigers and lions in the zoo were reported to be showing respiratory signs as well but were not tested.

All infected animals have recovered or are recovering, except for the initial positive dog in Hong Kong. That dog, a Pomeranian, was 17 years old and had significant underlying health problems; no necropsy was performed to determine the precise cause of death.

 reported on March 13 that it had tested thousands of canine and feline samples for the virus using a proprietary SARS-CoV-2 (COVID-19) RealPCR test and 100% of the results were negative. WSAVA, the AVMA and the CDC have emphasized repeatedly that there is currently no evidence that pets can spread SARS-CoV-2 to humans.

A recent study performed at the Harbin Veterinary Research Institute (HVRI) of the Chinese Academy of Agricultural Sciences investigated the susceptibility of several domestic animal species to SARS-CoV-2 infection as well as transmission between members of these species. A 

, which has not yet been peer reviewed, was released on March 30.

Despite the lack of peer evaluation, the study does offer preliminary data that may help guide the direction of future research as veterinarians, physicians and scientists around the world work to understand the virus, develop treatments and vaccination, and gain control of the pandemic.

The investigators examined the behavior of the virus in ferrets, cats, dogs, pigs, ducks and chickens. Two strains of SARS-CoV-2 were used in the ferret experiments. The first was isolated from the Huanan Seafood Wholesale Market in Wuhan, and the other was isolated from a human patient in China. For all other species, the viral strain isolated from the human patient was used.

In a series of experiments, the authors investigated:

Viral replication after intranasal inoculation in ferrets (n = 10), cats (n = 6) and dogs (n = 5), and after intratracheal inoculation in ferrets (n = 8)

Transmission between cats. Subadult (8 months old, n = 3) and juvenile (70-100 days old, n = 3) cats were inoculated intranasally and housed individually. A naïve cat of similar age was housed next to each inoculated cat. There were no control pairs.

Susceptibility in pigs, chickens and ducks (n = 5 for all species)

Transmission in dogs, pigs, chickens and ducks. Five animals of each species were inoculated intranasally and group housed with naïve counterparts of the same species (dogs n = 2, other species n = 3). There were no control groups.

Nasal or oropharyngeal swabs, and fecal or rectal swabs were collected for analysis periodically during the experiments. These samples were evaluated for the presence of viral RNA using quantitative PCR as well as for infectious virus using virus titration in Vero E6 cells. Tissue samples were collected after euthanasia for evaluation of viral RNA, infectious virus and histopathology. Serum samples were evaluated by enzyme-linked immunosorbent assay for antibodies to SARS-CoV-2.

Ten ferrets were inoculated intranasally, and a subset (n = 4) was euthanized four days post inoculation for tissue sample collection. Both viral RNA and infectious virus were detected in tissues from the upper respiratory tract (nasal turbinate, soft palate and tonsils) of all ferrets. Viral RNA and infectious virus were not detected in any other tissues.

Nasal washes and rectal swabs were evaluated from the remaining ferrets (n = 6) every other day starting on day 2 and ending on day 10. Nasal washes from all ferrets showed the presence of both viral RNA and infectious virus 2 to 8 days after intranasal inoculation. Viral RNA, but not infectious virus, was present in the rectal swabs from some of these ferrets.

Two ferrets became symptomatic (fever and inappetence) 10 to 12 days post inoculation and were euthanized. Pathology was found in the lungs of both ferrets, but viral RNA was not found in the pulmonary tissue of either animal. Antibodies to SARS-CoV-2 were detected in all six ferrets at 13 days (n = 2) and 20 days (n = 4) after intranasal inoculation.

When eight ferrets were inoculated intratracheally with the virus, viral RNA was found only in tissues of the upper airways on days 2, 4 and 8 post inoculation. No viral RNA was detected in the tissue of ferrets euthanized on day 14.

Subadult cats (8 months old, n = 5) were inoculated intranasally. Two cats were euthanized on day 6. Viral RNA and infectious virus were found in the nasal turbinates, soft palate and tonsils of both cats. The trachea of one cat contained both viral RNA and infectious virus, while the small intestine of the other cat contained viral RNA only.

The remaining three cats were each housed individually and placed next to uninfected cats to study the potential for cat-to-cat transmission. Fecal samples were collected from all cats during the study because nasal washes were not possible. Viral RNA was detected in the feces of all infected cats by day 5 post inoculation and in one exposed cat on day 3 post inoculation.

After euthanasia, viral RNA was detected on the soft palate and tonsils of all three inoculated cats and the soft palate, tonsils, nasal turbinates and trachea of the exposed cat. Antibodies were detected in the serum of the three inoculated cats and the exposed cat. Neither viral RNA nor antibodies were detected in the remaining two exposed cats.

