A cat in Belgium, owned by a person with COVID-19, has tested positive for the virus. The cat developed diarrhea, vomiting and respiratory difficulty about 1 week after the owner got sick, and SARS-CoV-2 was found in the cat’s feces. It’s not clear whether the test used was PCR (which can detected live or dead virus) or virus isolation (which only detects live virus), or if other samples were also tested. It’s also not clear whether the cat was sick because of the infection with SARS-CoV-2 or whether it had some other co-incidental problem (or whether the cat is still alive or not).  They were clear that this is another suspected case of human-to-animal transmission, and not the other way around.

Is this surprising?

Is this concerning?

  • I don’t have any more concern today than I did before this report, since it was likely that this was going to happen, and animals (still) presumably pose very limited risk. An infected cat isn’t a big concern in the household since the person who exposed the cat in the first place is the main risk. This virus is being transmitted very effectively person-person, so animals likely play little role, if any in the grand scheme of things.  But we still want to take basic steps to keep the risk as low as possible.

So, what do we do?

  • The same thing we’ve been saying all along. If you’re sick, stay away from animals just like you would other people. If you have COVID-19 and have been around your pets, keep your pets inside and away from other people. While the risk of transmission to or from a pet is low, we don’t want an exposed pet tracking this virus out of the household (just like we don’t want an infected person doing that).

This is completely unsurprising. It doesn’t mean things are changing or that we have more risk today than yesterday. It just emphasizes again the importance of paying attention to basic infection control measures.

If you’re worried about getting COVID-19, worry about your human contacts, not your pets. Keep pets away from high risk people, but otherwise, your risk is from exposure to people, not your pet.

While it feels like “all COVID all the time,” other infectious disease issues still carry on beyond the current pandemic. They’re not as big, but they’re still relevant (and a break from writing about COVID-19 is nice).

The FDA has announced a voluntary recall of whole capelin fish treats from IcelandicPlus LLC, because of concerns about botulism. Here, as with most botulism recalls, the concern is the potential for botulism, not identification of the bacterial toxin in the treats or reports of disease. Most often, the risk is limited, but with such as serious disease, there’s little risk tolerance.

Botulism is a paralytic disease caused by toxins produced by the bacterium Clostridium botulinum. This bacterium can be found widely in the environment in some regions. If we ingest a few of these bacteria, it’s not usually a problem. If a person or a pet ingests a minute amount of the toxin, it can cause botulism.

The risk of botulism is primarily a concern in two situations. One is infants that may ingest the bacteria themselves. An infant’s intestinal bacterial population is poorly developed and this can allow the bacteria to grow in the gut (when they likely wouldn’t in an adult).  As the bacteria multiply they produce toxin, which then causes botulism.  That’s one reason we’re not supposed to give honey to infants too, because it sometimes contains C. botulinum spores.

The bigger issue is ingestion of toxin that’s already in something that’s being eaten.  The bacterium grows in specific conditions when there’s no oxygen, such as in decaying matter. When it grows, it produces toxin, and when the toxin is ingested (whether the bacteria are still there or not), botulism ensues. That’s where concerns come into play with this recall.

The recalled pet treats are whole, dried, un-eviscerated fish. That’s allowed, but there are rules about the size of the fish that can be sold like this. With larger fish, there’s more potential for conditions amenable to C. botulinum growth to occur in the fish’s gut during drying. FDA guidelines limit these small dried whole fish to 5 inches in length.  Larger cured fish have been linked to a few outbreaks of botulism in people. Since the company (IcelandicPlus LLC) has been selling fish in excess of this size, they’re being recalled.

The company has also stated that they will be changing their supplier to ensure fish are consistently less than 5 inches and that fish greater than this size will be eviscerated. That’s good, but I’d hope the company would have their own quality control program to check this, and not just blame and change the supplier.

