As the need for social distancing becomes abundantly clear, we need to figure out what that means. This isn’t a two-week venture anymore. A much longer period of social distancing will be required to help limit the damage from COVID-19. The challenge is maintaining some semblance of normal activities in the meantime.
Where does veterinary medicine fit in the scale of essential vs non-essential services?
I assume clinics will remain open longer than many service industries because there are clearly some components of veterinary service that are essential to animal health. At the same time, it can’t be “business as usual,” both because of our social responsibility and the need to protect clinic staff.
How can we maintain social distancing and still run a veterinary hospital?
We have to adapt, modify some expectations and be a bit creative – but it can be done. There isn’t a standard approach to this, but the general concept is clear: reduce the number of direct and indirect human-human contact points as much as possible. In a profession where our patients are accompanied by and live with humans, that’s not necessarily easy to do.
It might not be easy, but there are a number of things that can be done in a clinic to improve social distancing. Here is a quick list to use as a start. These measures will likely get refined over time, as we learn more about the virus, its spread, and we see how things are working (or not) in veterinary clinics. A lot of fairly basic things can be done to reduce those critical contact points, including but not limited to:
- Close waiting rooms. Admit and discharge patients via quick drop off at the front desk or directly from vehicles.
- No walk-ins for anything. People have to call ahead so plans are in place, whether it’s for an appointment or to pick up something like pet food. To get pet food or supplies, owners should call first so it’s ready for them when they show up.
- Electronic payments only. No handling of cash.
- Reduce the need for signatures. We’re trained to get signatures on anything but documenting verbal consent should be considered an acceptable alternative under the circumstances (that’s on my list of things I’m talking about to various regulatory groups at the moment).
- If signatures are needed, the pen should be disinfected (e.g. collected from the person with a disinfectant wipe) or ideally, the owner should use their own pen (especially when you consider that pens go in mouths all the time (gross, but I’m a prime offender myself)). Ask the owner to bring a pen when they call before coming to the clinic.
- Screen owners before their appointments to keep sick people or people with travel risk factors out of the clinic (see flowchart below, however, note that I’d now consider “normal admission” to be a drop off or vehicle admission).
- Keep sick staff at home. This should be common sense but it’s cold and flu season, so there’s a lot of background infectious disease out there. While disruptive, we need to do this to contain COVID-19 and also to keep everyone calm. People aren’t as dismissive of someone coughing in their vicinity as they used to be.
- Cohort staff if possible. If clinics can keep groups of staff together, whether that’s based on time (shifts) or work within specific areas of the clinic, it might help reduce the risk of large numbers of staff going off sick if one is exposed.
- Making sure hand sanitizer is available at all admission points (realizing we’re running low).
- Use telemedicine as much as possible. Many followups and consults can be done remotely. We can’t vaccinate or do surgery remotely, but there are common conditions that can reasonably be diagnosed and managed from a distance, especially with the use of photos and videos from owners.
- Encourage staff to be responsible about social distancing outside of work. Not everyone has bought in to the necessity of these measures (the idiots crammed on beaches in Florida for spring break being a great example of that). A lot of good efforts can be undone by a single irresponsible individual.
- Consider ways to help our vulnerable populations stay safe. That might be repurposing staff (if clinic work decreases) to deliver food and supplies to high risk people (e.g. elderly) or people who are home because they are sick or self-isolating. Leaving a package on the doorstep and getting electronic payment over the phone essentially eliminates the risk of transmission, even if a person has COVID-19.
- Be diligent about disinfection of contact points, especially areas where clients come in. Frequent wiping down of the admissions desk area (the most likely congregation point) is easy to do.
Overall, there are lots of things we can do to reduce contacts and reduce the risk. Most are minimally disruptive if everyone works together with some patience and understanding. If we end up having to (further) scale down elective activities, the impacts on the profession and pets will increase. That could conceivably become necessary as a broader control tool in the community, or because of limitations in supplies (already an issue) or staff (if many staff get sick or are self-isolating). The key is to try to do as many easy, practical and minimally disruptive measures as we can – starting immediately – to reduce transmission risk before we get to that point.
Here is a flowchart we’ve designed for triage of cases (and the risk from animal owners) coming to the veterinary hospital at the University of Guelph, to help manage contacts and case admissions. It can be adapted or used by other clinics as well.