Beagles (3 months old, n = 5), specific-pathogen-free (SPF) Landrace and Large White pigs (n = 5, 40 days old), SPF White Leghorn chickens (4 weeks old, n = 5), and SPF Shaoxin ducks (4 weeks old, n = 5) were inoculated intranasally. Each inoculated group of animals was housed with naïve counterparts (dogs n = 2, livestock n = 3) to evaluate for transmission.

Viral RNA was detected on rectal swabs of three of the inoculated dogs, but no infectious virus was found. Neither viral RNA nor infectious virus was detected in samples from the naïve dogs. Antibodies were present in two of the inoculated dogs and in neither of the naïve dogs.

In the pigs, chickens and ducks, no viral RNA, infectious virus or antibodies were detected in any of the experimental subjects.

Based on the study results, the authors formed the following conclusions:

Ferrets and cats appear highly susceptible to infection with the novel coronavirus.

SARS-CoV-2 can replicate in the upper respiratory tract of ferrets for up to 8 days.

Respiratory droplet transmission of the virus between cats is possible.

Dogs appear to have low susceptibility to the virus, and intraspecies transmission is not likely.

Pigs, ducks and chickens do not appear to be susceptible to the virus.

There is minimal discussion of the data presented for juvenile cats, making it difficult to draw conclusions, although the authors comment that they believe the virus replicates better in younger cats.

Caution should be taken when extrapolating the conclusions of this study to wider populations of domestic animals. The data represent small sample sizes for each species with infections occurring under experimental conditions. Inoculations were performed with high viral loads. Minimal information is provided on clinical signs in infected animals, which makes it impossible to draw conclusions on the progression or severity of disease in these animals. Finally, no control groups were used in the transmission studies. As noted previously, the manuscript is currently awaiting peer review.

Many questions remain as to the virus’ behavior in animals. What is the degree of clinical illness? Can transmission occur between members of the same species? Can infected animals transmit the virus to humans?

At this time, the CDC recommends that infected people limit contact with pets until more is understood about the virus. The results of this study, combined with recent reports of the virus in cats and a tiger, suggest that precautions may be especially important for infected cat owners. It is important to note that even though it appears that cats can become infected with the virus, there is no evidence that the virus can be transmitted from a domestic cat to a human.

Ultimately, more research is needed to understand the effects of SARS-CoV-2 on companion animals. The results of this study provide preliminary information regarding susceptibility that may direct further research to focus on the species that appear to be most susceptible to the virus: ferrets and cats. Additionally, the authors suggest that ferrets may serve as an appropriate experimental model for testing of antiviral drugs and vaccinations against the novel coronavirus.

Dr. Boatright, a 2013 graduate of the University of Pennsylvania, is an associate veterinarian, freelance speaker and author in western Pennsylvania. She is actively involved in the AVMA House of Delegates as well as her local and state veterinary medical associations. She is a former national officer of the Veterinary Business Management Association.

Nascent research from China details the potential for infection with SARS-CoV-2 in domestic animal species, including ferrets, cats and dogs, as well as some livestock.


Early study results show cats, ferrets susceptible to COVID-19

We all know that pet owners consider location when they’re looking for a new veterinarian—and you obviously aren’t likely to pick up and move your practice anytime soon. But there are other factors that you can control when looking to expand your client base.

 reveals that more than 80% of pet owners choose their veterinarian based on two primary factors. The first is their perception of you as caring, honest and trustworthy; and the second is recommendations from other pet owners (

). That means word-of-mouth recommendations are critical to growing your client base. 

And in today’s world, that doesn’t necessarily mean your favorite client is singing your praises at the neighborhood barbecue. Social media outlets amplify the power of your current advocates—and offer you opportunities to build relationships with potential new clients.

If you haven’t already, take these four steps to bump your practice’s word-of-mouth power:

 It’s free, and it takes only a few minutes. When you complete this step, more information about your business is available any time local pet owners search online.

Ask your most satisfied client each week to post a review of your practice.

 The first step a pet owner might take is a Google search, and with a little prep on your part, they could find your practice location, hours and positive reviews front and center.

Add social media requests to your outreach efforts.

 A note asking clients to follow you on Facebook or inviting them to engage on some other platform is a low-cost, low-effort way to remind them that your practice is using social media, offers solutions there and wants to build a relationship.

 Give clients an easy way to tell you what they love about you, and also if you fell short in some way. You need to know what clients 

 think. If there’s a problem, that needs to be shared with the team. Send surveys, offer feedback forms on your site and share your email. The good stuff will give you a boost and you can ask those pet owners to share their joy more publicly. And any negative feedback gives you an opportunity to respond, minimize any broader damage and build a lasting relationship.

