Q&A Summary of PVMA Virtual Town Hall

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On Thursday, March 19, 2020, PVMA held a Virtual Town Hall to answer important questions that were submitted by your veterinary colleagues. Our panelists included Dr. Kevin Brightbill, Dr. Tina Dougherty, Dr. Kate Harnish, Dr. Bryan Langlois, Dr. Lloyd Reitz, and Dr. David Wolfgang. We have compiled those questions and answers below. If there have been any changes to the topic since the Town Hall, that question has been answered with the most up-to-date information we can provide.

 

LIFE-SUSTAINING BUSINESSES, ESSSENTIAL VS. NON-ESSENTIAL PROCEDURES, ETC.

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Q: The Governor just announced that all “non-life sustaining business” should close. Veterinarians were not on the list released to the press. What is the status of veterinary medicine?

A: Kevin Brightbill, DVM, State Veterinarian, Director, PA Department of Agriculture, Bureau of Animal Health and Diagnostic Services, said that The Governor’s office has confirmed that veterinary services DO fall under Healthcare and are permitted to stay open.

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Q: Is there a difference between essential and non-essential services? In other words, should veterinary practices be open for all services, including well visits, or only emergency and urgent care?

A: Food animal medicine and surgery are considered essential as well as non-elective care (i.e. emergency and/or critical care) and procedures for companion animals.Elective procedures are generally categorized as ones that can be postponed for a period of up to 2 weeks while not having a detrimental effect on the health of the animal during that time. Some procedures may be judgement call on the part of the veterinarian, as an animal may be in severe pain or in danger of losing its life without having what may be generally considered an “elective” procedure.Spay/neuter surgeries that do not need to be performed to serve a lifesaving function (i.e pyometra), declaw procedures, lump or mass removals that are not urgent, basic dental prophylaxis procedures, and sedation for things like grooming or nail trims (unless medically needed) are not essential and should not be performed during this shutdown. Feral Cat TNR (trap, neuter, release) services will be considered elective as well during this period.

Multiple extractions would not be considered elective because it is medically needed to alleviate discomfort from the animal. Any dental procedure where major dental pathology is present would be deemed non-elective.

Veterinarians should use their best judgment. While the state is not going to be auditing every procedure you perform during the shutdown, we should be aware of the need to conserve PPE and keep our staff, clients, and ourselves as safe as possible.

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Q: What about vaccinations such as rabies? If a vaccination is expiring and a new vaccination is legally required, is it considered urgent to see that animal?

A: The state is not waiving the legal requirements on vaccinations; however, there is little chance that the state will be checking expired vaccinations at this time. Dr. Brightbill advised delaying vaccinations if possible, with the exception being if there is an active case of rabies in the community or any other situation that may further compromise public health.

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Q: Are veterinarians entitled to move to their practices or run a field service should the government install a curfew? Do provisions exist to maintain at least a minimal veterinary care service in this and the surrounding states?

A: We do not anticipate that the state will impose a curfew. Since non-elective veterinary services are considered life-sustaining, care will still be provided to the public. If a veterinarian does provide mobile care, all prescribed precautions for virus transmittal should be in place, as well as social distancing.

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Q:What are recommendations for house call vets. Especially small animal vets?

A: House calls should only take place for emergency or urgent care. You should ask the client if anyone in the household has tested positive for COVID-19 or is quarantined. House calls should not take place in these situations. Use proper protocols, such as the use of PPE and basic hygiene, such as proper handwashing. Direct human contact should be limited, and social distancing maintained. AVMA has published guidelines for house calls and mobile vets here.

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Q: As the State has declared veterinary clinics “essential,” if my practices should close (illness with COVID-19,  to protect employees from the public exposure to COVID-19, etc.), will I be precluded from government support (small business low-interest loans, individual unemployment, etc.)? Could we face disciplinary actions?

A: Dr. Brightbill and PVMA will investigate any repercussions for veterinary practices shutting down during this period. We will communicate what we find through PaVMA.org. From the perspective of the state board, based on precedent, if a practice closes, they are responsible to clearly communicate alternative emergency care. Practices should coordinate with a local emergency hospital or another general practice that is open for emergency care. Contact information for the emergency care provider should be provided on your voice mail message and website.