Une traduction française de notre document récent, La médecine vétérinaire en période de restriction des services électifs et de distanciation sociale, est maintenant disponible. Traduit par Dre Nathalie Therrien, MV (merci beaucoup!).

For the English version, please see our previous post on veterinary medicine, essential services and social distancing.

Hopefully this is the last time I’ll take up a blog post to send out a request, but as I’ve mentioned before, I’m helping Dixon’s Distilled Spirits repurpose their alcohol to make hand sanitizer during the COVID-19 pandemic. They’ve donated a few thousand litres of hand sanitizer to healthcare providers and first responders over a wide area in the province, including Kingston, Owen Sound, Brantford and Cambridge (for those of you from outside Ontario – that’s a pretty big range).

They have lots of alcohol, and with the help of Worms & Germs Blog readers we even found a source of hydrogen peroxide, but we’re still trying to find a large volume supplier of glycerol. If anyone reading this in Ontario has a connection with a company that makes glycerol that could go into hand sanitizer, please let me know directly at jsweese@uoguelph.ca.

Lots of people are stepping up to do good things during this outbreak. If anyone can help us find more glycerol, that would be great.

Much has been reported about the 17-year-old Pomeranian in Hong Kong that was the first dog to test positive for SARS-CoV-2, the virus that causes COVID-19.  It was positive on a series of PCR tests on nasal and oral swabs over the first week it was in quarantine.  They also collected blood samples to test for antibodies against the virus. The blood first tests were negative, which wasn’t too surprising, but was taken by some to mean the dog wasn’t infected (just “contaminated” with virus such that there was no immune response). However, subsequent testing of a sample taken back on March 3 showed that the dog did indeed produce antibodies against the virus, and therefore was definitely infected at some level.  Unfortunately, as previously mentioned, the dog died a few days after being released from quarantine (it’s not suspected that its death had anything to do with its infection with SARS-CoV-2).

The update from the Hong Kong Agriculture, Fisheries and Conservation Department also provides some more information about other testing they’ve done to date. They have tested 17 dogs and 8 cats from households with human COVID-19 infections, and two of the dogs tested positive.  It’s interesting (and encouraging) that no cats have tested positive so far, since I’ve had more concerns about the susceptibility of cats, but finding positive results in 2 out of 17 dogs definitely tells me we need to study this more.

This report  doesn’t tell us whether dogs and cats are a source of infection, because being infected doesn’t necessarily mean an individual is infectious (i.e. able to pass the virus on). We need to test more animals to see how common infection is and whether live virus can be recovered from infected animals. Unfortunately getting samples from households of infected people with pets has been a challenge due to the social distancing and human-to-human transmission concerns (which are clearly paramount).

I’ve written a lot about COVID-19 issues in veterinary medicine, but most of that material has focused on brick-and-mortar practices. There are lots of mobile veterinarians out there too, and they have different challenges with COVID-19.  Small animal mobile veterinarians are at increased risk of exposure because they go into households where they can’t use many of the social distancing practices that we can use in a standard veterinary clinic.

Many of these veterinarians are asking what they should do. Like most things pertaining to this virus, there’s no straightforward answer. The easiest way to prevent risk of exposure is for mobile veterinarians to stop doing house calls, but that’s not necessarily the best thing for veterinarians, owners or pets. The real questions relate to what can be done to reduce risks, what risks remain and how much risk is acceptable (to those directly involved and broader society).

There are lots of things that can be done, but I’d say the two most important considerations are 1) screening for high risk people in the household and 2) having an assistant.

Identification of high risk households

This may be the most important protective measure, and it’s similar to what many clinics are doing. It involves identifying households where COVID-19 risks are higher by calling clients in advance to confirm no one has COVID-19, is self-isolating or has acute respiratory tract disease. If any of these risk factors are present, the appointment should be rescheduled, the patient can be diverted to a veterinary hospital (where things can be contained better), or the mobile visit can go proceed using enhanced social distancing and infection control measures. This doesn’t eliminate risk completely, because there’s always potential for asymptomatic infections and shedding of the virus before someone shows signs of illness, but it helps a lot.

