Updated on May 26, 2020
Because there is currently no vaccine available to prevent COVID-19, the best way to avoid becoming ill is to avoid exposure to the virus. Certain preventive actions are helpful, including screening and testing employees for exposure to and illness with COVID-19; clear direction regarding what steps are to be taken if veterinary healthcare team members develop symptoms of acute respiratory illness; hygiene and respiratory etiquette, including the use of cloth face coverings; and social distancing in the clinic among employees and during interactions with clients and vendors.
Screening and testing employees for exposure to and illness with COVID-19
Consider conducting daily in-person or virtual health checks (e.g., symptom and/or temperature screening) of veterinary team members before they enter the clinic. In some areas screening may be required as part of “reopening” plans. Employers who opt to screen must ensure that screening incorporates appropriate safety measures, such as social distancing and use of PPE (e.g., mask, gloves, protective eyewear). Provisions should also be made for appropriately documenting any screening that is conducted, including managing medical information obtained from employees to ensure it remains private and confidential.
Questions that may be asked include:
- Whether they have experienced any of the following CDC-specified symptoms of COVID-19:
- Shortness of breath or difficulty breathing;
- Or at least two of the following symptoms: fever (> 100.4 F), chills, repeated shaking with chills, muscle pain, headache, sore throat, new loss of taste or smell.
- If they have tested positive for COVID-19 or are currently waiting for COVID-19 test results.
- Whether they have self-quarantined (remaining in their home and participating in outdoor activities without coming closer than six feet from others) and if so, for how many days and why.
- If they have been exposed to anyone who has tested positive for COVID-19 or anyone who is currently waiting for COVID-19 test results.
- Whether they have been exposed to anyone with any of the CDC-specified symptoms of COVID-19.
- If they have traveled outside their state or regional area.
Employers may only ask these questions of veterinary team members who are working in the clinic in-person. COVID-19-related medical questions may not be asked of team members who may be working remotely/telecommuting. Employers may also not ask other medical questions that are unrelated to COVID-19 unless those questions are consistent with the team member’s ability to perform the essential functions of their job.
On April 23, 2020, the Equal Employment Opportunity Commission (EEOC) provided updated guidance for employers wishing to conduct COVID-19 diagnostic testing. The EEOC indicated that such testing may be conducted for COVID-19 because an individual with SARS-CoV-2 may pose a direct threat to the health of others in the workplace. Consistent with Americans With Disabilities Act (ADA) standards, employers should ensure that tests are accurate and reliable and recommends that employers review guidance from the FDA about what may or may not be considered safe and accurate testing, as well as guidance from the CDC or other public health authorities (including checking for updates). Employers may adopt a regularly scheduled approach to medical testing or test on a case-by-case basis based on symptoms or exposure.
Steps to be taken if veterinary healthcare team members develop symptoms of acute respiratory illness
Veterinary healthcare team members who develop symptoms of acute respiratory illness should follow CDC-recommended steps. These include staying at home except to get medical care and not returning to work until they are free of fever (fever is defined as a temperature of 100.4F or higher, using an oral thermometer) or signs of a fever without the use of fever-reducing or other symptom-altering medicine (e.g., cough suppressants) for at least 72 hours; other symptoms (cough, shortness of breath) have improved; and at least 10 days have passed since symptoms first appeared. Team members who appear to have symptoms of acute respiratory illness upon arrival at work or who become sick during the day should immediately be separated from other team members and clients and sent home. Flexible sick leave policies are important and team members should be made aware of these policies.
If a team member is confirmed to have COVID-19, the veterinary practice owner should inform other team members of their possible exposure to COVID-19, but maintain confidentiality as required by law. Team members who are exposed to another employee with confirmed COVID-19 should contact their physician or local health department to determine how best to proceed. It is possible that public health officials may ask that the veterinary practice be temporarily closed for personnel isolation and disinfection. AVMA has developed guidance for managing employees known to be exposed to confirmed or suspected cases of COVID-19 or that are confirmed or suspected to have COVID-19 themselves. Review human resources policies to make sure that policies and practices are consistent with public health recommendations and existing state and federal workplace laws.
Hygiene and respiratory etiquette
Veterinary healthcare team members need to wash their hands often with soap and water for at least 20 seconds, especially after blowing their nose, coughing, or sneezing, going to the bathroom, and before eating. If soap and water are not readily available, an alcohol-based hand sanitizer with at least 60% alcohol should be used. Hand sanitizers should be placed in multiple locations, including in exam rooms, procedure areas, offices, and conference rooms to encourage hand hygiene. Team members should avoid using other employees’ phones, desks, offices, and other work tools and equipment, when this is possible. If tools and equipment are shared, frequent cleaning and disinfection is advised.
