Reposted from JAVMAnews
By R. Scott Nolen
Published on March 31, 2020 Updated April 3, 2020
COVID-19 outbreak, shelter-in-place policies reshape delivery of veterinary services
With more than 140,000 cases of novel coronavirus disease confirmed in the United States as of March 30, the Trump administration had announced the creation of a Coronavirus Task Force, declared a national emergency, and closed the U.S. borders with Canada and Mexico while the State Department issued a Level 4 “do not travel” advisory, recommending that United States citizens avoid any global travel. Meanwhile, at least 15 states in addition to local governments had responded with various shelter-in-place policies to turn the tide of infection, such as ordering the closure of schools as well as malls and other businesses deemed nonessential. Veterinary organizations are requesting federal and state lawmakers exempt veterinary practices from such measures and allow practices to remain open during the quarantine. “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,” the AVMA explained in a March 17 statement.
Improvise, adapt, overcome
Most jurisdictions recognize veterinary practices as essential and are allowing them to operate during the COVID-19 outbreak, but it’s far from business as usual. Many clinics have temporarily suspended elective procedures, such as routine dental cleanings and nail trims, while still performing emergency procedures and some vaccinations. Social distancing is observed by providing curbside pickup so clients need not enter the hospital. Clients who are feeling ill may be asked to postpone their pet’s appointment or have someone else bring the animal in; if that’s not possible, then other arrangements may be arranged. Kathryn Coyne, CEO of the Animal Medical Center in New York City, said the most obvious impacts of the epidemic at the hospital are a decline in elective appointments and a 50% drop in patient visits. “A heated, outdoor waiting area in our parking lot separates the general public seeking care from our medical and clinical staff in order to reduce the risk of virus transmission,” Coyne said. “There is no public access to the building with few exceptions, and all discussions with clients … take place by phone as the animal is admitted for care. “We have established separate hotline numbers, one for clients and another for referring veterinarians, to call with questions and to help determine if they should send an animal to our ER (emergency room),” she added. This is a time when a small business can really build relationships with their clients by making sure that they communicate clearly. John Volk, senior consultant, Brakke Consulting Coyne said the Usdan Institute for Animal Health Education at AMC hosted a live presentation on Facebook on March 18 to answer client questions on COVID-19 that is available at facebook.com/theanimalmedicalcenter. The AVMA, in addition to communicating with public officials about the importance of veterinary services, is helping veterinary practices keep their teams safe as they continue to provide medical care for patients. These include recommendations for mobile practitioners and brick-and-mortar clinics to keep staff and clients safe and veterinary patients well cared for. Veterinary practices that remain open may need to provide documentation for staff traveling to and from work. While not required in every jurisdiction, the AVMA has created a customizable template practices can use to issue essential employee authorization letters if needed. Moreover, the AVMA Board of Directors approved delaying the termination of membership to June 1, 2020, for all members who are in default of payment of dues as of April 1, 2020. The American College of Veterinary Surgeon’s Board of Regents sent out a notice March 24 encouraging all veterinary surgeons to consider the following decision-making framework when determining the necessity of surgery: Work collaboratively with local, state, and national public health officials to fulfill the obligation to protect animal health and welfare, prevent and relieve animal suffering, and promote public health. Make medical and surgical decisions in the spirit of one health, and consider the impact of resource use on human and animal health locally, nationally, and globally. Surgery should be considered necessary, urgent, or an emergency if not performing surgery will cause irreversible harm. Criteria to determine irreversible harm include the following: threat to the patient’s life, threat of irreversible damage to the patient’s physical health, threat of permanent dysfunction of an extremity or organ system, risk of metastasis or progression of staging, and risk of rapid worsening of severe symptoms.