To help mitigate the spread of COVID-19, local governments everywhere are asking—and in some areas ordering—non-essential businesses to close, including some veterinary clinics. But doing so, according to the World Small Animal Veterinary Association (WSAVA) and American Veterinary Medical Association (AVMA), could jeopardize the welfare of countless animals and their owners.

As WSAVA President Shane Ryan, BVSc (Hons), MVS, CVA, GradDipAnimChiro, MChiroSc, MRCVS, explains in 

, veterinary professionals not only provide essential care to animals but they also “ensure animal health and welfare, and support the human-companion animal bond by protecting these deep and important relationships.”

Christopher Shapley, DVM, CVA, veterinary acupuncturist and herbal medicine specialist at Brick Town Veterinary Hospital in Brick Township, New Jersey, agrees. The human-animal bond is more critical than ever, he told dvm360, especially with so many people in self-isolation. “Veterinary practices must remain open to not only ease the suffering of the sick but to reduce the stress of pet owners so they can safely and soundly tend to their own needs,” Dr. Shapley says.

Some states, including Maryland, Michigan, Connecticut and Pennsylvania, have categorized veterinary practices as essential. In its call for authorities to classify veterinary practices as “essential businesses,” the AVMA stated in a 

 that “veterinary teams provide essential animal care, play a critical role in protecting the health of animals that enter the food supply, and serve as trusted members of the local community in disaster situations.”

Memorandum on Identification of Essential Critical Infrastructure Workers During COVID-19 Response

,” the U.S. Department of Homeland Security Cybersecurity & Infrastructure Security Agency included animal agriculture workers in its list of “essential critical infrastructure workers.”

This includes “those employed in veterinary health; manufacturing and distribution of animal medical materials, animal vaccines, animal drugs, feed ingredients, feed, and bedding, etc.; transportation of live animals, animal medical materials; transportation of deceased animals for disposal; raising of animals for food; animal production operations; slaughter and packing plants, renderers, and associated regulatory and government workforce.”

Although Brick Town Veterinary Hospital remains open to the community, Dr. Shapley says it’s far from business as usual.

“Social distancing in practice, treating only sick patients and performing only emergency surgeries are the “new normal” during this pandemic,” he says. “Veterinarians must stay vigilant and continue to service the community with their own safety in mind.”

Articles

Both associations have urged lawmakers to classify veterinary practices as ‘essential’ because, they say, not doing so could negatively impact both animal welfare and the wellbeing of pet owners.

AVMA, WSAVA: veterinary practices are ‘essential businesses’ 

Association for Animal Welfare Advancement

 (AAWA) will host a free, RACE-approved webinar for veterinary practice and animal shelter professionals offering guidance on the veterinary community's response to COVID-19, including considerations for those impacted by the crisis who have pets in their care.

Moderated by Trupanion's Chief Veterinary Officer and 

 founder Steve Weinrauch, BVMS, MRCVS, the webinar will bring together leading organizations in human, animal and environmental health.

“By joining forces with these worldwide authorities in pet health and welfare, our goal is to provide the most current and useful information to the veterinary and sheltering community,” says Dr.  Weinrauch, BVMS, MRCVS. “We look forward to spearheading this critical community effort with our esteemed colleagues.”

A consumer webinar will be scheduled in the coming weeks.

 Guidance for COVID-19 Community Response for Nonprofit, Government, and In Practice Veterinary Personnel

Steve Weinrauch, BVMS, MRCVS, chief veterinary officer, Trupanion

Jim Tedford, CAWA, president and CEO, Association for Animal Welfare Advancement

Michael Lappin, DVM, PhD, DACVIM (SAIM), chair, WSAVA One Health Committee

Julie Levy, DVM, PhD, DACVIM, DABVP (Shelter Medicine Practice), Fran Marino endowed professor of shelter medicine, Maddie’s Shelter Medicine Program, University of Florida

 Wednesday, March 25, 11:00 a.m. – noon PDT

 There are two ways to access this webinar:

The first 3,000 veterinary professionals who 

 will be eligible for RACE credits and will join the webinar via the Zoom platform.

The webinar will also be streamed live on 

. Please note that RACE credits are not available for those viewing the  Facebook Live stream.


Using One Health as a driving philosophy, leadership from the Association for Animal Welfare Advancement, WSAVA, shelter medicine, and MightyVet are participating in the  webinar, which will address considerations for those impacted by COVID-19 who care for pets.

