As COVID-19 infections forced nearby veterinary clinics to cut services, patient volumes rose at the lone 24-hour animal hospital in Fargo, North Dakota.
Dr. Tanya Borud, co-owner of Red River Animal Emergency Hospital and Referral Center, said in late November case numbers were up 25%-30%—causing prolonged delays for examination and treatment of the most stable patients, whose numbers had already been up since the start of the pandemic. She attributes the rise in cases to a mix of absences at other veterinary practices and increased attention to pets as people worked from home.
The hospital has had its own absences because of COVID-19 infections and exposures, although no outbreaks were documented within the building, Dr. Borud said. But hospital leaders have developed plans for how to continue running, even in a limited capacity, and what types of cases they should take if more veterinarians and staff members become infected amid the surge of COVID-19 infections.
Making it work
Dr. Borud is among the veterinarians and veterinary association leaders who have described difficulties in protecting veterinary teams from the virus and continuing to treat patients as the number of confirmed COVID-19 cases rose sharply in the U.S. during the fall. By early December, the nation was recording 200,000 cases daily and had exceeded 15 million cumulative infections.
In North Dakota, at least 83,000 people had been infected and more than 1,000 had died by early December, according to the Coronavirus Resource Center at Johns Hopkins University. More than 35,000 of those infections and 400 of those deaths occurred in November.
Dr. Derine Winning owns Valley Veterinary Hospital in Fargo and is a partner in Red River Animal Emergency Hospital and Referral Center. In her clinic of 25 people, she said, a few employees have been out with COVID-19 and more have taken leave because of exposure to people with the disease. Those who developed the disease had mild symptoms and recovered, and she thinks they all contracted the SARS-CoV-2 virus outside the practice.
“Sometimes, we have limited staff because there are people out with exposure or with COVID, and so we have to adjust as each day comes,” Dr. Winning said. “And we’re still trying to treat illness. We’re still trying to prevent pain and suffering in our patients. We’re still practicing preventive health care, especially in light of public health concerns.”
Public health veterinarians and veterinary association leaders indicated that little information is available so far to show how often COVID-19 has spread in veterinary settings, especially as public health departments struggle to keep up with contact tracing. At least one state—Illinois—collected local health department reports on outbreaks among veterinary clinic employees, with employees at 16 clinics identified by Dec. 9, 2020.
Dr. Connie Austin, state public health veterinarian and infectious disease epidemiologist for the Illinois Department of Public Health, said the state collects occupation-related infection data from 94 local health departments, which collect workplace data through contact tracing and, to a lesser extent, calls from business managers seeking advice.
“Certainly, the local health departments are trying to keep up with interviewing all the cases,” she said.
Each outbreak in a veterinary clinic involved two to 10 infections, and the outbreaks were spread across the state. In late October, the state changed the definition of an outbreak to at least five infections, and none were recorded for November or early December at veterinary clinics. The available outbreak data relate to transmission between employees at practices, and the IDPH has not received any reports on transmission between veterinary clinic staff members and clients, Dr. Austin said.
Health officials and VMA leaders from several other states likewise said they knew of infections among employees at veterinary clinics but none involving transmission between employees and clients. Complaints to federal safety authorities also mostly reflect concerns about actions by co-workers.
Few data analyzed, published
Dr. Dustin Oedekoven, South Dakota state veterinarian, knew of some veterinarians and clinic staff members infected with SARS-CoV-2, as well as some within his office. He said the state had no data that could show the prevalence of infections in clinics, but he knew from conversations with veterinarians the disease had taken a substantial toll on clinics.
Chris Copeland, executive director of the Texas VMA, steers veterinarians toward Centers for Disease Control and Prevention guidelines when they call for advice regarding what to do about employees who test positive for COVID-19, have contact with someone who is positive, or become ill. He has heard stories of infections brought in by clinic employees who had been infected outside of work—usually through family or friends.
Dr. Nicole Johnson, who is a practice owner in Pekin, Illinois, developed mild COVID-19 symptoms starting Nov. 1, 2020, including cough, fever, sore throat, and a few bouts of fatigue. She strongly suspects she contracted it from a family member.
“My symptoms were so mild that it’s very surreal to me to think that ‘Hey, I actually had it,’” she said.
Her receptionist previously had developed the disease, back in August, just after Dr. Johnson bought out her business partner. And one of Dr. Johnson’s two full-time associates tested positive for COVID-19 on Nov. 12, 2020, following a positive test in one of that associate’s children.
Dr. Johnson said the clinic maintained curbside pickup since mid-March. Inside, she requires masks, distancing during breaks, and frequent hand-washing and sanitizing.
