Busy times, stress for veterinarians during pandemic

The AVMA House of Delegates Veterinary Information Forum focused on “Veterinary Medicine in the Aftermath of COVID-19: What Have We Learned That Will Guide Our Future.” The forum took place virtually July 30 during the HOD’s regular annual session.

Delegates discussed how busy their practices are now, concerns they have for keeping themselves and their staff members healthy, how to balance work with having children who aren’t going to school in person, and more. Federal agency representatives also gave an update on SARS-CoV-2 in animals, their efforts to communicate with those on the front lines, and preventing drug shortages and the sale of fraudulent products.

No good options

Delegates took much of the time to express their concerns about and suggestions for how to work safely and effectively during a pandemic.

Dr. Diana Thomé, Washington state alternate delegate, said she was looking for strategies for parents dealing with returning to work while their kids are at home. “There are potential staffing shortages that might occur for working families and in particular working mothers as they have to educate their kids this fall,” she said.

Other well-being issues were brought up by Dr. Wendy Hauser, who is the American Animal Hospital Association delegate. She’s been bringing her own pets in for care and having conversations with the staff members.

“From the outside, things are running efficiently, but from their perspective, they are stressed,” Dr. Hauser said. “One is a lack of efficiency, the additional time it’s taking. I understand the flood gates are open now, but we can’t ask people to work consistently these longer days to make up for a lack of efficiency.”

“The other pain point is the lack of patience on the part of clients. What communication tools could be enhanced for our veterinary hospitals to help them deal with unhappy clients rather than knee-jerk fire them?”

Dr. William Grant, California delegate, said his clinic is averaging 70-100 transactions a day. It also had two exposures to COVID-19 among staff members. The infections came from family members or other people outside the hospital.

“I think our focus, which was protecting staff from the general public, actually protected staff from each other. It worked out well,” he said. “We do have quite a bit of stress going on with the number of cases we’re seeing, but if we really focus on taking care of our staff, it really protects them not just from people coming in, but from the people at home, which was the case for the two we saw. We were fortunate.”

Another practitioner wasn’t so lucky. Dr. Issac Bott, Society for Theriogenology delegate, has a mixed animal practice in Springville, Utah. Despite his team being diligent about wearing masks and following guidelines, at the end of June, he and two other staff members contracted COVID-19, which forced him to close his practice for two weeks. He also applied for a Paycheck Protection Program loan and received one.

“If not for that, my clinic—which has been running since 1966—would have failed,” Dr. Bott said. “I wanted to thank the AVMA for their work on COVID.”

Dr. Kate Boatright, Pennsylvania alternate delegate, works with a lot of veterinary students and recent graduates. She thinks it will be important for practitioners to work on being mentors for recent graduates in the next few years because the pandemic has had a big impact on their education.

“We’re going to be filling in gaps down the road,” she said. “We need to be patient. For the next several years, this will have a ripple effect on their education.”

Dr. Cheryl Greenacre, delegate for the Association of Avian Veterinarians, is a faculty member at the University of Tennessee College of Veterinary Medicine.

“We do need to make sure we teach fourth-year students and have hands-on instruction and put them in the clinic,” Dr. Greenacre said. However, she said, “You have to put yourself in my shoes and other faculty, technicians, and staff working at a university. We have no choice; we have to go in. We’re considered essential workers, seeing students and patients.

“We have faculty out sick with COVID-19. How bad do you let it get, and where do you draw the line? No one had a good answer for this. Me personally and others, we have moderate risk, and my husband has severe risk. I have no choice, I have to go into work.”

Dr. Greenacre suggested the AVMA form an advocacy group for veterinary academic faculty to give this group a collective voice.

COVID-19 virus in animals

Drs. Casey Barton Behravesh, director of the One Health Office for the Centers for Disease Control and Prevention’s National Center for Emerging and Zoonotic Infectious Diseases, and Jane Rooney, assistant director of the One Health Coordination Center at the U.S. Department of Agriculture Animal and Plant Health Inspection Service’s Veterinary Services, gave the presentation “Mobilizing a One-Health Approach to Understand the Role of Animals in COVID-19.”

“Since the emergence of SARS-CoV-2, much emphasis has been placed on the one-health aspects of the pandemic,” Dr. Barton Behravesh said. “This is critical to address the pandemic as well as future health threats. We’ve been coordinating, collaborating, and communicating across all relevant sectors, including the CDC, USDA, state partners, and Interior Department.”

She also noted that published and preprint research on experimental or natural infections with the COVID-19 virus in animals has found that cats, ferrets and minks, golden hamsters, nonhuman primates, and tree shrews are highly susceptible to SARS-CoV-2 infection. Dogs and Egyptian fruit bats are moderately susceptible. Mice, poultry, and pigs are not susceptible.

As of Aug. 5, animals positive for SARS-CoV-2 reported globally were 27 cats, 18 dogs, four tigers, three lions, and 31 affected mink farms, with most of the mink farms being in the Netherlands. In all, 1 million minks have been depopulated.

Preventing drug shortages, fraud

Dr. Steven Solomon, director of the Food and Drug Administration Center for Veterinary Medicine, said drug shortages, fraudulent products, and veterinary telemedicine have been the center’s focus during the pandemic.

“When COVID-19 started affecting facilities, we proactively contacted animal health drug makers and set up a mechanism for them to forecast and report so they could keep animal drugs available,” Dr. Solomon said. “We’ve mitigated multiple drug shortages through working together.”

Examples of active pharmaceutical ingredients and finished products that were either at risk of going into shortage or were in actual shortage included sedative and anesthesia products, nonsteroidal anti-inflammatory drugs, cardiac drugs, and antimicrobials, according to the FDA CVM. Some of the root causes of manufacturing slowdowns were a lack of personal protective equipment for production, sudden closures because of COVID-19–related issues, decisions by foreign governments to shut down export of specific active pharmaceutical ingredients, and a decrease in air travel leading to shipping products by sea, resulting in shipment delays, the agency said.

The pandemic has also offered a tremendous opportunity to capitalize on fears by selling products that have false claims, Dr. Solomon said.

“We monitor for claims and hazardous products. When hydroxychloroquine popped up, we warned against that. We did the same for ivermectin and worked with online marketplaces to remove (these drugs) from websites,” he said. “Fraudulent products for COVID-19 have been plentiful, like claims that CBD could cure COVID-19.”

On July 21, the FDA CVM issued additional warning letters to Fishman Chemical of North Carolina and New Life International for marketing unapproved chloroquine products labeled for use in ornamental fish. An agency spokesperson said although neither product identified in these warning letters made claims about use in people, the agency is concerned that consumers may mistake unapproved chloroquine phosphate animal drugs for the human drug chloroquine phosphate.

Finally, Dr. Solomon said the FDA CVM recognized that many veterinarians wouldn’t be able to see patients in person while states were under stay-at-home orders and even after reopening.

“Through guidance, we temporarily relaxed some in-person visit requirements of the veterinarian-client-patient relationship,” he said. “This allows vets to expand the use of telemedicine, instead of doing an in-person examination before prescribing extralabel drugs and veterinary feed directive drugs.”