Veterinarians had already been through a coronavirus pandemic prior to the SARS-CoV-2 outbreak.
Porcine epidemic diarrhea virus has plagued swine operations in Europe and Asia for three decades, but in 2013, the virus arrived in the United States, infecting millions of immunologically naive pigs. By the time the PED outbreak was contained the following year, the virus had already spread to 29 U.S. states, killing an estimated 7 million pigs.
During the early months of 2020, as another novel coronavirus was burning across the planet, veterinarians weren’t consulted regarding their experiences with managing this particularly nasty family of viruses in animal populations.
“No one thought to look to veterinarians or draw upon our research and knowledge about coronaviruses,” said Dr. Laura Hungerford, a professor and head of the Department of Population Health Sciences at Virginia-Maryland College of Veterinary Medicine.
“No one from the human medicine side of things thought to reach out to ask, ‘How did you stop the PED epidemic? How useful were vaccines? What should we do to try to stop the spread of COVID?’” Dr. Hungerford said. “There are a lot of lessons here.”
One of those must be a better understanding—by the public and members of the public health community—that veterinary medicine is much more than a career for people who love animals. Veterinary medicine is also a public health profession protecting people at every point of contact with the rest of the animal kingdom.
The very real threat from these zoonotic diseases is practically shouting at us that a one-health approach is essential.
Dr. Bruce Kaplan, co-founder of the One Health Initiative
One health now
The COVID-19 pandemic confirms what one-health advocates have been saying for years: Multidisciplinary collaborations among veterinarians, physicians, and public health professionals are necessary to address the growing public health threat associated with zoonotic diseases.
SARS-CoV-2 is just the latest in a growing list of viruses that have spilled over from animal hosts into human populations. Most emerging infectious diseases over the last several years have been, in fact, zoonotic in nature: West Nile virus infection, avian influenza, monkeypox, severe acute respiratory syndrome, Middle East respiratory syndrome, and now COVID-19.
Dr. Bruce Kaplan, co-founder of the One Health Initiative team and website, can imagine several potential nightmare scenarios involving these pathogens. One such scenario involves Nipah virus. Although a small number of Nipah virus outbreaks have been reported in Asia, the World Health Organization has identified the virus as a priority disease for WHO research.
“This dreadful disease can spread from bats to pigs and then to humans and has a mortality rate of between 40% and 75%,” Dr. Kaplan said. “There are, of course, many other zoonotic disease candidates that have emerged and more that shall emerge in the future.
“The very real threat from these zoonotic diseases is practically shouting at us that a one-health approach is essential,” he added.
Veterinarians in action
A paradigm shift was underway well before the COVID-19 pandemic. In 2009, the Centers for Disease Control and Prevention became the first—and, so far, only—federal agency to establish an office dedicated to one-health activities, both domestically and globally. The current director, Dr. Casey Barton Behravesh, said the CDC office has been involved with the federal response to the COVID-19 pandemic since the start. The office created and chairs the One Health Federal Interagency COVID-19 Coordination Group, comprising 20 federal agencies across multiple departments.
Additionally, the office guides domestic and global strategy and priorities on the one-health aspects of the coronavirus, including surveillance and testing for SARS-CoV-2 in animals; consultations with and technical assistance for state, local, federal, and other partners; conducting and supporting research to better understand transmission dynamics between people and animals; and developing guidance to keep people and animals safe and healthy.
“We are still learning about the virus that causes COVID-19, and more studies are needed to understand if and how different animals, including pets, could be affected by COVID-19 and the implications this could have for human health,” Dr. Barton Behravesh explained. “To help fill the gaps in our knowledge of SARS-CoV-2 in pets, CDC, USDA, state public health and animal health officials, and academic partners are working in some states to conduct active surveillance of SARS-CoV-2 in pets, including cats, dogs, and other small mammals, that had contact with a person with COVID-19.
“These animals are being tested for SARS-CoV-2 infection and also tested to see whether the pet develops antibodies to this virus. This work is being done to help us better understand how common SARS-CoV-2 infection might be in pets as well as the possible role of pets in the spread of this virus.”