Of course, all of these strategies to connect with clients and potential clients give you a chance to communicate more information, more often. As you can see in Figure 1, clients choose their veterinarian both because they care and because other pet owners like them. So, think about how your practice’s messaging reflects your personality and philosophy. And evaluate the mix of content that you share. e-Newsletters and social media give you great opportunities to educate clients about their pets’ health needs, showcasing your know-how. And they also give you a chance to display your team’s compassion and the great relationships you build with pets and their people.

Kimberly Ness is a marketing strategist and consultant with Trone Research + Consulting, the brains behind Diggo. Diggo, the voice of the pet owner, provides veterinarians with an unfiltered, unbiased view of what today’s pet owners think about veterinary care and their pets’ health. For more Diggo research and reports, visit 


New research reinforces the power of word-of-mouth referrals in growing your veterinary practice.


4 Strategies that get pet owners in the door

As COVID-19—and the world's reaction to it—continue to evolve, veterinarians are looking to both veterinary organizations and their peers for news and information about how to continue providing essential veterinary care while keeping their teams safe. 

For the latest on how COVID-19 is impacting the practice of veterinary medicine, dvm360's Chief Veterinary Officer Adam Christman, DVM, MBA, spoke with Scott Weese, DVM, DVSc, DACVIM, professor of internal medicine, zoonotic disease, public health and microbiology at the University of Guelph Ontario Veterinary College, and Beth Davidow, DVM, DACVECC, clinical assistant professor of emergency and critical care at Washington State University College of Veterinary Medicine.

Together, these veterinary experts detail what is known about COVID-19 and how it is impacting the practice of veterinary medicine, including these key topics:

Providing the best possible care during the pandemic

Discerning what are 'essential' veterinary services

How the veterinary teams and veterinary communities are uniting during this crisis

Maintaining the human-animal bond during the crisis

Implementing PPE and social distancing in practice

Testing a feline antiviral drug for COVID-19

Check out their conversation in the video below.

Take a listen as veterinary experts detail how COVID-19 is impacting the veterinary profession—and what the future may hold.

Elucidating the consequences of COVID-19 for veterinary practices

There are many, many steps that must come before cutting the ribbon on a new veterinary clinic. There’s planning, building, designing and everything in between. But before any of that can even be started, the perfect site needs to be chosen. Whether you have the perfect spot in mind or you’re still looking for that love-at-first-site moment, here are the fundamentals of site investigation.

 in a growing area as far from other veterinary practices as you can get.

 to make sure the site is zoned correctly. Identify any restrictions on that zoning, such as an inability to have outdoor dog runs.

Have a geotechnical report (also called a soils report) done. 

The report should include foundation recommendations. If the soil is bad, you will need to find out if the foundation can be built affordably on that type of soil. Have a survey done of the geotechnical report that identifies easements, wetlands, property lines and any other site restrictions.

f your selected site has water and hasn’t been identified as a wetland,

 this will need to be determined because most states have regulations about building near a wetland and you may not be able to build there.

Discuss with an architect or civil engineer whether the site is flat enough to build on.

 Check to see if you can get utilities to the site and what the cost is to do so. Some sites have access already, but some don’t. You’ll need professional help for this.

Get a sense for any other major site development costs,

 such as turn lanes that will be put in at the road, storm water ponds, etc.

Figure out whether the site has unusual local (often environmental) requirements 

that will restrict its use. For example, in parts of California you aren’t allowed to cut down oak trees, so you have to work around them.

After this has all been done and the site has passed or is passing muster, remember to complete a phase 1 environmental study to ensure there are no environmental hazards on the site. Even if the site looks like it hasn’t been used, it’s still an important step to carry out.

If you're opting for a leasehold space instead of building new, there’s still plenty to keep in mind before you make your final decision:

 You don’t want to be in the dead shopping center.

is as far from other veterinary practices as you can make it.

Check (and double check) that the space is in good shape.

 Look for mold or other common problems. The building should be well taken care of.

Try to find a space without a business above it. 

You can work with a business above you, but it’s much more difficult. Single-story shopping spaces work best. Square or rectangular spaces work better than long, thin ones. A narrow place wastes space (say that five times fast). In the event that you 

choose a small space, look for something no narrower than 25 feet. It is extremely difficult to work in anything narrower than that. You should also avoid irregularly shaped spaces, such as an L-shaped space with a center staircase.

Determine the availability of utilities to the space.

 Ask the building owner whether you can expand utilities if needed. At some point you may need more power to the unit and need to know ahead of time that you will be able to make those changes.

At the end of the day, always be sure to think strategically about your plan. In the future, will you expand or move? If you plan to expand, try not to locate next to something that will be there forever so you have the potential for grow.


From location to soil to utilities, here are the fundamentals for finding that perfect site to build or lease your veterinary hospital space. 