Personnel

Mobile veterinarians can’t do it all themselves (though they can do a lot!). Someone has to help restrain the animal for procedures. If the owner is the one restraining the pet, this results in unavoidable close contact between the owner and vet. That’s not ideal.

If a mobile vet has a technician or assistant with them, that’s much better because the owners can be largely, or completely, removed from the equation. The pet can be handed off on arrival, the vet and tech can do their work, things can be discussed with the owner at a distance, and ultimately the job is done without much difference from the usual routine.

Yes, the vet and assistant will have close contact throughout the day, but that’s unavoidable. I’d rather have multiple contacts with one person than contact with multiple people. That is IF (any only if) that person takes social distancing seriously, even outside of work.  When there are situations at work when you can’t maintain that social distance, it is critical that everyone does it properly at all other times to decrease their risk of exposure.  If I’m exposed to one person regularly during the day, I have a responsibility to be diligent with social distancing outside of work to protect myself, my family AND that close occupational contact.

Social distancing

The whole concept of social distancing is to reduce the number of human-human contacts and the closeness of those contacts. If we can prevent direct contact and stay 2 metres away from others, the risk of transmission of the COVID-19 virus (and a lot of other pathogens) drop greatly. Trying to maintain that distance during a house call means choreographing movements a bit and having owners keep other people (e.g. rest of the family) away so there’s less chance of accidentally invading anyone else’s “bubble” .

Depending on the household and weather, there may be ways to reduce contact with the household environment too, such as examining the animal in a garage, on a porch or somewhere outside. There’s a balance between avoiding the household environment but also being able to effectively and safely work with the patient.

Self-screening

“If you’re sick, stay at home” has been a message for years, but it’s been largely ignored in the past – not anymore, and it’s now critical. Mobile vets have to do their part to avoid spreading this virus. Some are taking their temperatures every morning, which is an easy and free screening tool for them. If a vet or assistant isn’t feeling well, a self-screening tool like Ontario’s online COVID-19 self-assessment should be done. However, if in doubt, stay home. Even if you are sick because of something else entirely, we don’t want to spread colds or flu or anything else, and clients will certainly be unimpressed if a vet is coughing, sneezing or looking rough when they show up.

Animal handling

There’s been a lot of discussion about the potential for a pet’s haircoat to be contaminated with COVID-19 virus and be a source of infection, but we have basically zero data either way.  There’s presumably some degree of risk. However, it’s only relevant if the animal is in a household (and in contact) with an infected owner. So, if we are already screening to identify high risk owners, we drop the potential haircoat contamination concerns a lot. Beyond that, it’s a question of balancing practicality, prevention and personal protective equipment (PPE) supplies. I don’t think we need to bring out enhanced PPE for every animal contact, we just need to use good routine infection control measures. I’d rather save my PPE for when it’s clearly needed, to make sure I still have some.

Infection prevention and control

It’s not rocket science, but good old infection control, particularly hand hygiene, is critical on house calls too. We rely on routine practices to protect ourselves when we run into unknown or unexpected risk situations. Even if there was SARS-CoV-2 on a surface in a household, as long as I wash my hands or use a hand sanitizer after I touch it, the risk I’ll get infected is low. Other routine precautions like wearing proper protective outerwear (e.g. lab coat) over regular clothing, limiting the supplies brought into the household to the essentials, and routine cleaning and disinfection of equipment are also relevant.

Other measures

Some of the alternative approaches and measures outlined in our recently posted  guidance document on elective vs essential procedures, patient handling and social distancing in veterinary medicine apply to mobile practice as well, including things like making more use of telemedicine, drug/food drop-offs, and  reducing the need for signatures.