Before the pandemic, several federal agencies had endorsed the one-health concept, including the Fish and Wildlife Service, Food and Drug Administration, and Food Safety and Inspection Service. Yet, there’s a sense in Washington, D.C., that these programs are not coordinating their efforts.
Dr. Kurt Schrader, a veterinarian and a U.S. representative from Oregon in Congress, attempted to tear down these silos in 2019 with bipartisan legislation that he introduced with his veterinary colleague, Dr. Ted Yoho, who has since retired from Congress. The Advancing Emergency Preparedness Through One Health Act (HR 3771/S 1903) would require the U.S. Department of Agriculture and Department of Health and Human Services to work with other departments and relevant agencies on a national one-health framework to coordinate federal one-health activities.
Although the bill didn’t make it out of committee, Dr. Schrader is expected to reintroduce the measure during the new Congress, which may be motivated to act on it and similar legislation in light of the pandemic.
On the front lines
Veterinary medicine is a public health profession, although it can be less obvious for veterinarians not directly involved in epidemiology, food safety, toxicology, and research on infectious diseases. The SARS-CoV-2 outbreak may have changed that, as veterinarians across all sectors stepped up to respond to the COVID-19 pandemic.
Veterinarians were essential in understanding how the novel coronavirus affected animal populations, including livestock and pets. They spoke to the news media and reassured the public about how studies so far show no animal species transmits the novel coronavirus to humans, with the exception of the unidentified source and possibly farmed mink.
“Veterinarians have been on the front lines, educating pet owners and members of the public in addition to serving in local, state, and federal public health departments to combat this pandemic,” said Dr. Donna DeBonis, president of the American Association of Food Safety and Public Health Veterinarians.
This past October, the AAFSPHV honored veterinarians worldwide with the 2020 Food Safety and Public Health Veterinarian of the Year Award for their work before, during, and after the pandemic.
“Since the start of the pandemic, we have seen an increase in the interest in veterinary public health and anticipate the roles and opportunities for veterinarians will continue to increase,” Dr. DeBonis added.
Governors across the nation declared veterinary practices an essential service, allowing practices to remain open as much of the country went into lockdown. Veterinarians showed their adaptability no matter what segment of the profession they were in. While some veterinarians were dealing with market disruptions and working to ensure a safe and uninterrupted food supply, others were caring for horses, laboratory animals, zoo animals, and pets. All adapted their workplaces in some way to protect their teams while continuing to provide care for animals and services for clients.
The emotional bond between people and their pets during the pandemic is a subject of interest to many researchers. Early studies found pets had a positive influence on the owner’s mental health during this especially stressful time. For example, a study of Australian pet owners published July 2020 in the International Journal of Social Psychiatry found that pets made isolation easier, reduced loneliness, and increased companionship during the lockdown.
‘Prepare to take a beating’
As the COVID-19 pandemic stretched from days to weeks to months to a year, it became apparent that public health can be controversial.
Public officials were pilloried for shuttering large parts of society, including stores, schools, and sports venues; for requiring masks be worn in public; and for limiting or canceling social gatherings. The most public face of the nation’s handling of the pandemic, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, was one of several public health officials who received death threats.
“The inherently controversial nature of public health is caused by a constant tension between collective responsibility and individual behavior,” explained Dr. Donald Noah, a veterinary epidemiologist who has been deputy assistant secretary for the Department of Defense and Department of Homeland Security.
Currently, Dr. Noah is an associate professor of public health and epidemiology at the Midwestern University College of Veterinary Medicine. Public health, he explained, is at its best when it’s apolitical. Problem is, it never is.
“I tell my students, ‘Prepare to take a beating,’ because one thing we should always strive to do as public health veterinarians is have an opinion—one based on evidence-based research that you can argue in a way that’s collegial without spiraling into name-calling, which ends up being counterproductive,” Dr. Noah said.
On the point about the difficulties of communicating potentially controversial health information to the public, Dr. Hungerford believes veterinarians have an advantage over their colleagues on the human side of medicine.
“Most of us in veterinary medicine work directly with communities, and we understand no one likes to be told what to do or that we know better than the client,” Dr. Hungerford explained. “Listening and valuing where others are coming from is necessary to work toward a common good. As veterinarians, we know this, I think more so than many health professionals.”