Team members should avoid touching their face, in particular their mouth, nose, and eyes with their hands. When coughing or sneezing veterinary team members (and clients if allowed in the clinic) should cover their mouth and nose with a tissue, throw the tissue in the trash, and wash or sanitize their hands immediately afterwards.
CDC recommends the use of cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., among staff in veterinary clinics), especially in the face of significant community-based transmission. The purpose of cloth face coverings is to slow the spread of the virus and prevent people who may be unaware they have SARS-CoV-2 from spreading it to others. Professional judgement should be used in determining whether a cloth face covering, face mask, or other PPE is appropriate when performing particular tasks in the clinic.
Social distancing among staff in veterinary clinics
SARS-CoV-2 is transmitted person-to-person; therefore, limiting contact (incidence, closeness, and duration) with others is the best way to reduce its spread. Infectious disease experts indicate social distancing (maintaining at least six feet [two meters] from other people) is key to controlling COVID-19. Transmission from asymptomatic individuals is known to occur, so it’s important to maintain social distance even from those who do not appear to be ill. Applying social distancing principles in veterinary practices is challenging and requires thoughtful planning and coordination. Strategies include:
- Reviewing clinic layout to increase separation as possible. Increase space between staff members in reception and office areas. Repurpose less frequently used examination rooms or conference rooms to create additional work space. If finding additional space is not possible, consider whether it’s possible to place protective barriers between staff members who must sit in close contact (e.g., sneeze guards, plexiglass or plastic shields).
- Supporting work-at-home arrangements for staff members performing administrative functions for which an ongoing presence in the clinic is not required.
- Evaluating whether lounges/breakrooms, conference rooms, and other group spaces in the clinic should be temporarily closed (or repurposed) to help discourage accidental gatherings of staff in confined spaces.
- Planning in advance for procedures that potentially require staff members to be within six feet of each other (e.g., patient restraint, drawing blood, catheter placement, anesthetic induction, certain radiographic and surgical procedures). Consider if there are alternate ways to perform the procedure that do not require multiple people, gather necessary equipment in advance so as to minimize the time required, and consider whether it is possible to perform the task in steps that support social distancing between staff members.
- Splitting practice employees into smaller teams, as possible, that remain together and that refrain from or limit contact with other teams (e.g., separate shifts with consistent personnel, paired teams of veterinarians and technicians). If the number of employees in a clinic permits the creation of distinct teams, stagger their shifts to allow for time for disinfection of premises and equipment and in case members of a particular team need to isolate. This reduces the potential for exposure of all personnel in a veterinary clinic should a staff member become infected with SARS-CoV-2.
- Using cloth face coverings routinely in the clinic, in situations other than where PPE would normally be worn for medical or surgical procedures (appropriate PPE must be used in those cases). Doing so can help reduce risk of transmission of COVID-19 by asymptomatic carriers.
- Replacing longer in-person staff meetings with video- or teleconferences whenever possible.
Interactions with clients
Maintaining social distancing with clients is important as these interactions arguably present the greatest risk of SARS-CoV-2 exposure for veterinary staff. In some jurisdictions, executive orders/direction have been issued that limit customer access to businesses. For example, restrictions on gathering size (e.g., 10 people) may apply to activity in clinics. In most cases, established limits will not apply to employees working in the clinic, but may apply to clients in waiting rooms. As communities seek to re-establish normal business operations, executive orders/direction may change depending on the “phase” of COVID-19 in that area (e.g., rapid spread, flattening curve, recovery, revitalization, restoration). Local requirements should be regularly consulted regarding what extent of interaction with clients is appropriate. In all cases, animals that are sick or injured should receive veterinary attention. Strategies that support social distancing with clients include:
- Pre-visit triage to prioritize and determine which patients need to be seen at the clinic, to assist with scheduling (appointment with curbside waiting or drop-off and pickup), and to clarify client’s medical status with regard to COVID-19.
- Not admitting clients with respiratory disease and/or confirmed or pending results for COVID-19 into veterinary clinics. Have another individual bring the patient to the clinic or utilize telemedicine, if medically appropriate.
- Encouraging clients to don cloth face coverings when visiting your clinic.
- Curbside service (transfer of pets with little to no contact with owners, sometimes referred to as “concierge service”), to include staff use of PPE (e.g., cloth face coverings, masks, gloves, gowns) as appropriate. Use clinic leashes to transfer patients and instruct clients that pets being presented for care should not wear “outfits” (e.g., t-shirts, bandanas).
- Call-ahead, no-human-contact patient drop-off and return through a designated clinic entrance having restricted access to other clinic space. Consider animal containment when doing so, including designated carriers that can be readily cleaned and disinfected between uses and secure hooks for leashes.