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Q: Under what circumstances would it be deemed necessary to close general practices (and have only ER hospitals available?)

A: General practices that do not provide non-elective care should close, according to the Governor’s order. A general practice that provides emergency care can stay open for that purpose. All elective services should be canceled.

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Q: Are pet crematories “life-sustaining” businesses?

A: Yes. Proper burial or cremation of pets contributes to public health. Pet crematories should use proper procedures and hygiene when receiving and handling the deceased animal.

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PRACTICING DURING THE COVID-19 PANDEMIC

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Q: How can veterinary practices maintain governmental recommendations for social distancing and still see clients?

A: PVMA offers the following suggestions for social distancing while seeing clients in your practice:

1. Ask the client to call the office on their cell phone when they arrive and have a technician go to the car to retrieve the animal. The client should remain in their car, or if they do stand outside, maintain 6-8 feet of distance between other people. They should be available by phone to discuss care during the exam. A technician can return the animal to the car upon completion of the exam.
2. If clients do enter the practice, escort them to a private exam room immediately. Do not keep clients in a waiting room. Consider asking for the client’s cell phone number before they arrive and send a text when you are ready for them to enter.
3. If a client has traveled outside the United States in March, came in direct contact with a person with confirmed COVID-19, or has tested positive themselves, they should send their animal to your practice with a trusted agent and be available by phone during the exam.
4. Prescriptions and pet food purchases should also be conducted through car-side delivery service or shipped directly to the client.
5. It is suggested rather than checking clients out in the reception area after their appointment, provide their invoice to them in the exam room or at their vehicle. There they can provide their method of payment and they can stay in the exam room or vehicle while you go complete the payment. This eliminates the need to spend time in the reception area. If clients are in their vehicle during the appointments or have arrived to pick up food/prescriptions, the same concept can apply for the staff member to review the invoice with them there and take payment back inside to complete. Additionally, less contact can also be accomplished by taking payments over the phone from their vehicle.

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Q: The AVMA website states that veterinary staff should wear PPE when meeting clients at their car for curbside veterinary visits. What is the appropriate PPE for this interaction?

A: At a minimum, use gloves, and a mask. Limit physical contact with the client. Consider having the client pay by phone (credit card) rather than handling cash or a physical credit card.

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Q: In the event of a COVID-19 positive person in our hospital and subsequent shutdown, what exactly are the disinfection and quarantine protocols we should follow before considering re-opening for business?

A: You can find environmental cleaning recommendations here. Essentially, diluted bleach solutions, alcohol solutions with at least 70% alcohol, and most EPA-registered household disinfectants are effective. If possible, wait 24 hours to begin cleaning and disinfecting, but no matter what, cleaning staff should wear gloves and gowns.

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Q: What happens if an employee in your specialty emergency practice tests positive for the virus? Will the state shut the entire hospital down?

A: Veterinary hospitals are essential services, and it’s not in anyone’s interest to shut hospitals down. For now, if the Department of Health is notified of someone who tests positive, they contact the submitting healthcare provider, the local health department or the PA DOH Bureau of Community Health Systems (BCHS) then reaches out to the COVID-19 positive person and places them on a verbal isolation order. They work with the diagnosed person to identify and contact the people with whom they had close contact since becoming symptomatic and communicate to those contacts that they should self-monitor for symptoms. If those contacts get symptoms, they should call their local health department or BCHS.

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BOARD OF VETERINARY MEDICINE UPDATES

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Q: With many continuing ed conferences being canceled, will we be allowed to get more than 25% of our CE online? If not, what happens to vets that don’t have their 30 hours of CE completed by November?

As of March 22, 2020, Governor Wolf granted the Department of State’s request to suspend restrictions on distance-learning for continuing-education requirements for certain licensed professionals. Many licensing boards of the Bureau of Professional and Occupational Affairs have ongoing continuing education requirements. Although only a few boards are currently in renewal, many “in-person” continuing education programs are canceling courses or closing education centers and it is unknown how long they may be impacted.

