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Top 10 Influences of COVID-19 on Human & Veterinary Medicine

Jarod Hanson, DVM, PhD, DACVPM, HYTechVets LLC, ProMED-mail, University of Maryland School of Medicine

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Published Friday, April 3, 2020, at 5:10 PM CST

As we begin to understand the new reality COVID-19 has introduced, it is apparent that those in the veterinary profession are inextricably tied to human medical counterparts in numerous ways.

Together we will need to address not only COVID-19 but also the aftermath it leaves on our professions and ways of life. Given that, we can consider the following topics in which our professions have a shared, vested interest, and how we can chart a future course in a new direction than the one we find ourselves currently. 

1

Zoonotic Diseases

From bats to pangolins and additional potential hosts, zoonoses should receive significant attention and research funding, with renewed emphasis from both human and veterinary medical communities. Zoonoses should no longer be viewed as hypothetical or even anticlimactic, as was suggested with the 2009 H1N1 pandemic. They require ongoing attention and resource investment, rather than only during times of medical or economic emergency. A solid foundation in the study of zoonoses is required to allow medicine to thrive and for clinicians from both fields to employ their collective knowledge.

2

Government Intervention

Can governments, corporations, or business owners direct medical providers across the spectrum to assume personal risk? Can they assume control of privately owned equipment inventory? Can they conscript the workforce? 

Although we do not yet have answers to all these questions, the direction being discussed publicly by leaders is clearly yes to all if deemed in the public good. The Governor of New York has talked publicly numerous times about providing “his” medical personnel to other states, whereas Minnesota’s governor has requested supply inventories from all private medical operations, including veterinary clinics, for potential use in the pandemic response. 

This makes business planning a significant challenge in terms of being able to ensure supplies are on hand to continue operations, only to have those plans altered if an item deemed critical happens to be in the inventory and is assumed by state or federal government entities.

There are strikingly new and real scenarios that the global community will encounter in the days to weeks to come. If human healthcare providers are overwhelmed, can veterinary providers be pressed into service? If so, under what legal framework? There are many legal and ethical questions, but with increasing examples of this scenario being raised in popular and social media, having a plan to maintain continuity of business operations will be key. This may be as simple as changing a procedure or switching to an alternate item, or as complicated as having to move entirely to car-side visits and telemedicine, in order to maintain some sort of hospital operations without having to endure disease-related shutdowns or shuttering operations entirely due to lack of supplies and equipment.

3

Inventory Supply & Potential Substitutions

The illusion of “just-in-time” shipping and inventory management practices suggest significant fragility on supply chain collapse due to overwhelming demand and shuttered borders. Veterinarians are intuitive problem-solvers and are well-adapted to identifying alternative supplies and procedures—this will continue to be relevant, as supply chains will be decimated for the foreseeable future for many products. That is even prior to consideration of a partially nationalized medical supply chain (via the Defense Production Act) that could linger long after the pandemic ends, as national stockpiles of common PPE are rebuilt along with hospital and clinic inventories. 

Substitutions or alternative formulations of certain supplies and drugs will require changes or exceptions to a variety of laws, regulations, and state board rules. For instance, if certain antibiotics are no longer available to veterinary medicine, will we need to consider enhanced use of compounded products based on agricultural or reagent grade products? 

4

Risk Reduction Strategies

Patient flow in both human and veterinary hospitals are likely to change. Facilities may be redesigned, maximizing ability for rapid disinfection rather than comfort. Medical personnel may start considering—if they haven’t already—whether patients with vomiting, diarrhea, and/or respiratory disease should commingle with those presenting for preventive medical appointments.

For both human and veterinary fields, telephonic, in-car, and curbside screening will likely become the new normal, with enhanced personal protective equipment postures adopted in areas or situations where risks cannot be mitigated by physical distance. Appointments may begin with pre-screening of human and animal patients much the same way vitals and history were taken previously.