Dr. Randy Wheeler, executive director of the Iowa VMA, said his association was considering a survey on COVID-19 in clinics. He knew of at least five clinics with infections or exposures and spoke with veterinarians from three of them.
Dr. Kathryn Dalton, who is a former clinical practice veterinarian, is a postdoctoral researcher and primary coordinator on a Johns Hopkins University study of veterinary and animal care workers’ perceptions of risk during the pandemic and their ability and willingness to continue working during the crisis. She said the study involves a national survey conducted July through October with more than 1,600 participants across the U.S.
She said preliminary results suggested respondents had high willingness and ability to work during the pandemic and slightly less confidence in infrastructure and other support systems. They also reported high knowledge of safety practices related to COVID-19 yet lower confidence in them.
Researchers at the University of California-Los Angeles Fielding School of Public Health also announced in August plans to study occupational exposure to SARS-CoV-2 and other pathogens among people in veterinary medicine and other animal health care fields. The study involves a questionnaire and follow-up surveys on demographics, exposures to SARS-CoV-2, occupational risk factors, mental health, and pandemic preparedness, the announcement states.
Complaints portray frustration
Since the start of the pandemic, the Occupational Safety and Health Administration has tracked more than 30,000 complaints of safety violations related to COVID-19.
As of Nov. 22, 2020, the agency had received at least 110 complaints related to COVID-19 protections in veterinary settings, although agency officials summarized 10 of them as “other than serious,” according to agency data. Half the remaining 100 complaints contain multiple allegations, among them:
- 47 relate to face coverings, such as whether the employer failed to provide personal protective equipment or declined to make employees or clients wear masks.
- 45 allege employers failed to prevent exposure to people with COVID-19 symptoms or confirmed infections, usually involving employees who came to work while sick.
- 39 relate to lack of distancing between employees, among employees and clients, or both.
- 25 relate to sanitation.
A few dozen describe other failures, such as disregard of state orders to postpone unnecessary procedures. Brief summaries from OSHA describe the allegations in simple terms yet often portray frustration, fear, and distrust:
- “Known COVID-19-positive employees are still allowed to continue working.”
- “Told employees that coronavirus was a hoax and parvo would kill more dogs than corona would infect people.”
- “Hospital manager and owner knowingly allowed an employee experiencing COVID-19 symptoms to continue coming to work despite exposing numerous others that are immunocompromised.”
- “The hospital has remained open and working with 10 confirmed COVID-19 cases.”
Distancing difficult with some tasks
Dr. Austin, of the Illinois Department of Public Health, said veterinarians seemed to be protecting clients well through practices such as curbside pet pickup. But, inside the clinics, staff struggled to keep safe distances.
“I think the best way to prevent it is to make sure you don’t have somebody in the practice who is infectious,” she said. “That is extremely difficult because you can try to control—as much as you can—what goes on within the practice, but you also have to advise your staff, ‘Hey, don’t forget that everything you do outside of this practice is going to affect your co-workers.’”
Owners also can maintain sick leave and quarantine policies that encourage absences when people might be infected, review safety plans with employees, and maintain separate cohorts of staff to reduce the risk of infections across a practice.
Asymptomatic workers also may transmit the virus to others, so letting people continue to work after COVID-19 exposure may have greater effects than having them stay home, she said.
AVMA survey results indicate 98% of veterinary practices are limiting contact with clients, most often through curbside service. AVMA officials also recommend veterinarians protect workers by conducting daily health checks and sending home people who become ill, maintaining confidentiality but informing co-workers of positive tests, washing hands, and using face coverings.
Those recommendations reflect guidance from the CDC, which recommends that people stay home and monitor their health for 14 days after close contact with someone who has COVID-19.
The AVMA guidance states that veterinarians may find ways to maintain safe distances in practices by reducing the number of people involved in procedures, gathering equipment ahead of time to minimize time spent close together, or breaking tasks into steps.
Dr. Borud, of Fargo, said her hospital deliberated when a veterinarian should be allowed to return to work after a close contact develops COVID-19, as well as what risks her hospital faced if the infection spread. Dr. Winning said some insurance carriers may need education on what veterinarians do, the precautions they are taking, and the precautions they cannot take because of the close proximity of their tasks.
Dr. Winning has reduced appointments and left gaps in the schedule to give staff members reasonable workloads with breaks. She said each day is a tightrope walk.
“We’re still here, and we’re still doing the same thing that we’ve done,” Dr. Winning said. “Our goal is to treat the animals, take care of our clients, and keep our team and our clients safe while we’re doing that. We’re juggling a lot right now and veterinary workers—I’m not talking about my team only—they’re tired.”