The Boards listed below have restrictions on the number or percentage of continuing-education hours that can be done through distance education. The governor granted a suspension of restrictions that limited the ability of licensees to take classes online or participate in distance-learning opportunities for the current biennial renewal period to permit all licensees to complete their continuing education online during the COVID-19 pandemic.

This applies to the following boards and licensees:

• STATE BOARD OF ACCOUNTANCY

• STATE BOARD OF MEDICINE – Licensed Respiratory Therapists

• STATE BOARD OF MASSAGE THERAPY

• STATE BOARD OF OPTOMETRY – Optometrists

• STATE BOARD OF PODIATRY – Podiatrists

• STATE BOARD OF VETERINARY MEDICINE – Veterinarians

• STATE BOARD OF DENTISTRY – Dentists, dental hygienists and expanded function dental assistants

• STATE BOARD OF PSYCHOLOGY – Psychologists

• STATE BOARD OF SOCIAL WORKERS, MARRIAGE AND FAMILY THERAPISTS AND PROFESSIONAL COUNSELORS – Licensed social workers, clinical social workers, marriage and family therapists and professional counselors

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Q: Pennsylvania has been far behind most other states in their online continuing education allowances. When I contacted the state board about this several years ago, they said they relied on the Pennsylvania VMA for recommendations. What are you doing to increase the online continuing education allowances in Pennsylvania, not just temporarily but permanently?

A: The limits for online CE are part of the PA Veterinary Practice Act, which means changing them would be a legislative process that opens the entire practice act for change. Normally, PVMA tries to limit opening the practice act, as it could introduce other changes that we do not support. If there is a groundswell of support for opening the act to change CE requirements, PVMA will certainly look at advocating for this change.

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SHORTAGE OF HUMAN MEDICAL SUPPLIES AND PPE

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Q: Given the probability that our human counterparts likely will become overwhelmed and need help and resources at some point in some locations, is there a coordinated mechanism for veterinarians to volunteer their services and/or supplies?  We may not be licensed to treat humans, but we certainly can triage, prepare treatments, take vitals, etc.

A: PVMA has been informed that nursing homes and long-term care facilities cannot get PPE from PEMA unless they have an active COVID-19 case, and many of these facilities are low on supplies. Veterinarians can check with local health officials to see if there is an opportunity to help with drive through testing centers and other COVID-19 related services.

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Q: Is there a way for PVMA and AVMA to share with the general public the AVMA request for veterinarians to conserve PPE by delaying elective surgeries and dental cleanings? While my hospital has stated the rationale on our website and Facebook pages, there are comments from some clients stating they will “go elsewhere” to another clinic who will provide these services. Understandably, clients with female dogs that might go through estrus during this delay are concerned. While we are trying to educate our clients, it would help a lot if PVMA and AVMA could let the pet owners know that veterinary practices working to meet these AVMA requests are making the correct choice.

A: Yes, PVMA can work through social media to educate the public on the need to conserve supplies by canceling non-essential procedures. The AVMA also released some guidelines for use of PPE during the COVID-19 pandemic when the demands exceeds the supply. Click here to view those guidelines.

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COVID-19 AND ANIMALS

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Q: Can animals act as fomites and/or vectors for COVID 19?

A: Despite one dog testing a “weak positive” for COVID-19 in Hong Kong, there is no evidence that animals can get or transmit the virus. IDEXX announced on March 14, 2020, that it had evaluated thousands of canine and feline specimens during validation of its new veterinary test system for the COVID-19 virus and had obtained no positive result. Considering this information in total, infectious disease experts and multiple international and domestic human and animal health organizations (CDC, OIE, WHO) agree there is no evidence at this point to indicate that pets can spread COVID-19 to other animals or people.

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Q: How long does Coronavirus survive on a dog or cat of a Corona positive owner once they are isolated?

