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.
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.
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.
“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.
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.
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.