Practicing veterinary medicine during COVID-19

Updated on May 26, 2020

An evolving environment

At the onset of the COVID-19 pandemic, community leaders nationwide were asked to determine what services should remain available to community residents during shelter-in-place restrictions or lockdowns. Fortunately, veterinary practices have consistently been designated an essential healthcare business. Initial challenges were shortages of Personal Protective Equipment (PPE) and how to conduct business in the face of social distancing requirements, which were put in place in an effort to contain the spread of COVID-19 and "flatten the curve." To help meet those initial challenges, some states required healthcare professionals, including veterinarians, to postpone non-urgent/elective procedures to conserve PPE and reduce person-to-person contacts between healthcare staff members and the public to those absolutely necessary.

PPE shortages, while still present in some areas, have substantively lessened; social distancing strategies have largely been successful in flattening the curve; and executive orders restricting non-urgent/elective procedures have created a backlog of demand for veterinary services that, while not immediately urgent, remain important to protect the health and welfare of all types of animals and, in some cases, support good public health. As a result, some states are lifting such restrictions and allowing veterinarians to resume providing these services. In doing so, veterinary practices must continue to invoke strategies that support social distancing and keep their teams and clients safe, appropriately utilize PPE, and ensure provision of quality care for their animal patients.

Resumption of services, including veterinary services, is happening in phases and the White House and the CDC have created a plan for Opening Up American Again that provides broad guidance. With respect to federally recommended guidance, moving from one phase to another requires the following:

  • Symptoms—Within a 14-day period, downward trajectory of influenza-like illnesses AND downward trajectory of COVID-like syndromic cases
  • Cases—Within a 14-day period, downward trajectory of documented cases OR downward trajectory of positive tests as a percent of total tests (flat or increasing volume of tests)
  • Hospitals—Treat all patients without crisis care AND robust testing program in pace for at-risk healthcare workers, including emerging antibody testing

Potential application of the federal plan to veterinarians, veterinary team members, and the provision of veterinary services is summarized below. What and how veterinary services are resumed is dependent on plans issued by state governments on a statewide or county-by-county basis, so veterinarians should pay close attention to how the situation in their area is progressing through these or locally identified phases as well as the unique characteristics of their practice.

 

Phase I: Initial Resumption
For states and regions that satisfy gating criteria

Phase 2: Intermediate Resumption
For states and regions with no evidence of rebound and that satisfy gating criteria for a second time

Phase 3: New Normal
For states and regions with no evidence of a rebound and that satisfy gating criteria for a third time

People

  • Vulnerable* team members continue to shelter in place
  • Team members with vulnerable* household members observe extra precautions
  • Maximize physical distance in public
  • Limit gatherings to < 10 people
  • Vulnerable* team members continue to shelter in place; consider offering vulnerable team members duties that minimize their contact with other staff members or clients
  • Team members with vulnerable* household members observe extra precautions
  • Maximize physical distance in public
  • Limit gatherings to < 50 people
  • Vulnerable* team members back at work, but maintain social distance
  • Other team members minimize time in crowded environments, inside and outside of the practice

Practices

  • Return reduced staff gradually (25% at a time)
  • Encourage telework for team members where possible
  • Keep lobbies and common areas where clients and/or team members congregate closed
  • Strongly consider accommodations for vulnerable* team members
  • Continue returning staff gradually and to normal schedules
  • Encourage telework for team members where possible
  • Limited lobby and common area access with adherence to social distancing
  • Strongly consider accommodations for vulnerable* team members
  • Normal work schedules
  • Gradually return to normal lobby and common area access, adhere to social distancing

Elective surgeries

  • Assess sufficiency of PPE (ensure able to treat urgent cases and that shortages affecting human health care in area have been addressed)
  • Resume as clinically appropriate and with attention to impact on scheduling
  • Assess sufficiency of PPE (ensure able to treat urgent cases)
  • Perform as clinically appropriate

Perform as clinically appropriate

Travel

  • Minimize non-essential travel
  • Adhere to CDC self-isolation guidelines after trips

Non-essential travel can resume, restrictions to/from affected areas may continue

Restrictions to/from affected areas may continue

*Vulnerable team members are defined as those who are older (> 65 years old) or with serious underlying CDC-identified health conditions, including high blood pressure, chronic lung disease, diabetes, obesity, and asthma, or with compromised immune systems

Some states and communities have identified a Phase 4 (Post-pandemic) as availability of a vaccine, effective and widely available treatment, or the elimination of new cases over a sustained period of time through herd immunity or other factors.

Additional guidance specific to veterinary services is available across our webcenter. In addition, the CDC has issued guidance for companion animal veterinarians and the AVMA has compiled guidance for mobile and house call veterinarians, equine veterinarians, food supply veterinarians, and shelter veterinarians.

Employer obligations and liability

Employers have ethical and legal obligations to employees in veterinary practices, and federal and state agencies responsible for the health and safety of workers have issued new guidance for operations and communication within the workplace as the COVID-19 pandemic evolves. At the federal level, examples include CDC's Interim Guidance for Businesses and Employers and the Occupational Safety and Health Administration's Guidance for Preparing Workplaces for COVID-19.

The Occupational Safety and Health Act of 1970's (OSHA) General Duty Clause indicates that each employer shall:

  • Furnish to each employee employment and a place of employment that are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees.
  • Comply with occupational safety and health standards promulgated under the OSHA.

In addition to their ethical obligations and legal requirements under the OSHA, employers may face liability from employees seeking compensation. Many employers assume such claims fall under workers' compensation insurance; however, workers' compensation usually does not apply to pandemics unless there is demonstrable proof that the illness or injury was solely contracted within the course and scope of job duties. Most workers' compensation state statutes include an "exclusive remedy" provision that an employee's only course of action and remediation is through the workers' compensation claims process unless the employee experiences retaliation by the employer. Because workers' compensation carriers may not cover cases resulting from COVID-19, the exclusive remedy provision may not apply and, absent state statutes to the contrary, employees are free to pursue legal action. One area that appears to be gaining traction is claims of employer negligence—claims that the employer did not act reasonably to provide a safe working environment for their employees, including appropriate screening of workers to prevent transmission of SARS-CoV-2, adequate cleaning and disinfection, and provision of appropriate PPE.

Veterinary employers should consider creating written workplace policies related to COVID-19 that provide clear processes and expectations for employee behavior. Such policies may include:

  • Requirements for conduct, including but not limited to hand washing/sanitizing; social distancing with team members and clients; cleaning and disinfection of the workplace, including high-touch surfaces and equipment; and screening, self-monitoring, and management of team members for exposure to or illness with COVID-19.
  • Consequences for failure to comply with such policies.

To assist in creating appropriate policies and procedures for your practice, stay informed about the local COVID-19 situation and know where to turn for reliable, up-to-date information in your community. Monitor the CDC's COVID-19 website and your state and local health department websites. The International Association of Emergency Managers' Novel Coronavirus Hotspot Illness Radar may also provide helpful information.

Coordination with state and local health officials is strongly encouraged for all businesses so that timely and accurate information can guide appropriate responses in each location where their operations reside. Since the intensity of an outbreak may differ according to geographic location, local health officials will be issuing guidance specific to their communities. Goals are to reduce employees' risk of contracting COVID-19; reduce transmission among employees; maintain a healthy work environment; and maintain healthy business operations, including continued provision of quality patient care.