Animal welfare authorities to host global COVID-19 webinar for veterinary professionals

Dr. Sean Lee owns a large practice in a northeastern city. Recently, he locked horns with one of his associates over treatment approaches.

The first case involved a 7-year-old retriever mix with sudden lameness in the left rear leg. The dog was in mild distress, bearing weight on three legs and toe-touching on the affected leg. The associate advised the owner that a proper workup would involve an exam, x-rays, radiology consultation, pain management, screening blood work and possible surgery. The pet owner loved his dog but told the veterinarian he did not have the money for the suggested services. The veterinarian examined the leg, felt some instability and told the owner that the injury was most likely caused by an anterior cruciate ligament (ACL) tear but that the diagnosis could not be confirmed without the proposed diagnostic plan. When the owner asked what he could do for his dog with limited funds, the veterinarian told him to minimize the dog’s activity for 8 weeks. He also prescribed pain medications that do not require bloodwork clearance and told the very appreciative owner that the dog should do fine.

The second case that attracted Dr. Lee’s attention was that of a 4-year-old year old female boxer that was presented with sudden onset of urinary accidents in the house. The dog had a similar episode two years earlier that was cleared up with a course of antibiotics. During this visit, the doctor recommended a urinalysis, bladder x-ray to rule out any stones and, owing to the dog’s history, a culture and sensitivity if bacteria were detected. The client explained that her funds were limited and opted for the urinalysis and requested an antibiotic. The associate strongly recommended the workup to prevent what could develop into a more serious and complex urinary tract issue, but he told her he understood her budgetary restraints and agreed to prescribe only an antibiotic at this time, with the understanding that another recurrence would require the detailed workup he recommended.

Dr. Lee scheduled a meeting with his associate about these two cases. He felt the doctor was not assertive enough in encouraging the client to work up these two patients as initially proposed. Dr. Lee said that the doctor’s shortcut and expedient treatment decisions were akin to putting a Band-Aid on an infected wound. These patients were ultimately going to return with complications that could have been avoided with the proper diagnostics.

The younger doctor respectfully disagreed. He understood the importance of the bottom line, he told Dr. Lee, his goal was to assist his patients and their owners with honesty and transparency. In the first case, he said, he was reasonably sure from the physical exam that the dog had an ACL tear and felt that honoring the client’s desire for a conservative, inexpensive approach was very reasonable. In the second case, a urinalysis followed by antibiotics would resolve the presenting signs in 80% of the cases. Once again, he believed that respecting the client’s wishes and pocketbook was a reasonable decision.

Dr. Lee told the associate that he believed veterinarians should practice the best medicine possible at all times, adding, “Don’t worry about the clients’ pocketbook, because they will worry about that enough for both of you.” His young associate understood that veterinary practice is a combination of medicine and business. However, when the priorities between medicine and business become unbalanced, the patient, client, and practice all end up suffering.

Each agreed to respect the other’s input more in the future, but neither was very happy at the end of the meeting.

Do you believe in Dr. Lee’s “medicine at all costs” approach, or do you agree with his young associate that treatment should be tailored to each client’s wishes and finances? Let us know your thoughts at dvm360news@mmhgroup.com.

Veterinary medicine cannot depend on third-party insurance to pay its fees. On the other hand, prescribing the most idealized treatment plan can be a financial burden for some pet owners. It is our job as responsible clinicians to offer all available treatment options, recommend the treatment of choice and allow the pet owner to make an informed decision. This decision should not be subject to pressure, guilt or judgment from the doctor or staff.

Practice owners are often influenced a bit too much by the bottom line and, conversely, associates may have no interest in the clinic profit margin. I believe that a veterinarian who is truly interested in the patient’s welfare, but considers the client’s ability to care for the animal properly, can walk the financial tightrope laid out in this dilemma. First, veterinarians should advocate for the treatment protocol and diagnostics they believe are in the best interest of the patient. Second, all financial assistance options should be made available to the pet owner after an estimate is given. Finally, when financial restrictions are severe, treatment protocols can be modified to fit the client’s pocketbook, but not to the extent that the animal’s health and welfare are placed at risk.

No one ever said practicing veterinary medicine was easy. I’ve always followed a simple motto: “When in doubt, help them out.“

Dr. Marc Rosenberg is director of the Voorhees Veterinary Center in Voorhees, New Jersey. Although many of the scenarios Dr. Rosenberg describes in his column are based on real-life events, the veterinary practices, doctors and employees described are fictional.

Providing optimal care while respecting your veterinary clients’ financial limitations can be challenging, but can be done.

