COVID-19 and the international experience

Published April 5, 2020

The AVMA has been in contact with international colleagues to share resources and gather information regarding how the veterinary profession is faring in their regions.

Europe

Veterinary medicine as an essential business

Many veterinary associations and regulatory boards have advocated for veterinary medicine to be considered an essential business by local and national governments. The World Veterinary Association (WVA) and World Organization for Animal Health (OIE) published a joint statement titled COVID-19 and Designation of Veterinary Work as Essential Business. The Federation of Veterinarians of Europe (FVE) and World Small Animal Veterinary Association (WSAVA) also have statements posted on their websites, as do the Italian, British, French, and Spanish veterinary associations and/or regulatory bodies. However, services provided by veterinarians may not all be equally essential. Additionally, services considered essential initially may become non-essential as governments enact stricter travel restrictions and shelter-in-place requirements to mitigate the spread of COVID-19. In some cases, categorization of specific procedures as essential or non-essential has led to differences of opinion between veterinary associations in any given country or between the association and the regulatory body. Essential services always include those associated with food safety and security, public health, and urgent or emergent medical and surgical procedures. However, even services related to food safety and public health can be recategorized from essential to non-essential. For example, on March 26, the Italian government suspended all animal health-related epidemiological surveillance activities except those related to African swine fever and highly pathogenic avian influenza.

Protecting the health of veterinary clinic team members

Human medical needs for personal protective equipment (PPE) are prioritized over veterinary medical needs across Europe. However, PPE is still needed at veterinary clinics to help prevent spread of COVID-19 and protect animal and veterinary health during certain procedures. European veterinary associations and regulatory bodies have been continually developing and updating resources to assist their member veterinarians in determining how best to protect their animal health care teams and clients while preserving PPE and still providing essential medical and surgical services for their animal patients.

The Federazione Nazionale degli Ordini Dei Veterinari Italiani (FNOVI; National Federation of Italian Veterinary Orders), which is the regulatory body for veterinary medicine in Italy, is one association that has stepped up to assist Italian veterinarians during this crisis. FNOVI has responded to multiple government decrees enacted since late February to help control the devastating COVID-19 epidemic sweeping that nation by providing guidance to Italian veterinarians on allowed movements and procedures, as well as on government-funded compensation for employees required to take leave for health or business reasons during the pandemic.

In Italy, each veterinary clinic that stays open must guarantee that all measures designed to prevent spread of COVID-19 are in place. As recommended by FNOVI, common measures taken by Italian veterinarians include use of facemasks and gloves, maintaining a two-meter distance between clients and staff, screening clients at the reception area, washing hands, keeping a disinfectant dispenser in each exam room and in the waiting room and reminding clients and staff to use these dispensers often, and triaging clients/patients outside the clinic and/or by phone. These methods appear to be effective.

The same is true on farms. All biosecurity measures and use of appropriate PPE have been implemented, but the shortage of disposable materials has had a significant impact on large and food animal veterinarians, especially in Lombardia, the worst COVID-19 cluster area, which is also the most important area for animal agriculture in Italy. Veterinarians working in Italian slaughterhouses/food inspection are essential government employees under public services and, for the most part, are continuing to work as normal. Thus far, these veterinarians have access to sufficient PPE.

Ongoing shortages of PPE and continuing escalation of COVID-19 cases and deaths across Italy resulted in a March 9 government decree that restricted veterinary visits and examinations to emergency needs only. FNOVI released guidelines to help define emergency, but not all veterinarians concurred with those guidelines. Many struggled with the need for revenue to keep their businesses open and staff paid and the need to comply with best practices, including the use of PPE, to help mitigate the impact of COVID-19 on human health. Although the use of appropriate measures such as distance and PPE and limiting cases seen to those that are urgent and emergent have seemed effective in limiting spread of COVID-19 at veterinary clinics, more and more clinics are closing—largely because of ongoing and severe PPE shortages and the continued spread of COVID-19 across Italy. These closures, in turn, result in lost revenue and staff layoffs. Some of the economic losses are being met by financial aid packages offered by the national government.

Multi-country survey to assess impact of COVID-19 on veterinarians

CM Research, through Vetspanel, is conducting an ongoing survey to address the impact of COVID-19 on companion animal veterinary professionals and their practices. Initiated on March 13, the survey is being repeated every two to three weeks for as long as the COVID-19 outbreak continues. Respondents include a mix of owners and partners at companion animal practices, from small and large independently and corporate-owned practices across five European countries, the USA, and Australia. Results are available online and include:

  • The almost universal belief that the pandemic will get worse, even in countries where it has been present for longer (e.g. Italy and Spain); only about 1% of respondents think things are improving.
  • An overall concern about the risks of the pandemic, which is highly correlated with experience. This suggests that concern will only increase in those countries where prevalence of COVID-19 is not yet high.
  • Social distancing measures adopted in Spain and Italy have resulted in an increased use of online tools to deliver advice to clients.