Essential vs elective

The other big question around mobile practice is “what can (or should) I do?” Different states and provinces have taken different lines around veterinary medicine and what’s essential. Some aspects of small animal mobile veterinary medicine certainly fit in the essential category, but it warrants some thought. We want to consider animal care, animal welfare and owner welfare, while remembering the need to be socially responsible, maintain social distancing and keep an eye on supply shortages. Scaling back to only clearly low risk households and essential visits makes sense at the start, as we see how this pandemic progresses and how supplies hold out.

Yet another longer-than-ideal post, but there’s a lot of questions (and a lot of angst) about this subject. We’re figuring things out as we go, but some common sense can protect us and help with animal care and owner support.

Shortages of personal protective equipment (PPE) are a problem in many places right now because of massive demand (as well as hoarding and black market diversion) during the COVID-19 pandemic. Veterinary clinics facing shortages need to think about ways to extend the life of existing supplies, including conservation, extended use or reuse of items when feasible, and other alternative approaches for sparing PPE. We’ve put together a document, Personal Protective Equipment (PPE) Shortages in Veterinary Medicine, that addresses this issues and highlights ways veterinary clinics can maximize the use of PPE to protect themselves, patients and  help human healthcare by conserving PPE supplies.  (Also see yesterday’s post about how people in the community can also help conserve PPE by not using masks unnecessarily.)

During my (limited) ventures outside of home or the College, it’s getting more common to see people walking around wearing nose-and-mouth masks.

My first thought is “Where are you getting those? They’re short in supply.

My next thought is “Stop wasting masks! You don’t need them.

My last one is “At least wear it right! I can see your nose!!!”

The obvious question is, should people wandering around town wear masks at all?  The short answer is NO.

Outside of medical procedures, surgical masks (and similar nose-and-mouth masks) are used mainly to prevent an infected person from spreading infectious droplets when they cough or talk. So, if someone was sick, it would help protect people around them. However, if they’re sick, they should be at home, not out in public.

Masks are less effective for protecting the average person walking down the street.  The main benefit is probably preventing someone from touching their own mouth or nose and transferring whatever is on their hands to their mucous membranes. So it’s not entirely pointless, but the degree of benefit in this scenario is limited, and when masks are in short supply in many areas this is certainly not the best use of a scarce resource.

Recommendations from different areas vary a bit but in general, there’s limited support for mask use in the community. Here’s a table from a Lancet paper that compares several of these guidelines (Feng et al 2020).

So, if you’re walking around town, working in an office or doing anything else in public, you’re better off paying attention to hand hygiene (and just not touching your face) than wearing (and wasting) a mask.

Ontario announced a shutdown of non-essential services yesterday.  Wisely, veterinary medicine was classified as essential. However, it’s not business as usual. Rather, it’s “best as we can” given other restrictions and social distancing that are absolutely necessary to curb the spread of COVID-19. There’s no clear way to define essential vs elective in many cases, and there are no recipe book approaches to living in this unprecedented era of social distancing.

But, we do our best, including using our best judgement and often educated guesses to make certain decisions, since we can’t wait for definitive evidence or a published research study on everything to act.

To help veterinarians in these uncertain times, the Ontario Veterinary Medical Association has released a guidance document about elective vs essential procedures, patient handling and social distancing. It’s a bit Ontario-centric (since we’ve had input from our provincial regulator and recommend an Ontario human screening algorithm) but overall should apply well in most places – though veterinarians must always be aware of their own local regulatory guidance.

My standard disclaimer applies: things may change, so users of these documents should keep a lookout for revised versions.  I’m working on some additional information to complement / expand this document in the near future.

It’s still an evolving area with many unknowns, so definitive statements about COVID-19 and animals are often lacking.  We realize we might change some recommendations as we continue to regularly re-assess the evidence. Nonetheless, here’s the most recent information for the public on COVID-19 and animals from the Government of Canada (specifically the Canadian Food Inspection Agency).

Animal Health and COVID-19 – CFIA (English)

Santé animale et la COVID-19 – ACIA (Français)