The Dilemma: discount care or full disclosure?

Editor’s Note: As COVID-19 disrupts life and work around the globe, veterinary practices of all kinds are adjusting their protocols to ensure the safety of clients, staff and patients alike. This letter from Alastair Cribb, DVM, PhD, FCAHS, dean of the Cummings School of Veterinary Medicine at Tufts University, was posted today on the Tufts University 

 and is used here with permission. It outlines what those changes look like in a veterinary school setting, from promoting social distancing to conserving vital medical supplies to providing needed resources to human healthcare facilities. These actions are indicative of what is being done throughout the country and around the world to help flatten the curve and prevent further illness and death. It is only by working in unison that we will defeat this unseen enemy.

The worldwide COVID-19 pandemic makes these unprecedented times for global health. It reminds us that infectious disease does not respect borders nor, in many instances, species. Cummings School of Veterinary Medicine at Tufts University remains committed to keeping people and animals in our community healthy and safe through this crisis. We have made numerous policy changes to help protect and serve our community.

In order to protect our students, staff and faculty and to act responsibly in the face of a growing pandemic, we have transitioned to an online curriculum and asked our students to return home. Faculty and staff who do not need to be on campus to fulfill essential functions are required to work remotely. They are delivering our educational programs, continuing their research, and providing guidance to animal owners over the phone and internet. All these activities help to support social distancing that can reduce the spread of COVID-19 and the associated strain on our health care system.

Our clinics have moved to providing only essential and emergency care for pets, horses, wildlife and farm animals. For example, in the Foster Hospital for Small Animals we are no longer performing elective or other procedures that can be delayed without a significant risk to the patient. This has been done to conserve and reduce demand on medical supplies, such as masks and gloves at a time when they are in great need. We have changed our admission practices in our clinics so that clients no longer enter the building but drop off their animals to a client “concierge” service to limit person-to-person interaction. Finally, we are making available Cummings School’s specialized equipment—such as mechanical ventilators—to human healthcare centers to support severely affected patients.

In times such as these, maintaining our mental health and dealing with the challenges of social isolation are key to ensuring our collective wellness as we grapple with this highly infectious disease. We only need to look back at natural disasters such as Hurricane Katrina to see how people will choose to risk their own lives when pets are not accounted for in an emergency. There are also consequences for human mental health and increased suicide rates when crises lead to the loss of animals. We continue to have a societal responsibility to care for animals in order to support the human-animal bond and the mental health of animal owners in a time of great stress.

We all need safe and nutritious food. Veterinarians care for food-production animals to ensure their welfare and good health, as well as food safety. The care provided by veterinarians helps support agricultural livelihoods and the viability of our farms. Through Tufts Veterinary Field Service, we continue to provide essential and emergency services to New England farms.

We also have capabilities for infectious disease research, using the New England Regional Biosafety Laboratory on our campus. We already engage in research to understand the ecology of emerging diseases that are transmitted between animals and humans. We will expand this work to help us understand COVID-19.

Veterinarians are trained in animal and public health, with skills and knowledge that are critical during the COVID-19 pandemic. We are trained in principles of biosecurity and biocontainment that can support a broader public health workforce through training or direct service. We provide medically necessary care for animal patients at a time when many people are relying more than ever on their pets for critical emotional support. The veterinarian’s role in ensuring the integrity of our food supply and the livelihood of our nation’s farmers is also essential for public health and economic viability. And as a profession we continue to research emerging diseases that transmit from animal to human populations.

Veterinarians’ contributions to global and public health include and go beyond the necessary care of animals. We must—and will—do our part.

Alastair Cribb, DVM, PhD, FCAHS, is dean of Cummings School of Veterinary Medicine at Tufts University.

The dean of Cummings School of Veterinary Medicine at Tufts University explains how and why veterinary professionals are vital in the fight against the novel coronavirus.

COVID-19: how the veterinary profession can help

It is not often that I write anything truly newsworthy. This is in large part because by the time my thoughts are gathered, jelled and edited, they are yesterday’s news for the reader. But we are in rare times, and yesterday’s news is today’s science fiction, and hopefully tonight’s nightmare will soon be tomorrow’s bad dream.

In humans, several coronaviruses are known to cause respiratory infections ranging from the common cold to more severe diseases such as Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS). More dastardly than its coronavirus cousins, COVID-19 has brought the world to its knees.