A: There’s still a lot that’s unknown about SARS CoV-2, the virus that causes COVID-19, and environmental persistence. CDC suggests Coronavirus can live on hard surfaces up to 3 days, but there’s more research coming out every day. Given the physical characteristics of cats and dogs, there is no evidence that the virus can survive on the animal for more than a couple of hours. Out of an abundance of caution, dogs that have had direct contact with a patient with COVID-19 can be bathed. Cats can be difficult to bathe, so quarantine is suggested in this situation.

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Q: Is the new Coronavirus similar to or related to any known Coronaviruses of veterinary significance?  What’s the possibility of a mutation getting into the usual animal species we see?

A: SARS-CoV-2 is not closely related to the coronaviruses most familiar to veterinarians. Additionally, there are other more common strains of coronavirus, including HKU1, that cause the common cold in humans. While there is no way to predict the future, it seems likely that there will be a mutation that would facilitate another species jump and make it transmissible among animals.

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Q: Is there any information that identifies the time it takes from exposure to a positive TEST (no clinical signs)?

A: We are learning more about COVID-19, including the relationship between symptom onset and infectivity. There is new research every day, and we are doing our best to keep up with the science and base our public health decisions on that. A recent publication in the Annals of Internal Medicine estimated that the median incubation period from exposure to onset of symptoms is 5.1 days, with 97.5% of people who develop symptoms from COVID-19 will do so within 11.5 days after exposure. At this time, we are basing our public health investigations on symptom onset.

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Q: What is being done to give veterinary workers access to testing (i.e. to be tested)?

A: With testing still not widely available, testing is only being done on people who have traveled internationally in the previous two weeks, been in direct contact with a person confirmed to have COVID-19 and has symptoms. If you or your team meet these criteria, a primary care physician should be called to arrange testing.

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Q: Are there thoughts or recommended protocols at this time for immunocompromised pets being around their quarantined owners?

A: If a pet owner tests positive for COVID-19, they should limit their exposure to their pet or safely transfer to a trusted caregiver.

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Q: Most advice regarding potential/diagnosed COVID-19 patients is to have other family members care for pets while ill/isolated.  How do we advise single-human households? Can a pet be safely transferred out of the home of someone isolated/symptomatic to a non-isolated home which may allow a better quality of life?

A: The Pennsylvania Department of Agriculture issued the following advice to pet owners who may require care for their pet while sick with COVID-19:

• Identify a family member or friend who can care for pets in case of illness.
• Have crates, food, and extra supplies on hand for quick movement of pets.
• Have the pet’s vaccination record available, in the event boarding becomes necessary.
• Ensure all medications are documented with dosages and administering directions, including the prescription and contact information for your veterinarian.
• Pets should have identification: collar with dog license and rabies tag, or any other vanity style tag with owner information. Information can also be placed on the pet’s cage depending on the type of pet.
• Place a list of pets in the home on your front door for emergency responders. Include a description of each animal, location in home or on the property, and any other pertinent information specific to each animal.

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Currently, there is no reason to believe that pets transmit the virus. When transferring a pet from the home of someone with COVID-19, contact with hard surfaces in the home should be avoided. You should thoroughly wash your hands after the transfer is made. You may consider bathing the dog (cats may be more difficult to bathe).

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HUMAN RESOURCES

 

Q: I am employed by a veterinary practice still booking non-essential services and not compliant with social distancing protocols. I am concerned about my exposure, and that of my family, to COVID-19. What should I do?

A: The Governor’s order to close all non-essential services includes healthcare providers ceasing all elective procedures and services. If a practice is not in compliance, you can contact the State Veterinarian’s Office.
Pennsylvania Department of Agriculture | Bureau of Animal Health and Diagnostic Services
2301 North Cameron Street | Harrisburg, PA 17110
Phone: 717.705.1626 | Fax: 717.787.1868
agriculture.pa.gov

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Specific HR and employment law questions should be directed to organizations such as:

• Veterinary Hospital Managers Association (VHMA)
• Society of Human Resources Managers (SHRM)
• PA Department of Labor and Industry

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For more updates on this pandemic, visit our COVID-19 Resources page.

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