- Using telephone or videoconference to gather information on history and clinical signs and to conduct follow-up consultations.
- Documenting verbal consent, rather than requiring signatures.
- Using contactless electronic payment as much as possible.
- Actively integrating the use of telemedicine, as medically appropriate and consistent with state and federal requirements for a veterinarian-client-patient relationship (VCPR).
- Remote prescribing, when medically appropriate and in line with state and federal requirements.
- Contact-limited (deposit into client’s car) or contact-free (designated no-contact distribution location at clinic or direct-to-home shipping) distribution of medication and/or prescription foods, including contactless payment. The latter are particularly important for clients at increased risk of spreading COVID-19 or with increased risk of complications or severe disease should they be exposed. This is a good opportunity to develop and/or increase use of online prescription and pet food portals that are connected to your clinic’s website.
- When patients and clients are seen together inside the veterinary clinic, giving consideration to:
- Ensuring clients don cloth face coverings
- Traffic flow, including what areas clients will or will not be permitted to access and minimizing staff contact with those clients
- Admitting clients and patients directly from their cars into an examination room
- Allowing only one client at a time into waiting rooms or, if space permits, enforcing social distancing in waiting rooms. Adjust seating areas/arrangements to accommodate social distancing requirements as needed and ensure appropriate social distancing also is maintained between clients and reception staff.
- Appropriate signage to ensure client awareness of social distancing need and approach.
- Having staff members, rather than clients, hold/restrain animals.
- Those that address temperature concerns, especially during the summer months when clients may be waiting in vehicles where temperatures can climb rapidly (and endanger both clients and patients). Consider:
- Scheduling appointments sufficiently far apart, and not scheduling appointments for a half-hour or so mid-morning and mid-afternoon to accommodate any unanticipated delays or emergencies.
- Admitting animal owners directly into examination rooms, rather than having them wait in their vehicles. Depending on what COVID-19 phase an individual community is in, consider a limited in-lobby-into-exam room approach. Place tape on the floor to direct animal owners as to where they can sit and wait. Wipe surfaces (chairs, armrests) between clients.
- Having owners drop off their animals, rather than wait in their vehicles. Portable crates or temporary enclosures can help hold additional animals if an insufficient number of kennels or permanent enclosures are available.
- Using telemedicine when medically appropriate and in accord with state and federal requirements for a VCPR.
- Ensuring that veterinary technicians are fully utilized to support seeing patients and providing care
- Increasing attention to managing scheduled appointments, to include:
- Pre-review of records for routine appointments so that necessary equipment and products (e.g., vaccines, parasiticides) are readily available and do not need to be gathered
- Scheduling animals known to be ill as drop-offs, so that time to work them up is readily available without causing extended waiting times for clients
- Temporarily admitting animals discovered to need additional diagnostic work during a routine examination and having the owner return to pick up the animal later, with consultation provided via telephone or videoconference. This will avoid a prolonged waiting time in the vehicle for that client and will also prevent delaying subsequent appointments.
- Cooling support in parking/waiting areas:
- Adding tenting to the parking lot to create shaded waiting areas (if clients are to wait in such areas outside of their cars, appropriate distancing should be encouraged and monitored)
- Providing access to coolers of bottled water for clients who are waiting for their animals (consider providing sanitizing wipes for disinfection of equipment and product)
Vendors and deliveries
In addition to applying strategies for social distancing among employees and during interactions with clients, thought should be given to how other visitors to the veterinary clinic, including vendors and delivery personnel, will be accommodated. Contactless delivery and pickup of items to/from a designated area that is also regularly cleaned and disinfected is a preferred approach. Consider implementing alternatives to confirmatory signatures (e.g., e-mail or text confirmation). If signatures must be provided, use clinic pens or styluses or disposable alternatives. If face-to-face interactions cannot be avoided, utilize cloth face coverings, maintain social distancing as much as possible, and practice diligent hand hygiene. If entry to the clinic is required, limit where vendors are permitted to go, as possible. Arrange vendor visits so that vendors are provided access during times that have the least amount of employee and client presence. Contactless temperature checks prior to vendors having access to facilities could also be considered (consistent with public health recommendations and existing state and federal workplace law.
Considerations for specific veterinary practices
To help you navigate the nuances of practicing veterinary medicine during the COVID-19 pandemic, the AVMA has developed resources specific to several types of practice. Veterinarians should only examine animals at homes or facilities where someone is ill with COVID-19 after seeking assistance from local and state public health officials and should carefully follow guidance from those agencies, as well as that issued by the CDC. Appropriate PPE should be considered in all cases.