All indications are that COVID-19 originated in dark and filthy food sources known as wet markets in China. These nightmare marketplaces slaughter and sell wild animals ranging from reptiles, jungle cats, bats and monkeys to cats, dogs and nearly extinct pangolins (scaly anteaters, which some consider a likely source of the virus).

Until recently, most Westerners were unaware of the existence of these hellholes. Today, literally any sentient person has some awareness of the disease. Most of us have been inundated with information nearly 24/7. Initially, some people (including government representatives and pundits) minimized the risk and severity of COVID-19, but worldwide populations have been forced to accept reality: This virus is spreading more rapidly than anticipated. Anyone who isn’t aware of the world’s current plight is either hibernating in a deep cave or has been totally off the grid.

It was in early February, while I was attending the Western Veterinary Conference in Las Vegas and celebrating my birthday in Denver, that coronavirus first became a topic of news and conversation.

When I returned home to Anguilla, everything was still pretty normal. Flights were uneventful, ferries were readily available and immigration lines moved smoothly. Even with the worry about Italy, there was no obvious sense of foreboding.

Anguilla is a tiny British protectorate with a population of about 15,000. Saint Martin is three to five miles to the south with a population of about 77,000. Cases were confirmed in Saint Barth’s, French Saint Martin and, most recently, Dutch Saint Martin. As the global incidence increases, and with confirmed cases identified just a few miles from our beaches, the people of Anguilla are praying that the virus won’t find its way to our island. It seems almost inevitable. How long will our luck hold?

Medical care in Anguilla is limited. Our only hospital is a small facility that is still undergoing repairs and remodeling following devastating damage from Hurricane Irma. The hospital has about a half-dozen rooms and a couple dozen beds. At the moment there are two in-house respirators.

But the life’s blood of the Caribbean is tourism. And with beaches, five-star hotels and villas, magnificent restaurants, and yachts and cruise ships all currently in shutdown mode, the Caribbean’s revenue stream and the health of her people are all in jeopardy. If major European countries aren’t prepared for tens of thousands of cases and thousands of deaths, what could a nearly Third World society be asked to do? Like everyone else, we wash our hands a lot, maintain 6-ft distances between people and sneeze into our elbows. Every effort is focused on staying isolated.

Initially, the protection plan on Anguilla focused on social isolation. Late last week, the Anguilla government took aggressive steps to prevent coronavirus from breaching our shores: Local and regional airports are now closed, as are ferry terminals. Residents returning home and people traveling from other countries are subject to 14-day quarantine. For the next few weeks, the island will remain isolated from travel and, hopefully, remain disease free. Yesterday Anguilla was paradise, today her future is unclear and tomorrow, well, who knows?

Dr. Paul is the former executive director of the Companion Animal Parasite Council and a former president of the American Animal Hospital Association. He is currently the principal of MAGPIE Veterinary Consulting. He is retired from practice and lives in Anguilla, British West Indies.

In every corner of the world, people are doing their part to thwart the spread of COVID-19. dvm360 columnist Dr. Mike Paul shares what he’s experiencing on the tiny island of Anguilla.

Thoughts on coronavirus from the Caribbean

It's been a crazy week for anyone working in a veterinary practice. Odds are that your entire appointment protocols have changed in order to protect your team and your clients from COVID-19. Here's the latest on the novel coronavirus and other veterinary news.

Idexx Laboratories says it has tested thousands of dogs and cats, and they all 

came up negative for the coronavirus strain that causes COVID-19

The American Veterinary Medical Association (AVMA) 

has been keeping its members  up to date on its work to help keep veterinary practices open

, providing tips on how to best care for patients while maintaining a low personal risk, and how to conserve personal protective equipment.

dvm360’s Chief Veterinary Officer Dr. Adam Christman 

offers some tips to help your veterinary practice during the coronavirus pandemic

Certified leadership and wellness coach Kristina Guldbrand, CVT, BS, CSP, shares three techniques you need to implement right now to help improve your wellbeing 

In hopes of thwarting feline infectious peritonitis, Colorado State University researchers are developing an 

oral vaccine that targets feline enteric coronavirus

New legislation, if passed, would allow borrowers to 

pause interest accumulation and loan repayment 

while pursuing additional veterinary training and education.

In the latest episode of “The Dilemma Live,” Dr. Marc Rosenberg and Bash Halow, CVT, CVPM, discuss how they would address a team member who inadvertently gave a boarding dog 

regular kibble instead of the kosher food provided by the owners

Videos

Want to be in the know? Check out the veterinary news highlights from this week.