5

Personal Protective Equipment (PPE)

With increased demand for PPE in human healthcare and potential requests to turn over PPE and/or medical supplies to government, will human or veterinary hospitals be able to continue operations?

There is an immediate dearth of PPE in human hospitals, and questions linger about whether we will see the same in veterinary hospitals. Hospital staff around the world are being asked to make increasingly difficult choices: do they go to work without appropriate PPE, knowing they themselves could be infected, or do they stop providing patient care?

This conundrum has rapidly spread across the medical establishment as critical resources have dwindled, expanding to include the veterinary medical field. We are now faced with considerations surrounding continued provision of reduced quality of care and/or putting providers and staff in danger when seeing patients. Questions also remain about who is accepting that risk—providers, staff, patients/owners, or all involved parties.

Standards of practice will have to change, even if transiently. We need to maximize use of PPE, medications, and disinfectants in the highest risk situations while using whatever may be available in less risky situations. After the COVID-19 crisis passes, medical providers from all fields must ensure we can never again be left to fend for ourselves and forced to make impossible choices.

6

Scheduling to Prevent Disease

Even though scheduling complicated medical cases in the afternoon can lead to long days, if increased sanitation measures are actually to be implemented, seeing the sickest patients at the end of the day can reduce risk to all other patients, including surgical patients. Whether a morning sick visit for a human patient or a sick visit drop off for a potentially infectious veterinary patient, we need to critically evaluate how scheduling affects our ability to successfully manage infectious disease in all medical facilities.

7

Public Health

If human and veterinary medical professionals take away one thing from the COVID-19 pandemic, it should be that we are all truly in this together, as what affects one group has the potential to affect us all. Even though it was easy to hypothesize something like this could happen, few thought we could see a global emergency that has the potential to affect human and animal medicine at this scale, potentially with long-term consequences to both.

8

Epidemiology Matters

Three distinct porcine coronaviruses emerged in recent years in China: porcine epidemic diarrhea virus (PEDV), delta coronavirus, and swine acute diarrhea syndrome coronavirus (SADS-CoV). These efficiently and rapidly moved to the United States, most likely through infected feed ingredients. The damage was swift and severe. We have seen the same phenomenon with the rapid spread of African swine fever virus across large portions of the globe. 

These events were isolated to a single species, yet were just a preview of how efficiently viruses can move with global trade and travel. Health must be viewed with a global strategy, as simply closing borders, whether against human or animal disease, has proven ineffective and in many ways counterproductive. With so many medications, PPE, and other critical items manufactured in part or whole overseas, closing borders not only halts the flow of potentially infected people and animals but also affects the flow of these critical supplies. Often, by the time the disease is identified as community spread, has already occurred. 

9

Laboratory Testing Is a Shared Capacity

Although human and veterinary laboratories are often separate, we all rely on shared supply chains for common reagents and testing supplies. What if, during today’s pandemic, we had still been in the midst of the H3N2 canine influenza outbreak with limited availability of nasal swabs? Would we prioritize testing humans over animals, or would we need to take a more holistic approach and determine which disease represented a greater threat if allowed to spread undetected? Veterinarians have demonstrated diagnostic innovation, a necessary skill when typical supplies are unavailable. Can we look to veterinary population medicine diagnostic techniques employed by the swine and poultry industries, or wildlife veterinarians, and transition their population surveillance techniques to patient-level diagnostics?

10

Standards of Care in an Unknown Future

As we chart a course into an unknown in which medicine, as we know it, will need to adapt—from relative inventory abundance to scarcity, from direct interaction with clients to strict use of PPE, and/or seeing patients in the absence of their owners. Already many states are deeming veterinary workforces as essential, yet simultaneously we see many state veterinary and human medical boards trying to enforce current standards of care rather than allowing innovation and potentially protective adaptations such as telemedicine. If there were ever a time to try something new, it would be now; we face at least another month of social distancing while trying to answer multiple questions discussed herein, as well as trying to determine who has been infected, who is at risk, and what role (if any) animals play in the spread of SARS-CoV-2.

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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