One concept that we’ve recommended for COVID-19 control in veterinary clinics is staff cohorting. That involves keeping staff groups together to limit the risk of transmission should someone be infected. If groups (i.e. shifts, or teams that stick together and don’t interact with others) are formed, any single infected person would have contact with a smaller number of other people, thus reducing the risk of disease overall and protecting the clinic by making it less likely everyone would be sent home to self-isolate for 14 days at the same time.
In the ideal world, we’d strictly cohort permanently. However, cohorting can be very difficult, depending on staffing, clinic layout and clinic operations. It can cause major scheduling hassles, limit the amount of patient care, and interfere with work in the clinic in general. Like a lot of infection control practices, the cost-benefit has to be considered, and in many clinics, optimal cohorting isn’t sustainable. But that doesn’t mean the concept should be dropped completely. The goal should be to cohort as much as possible. There is increased risk with decreased cohorting. However, some of that risk can be offset by making sure other things are done really well.
Ultimately, it comes down to two key concepts (as for control of many infectious diseases): keeping the virus out of the clinic, and limiting its ability to spread if it sneaks in.
Keeping SARS-CoV-2 out of the clinic:
Restricting clinic access
Curbside drop off and pick up (including animals and products like food and medications) is very common now. Anything that keeps clients out of the clinic will reduce risk, as the fewer human-human contacts occur, the lower the risk of exposure to the virus. If only staff come into the clinic, there’s less risk of introduction.
Hopefully everyone’s gotten the point that coming to work when you’re sick isn’t showing you’re a dedicated employee – it’s showing you’re irresponsible. All clinic staff should self-screen every day. Basically, that means paying attention to their own health and not coming to work if they have anything that could be suggestive of COVID-19 (including decreased smell and taste). It’s not a guarantee that no one who’s infected will come to work, because some may have asymptomatic infections, but keeping actively sick people away is still a huge factor.
The demise of the “waiting room”
This will likely apply to many professions, like dentistry and human medicine. Having people congregate in a small waiting area is not likely to be acceptable, possibly ever again. (It never made sense to me in human medicine anyway – lots of people, including sick people, crammed into a waiting area is just a recipe for disease transmission). Rethinking how reception areas are used is good for the long term. Rather than “waiting rooms” they may ultimately be “check-in” and “check-out” areas, where there’s quick, one-way flow on the way into or out of an appointment (for the subset of situations where an owner has to be in the clinic). Check-in by phone, direct admission to an exam room, waiting outside, dropping off the pet and coming back later, and similar strategies can reduce the need for people to hang around together in a small room, and in turn reduce the risk to themselves and others.
The end of walk-ins
This will probably be a common theme in many professions too. Unexpected arrivals disrupt order and measures to carefully schedule how and when people arrive. That doesn’t mean someone can’t spontaneously decide they should swing by the clinic to pick up a bag of pet food, it just means they have to do it differently. That could simply be calling and saying “I’d like to stop by to get some food, I can be there in 5 minutes.” Staff can then have the food waiting on the doorstep, or know you’re coming in at that time so they can make sure the area is clear. Or, they can say “How about in 10 minutes? We’ll have space then.” Yes, it’s still a bit of a disruption, but it’s minor.
Reducing the risk of in-clinic exposure to SARS-CoV-2:
If an infected person is in the clinic but they are wearing a mask, the risk of them transmitting this virus is lower. Routine cloth mask use whenever a 6-foot gap can’t be maintained between people is emerging as a key infection control tool. Cloth masks are far from perfect, but they can do a good job containing most infectious droplets, which are probably the main source of exposure.
Fewer people = less exposure. Working from home needs to be considered whenever possible. That can include tasks like management, completing medical records and calling owners. It can also include telemedicine. Even in situations where an animal has to be seen in person, telemedicine can reduce the duration of contact. For example, for a new puppy appointment, we’d like to have a detailed discussion of a variety of issues, then do an exam and usually vaccinate. We can do the discussion part by telemedicine (with the vet at home), so it just needs to be followed up by a quick appointment for the exam and vaccination. The owner doesn’t need to be there, so by covering the discussion topics first, an owner-less visit or short owner visit can be achieved without compromising animal care.
Some things can be done to reduce contacts between staff in the clinic as well. We need to be within 6 ft of others at times (e.g. placing a catheter) but tweaks to clinic flow and operations can reduce the likelihood of crossing paths with someone, or having to work in close proximity, or the duration of time that needs to be spent in close proximity. Appropriate measures to do this will vary greatly between clinics, but there are a variety of things that can be done with both procedures and layout (e.g. moving tables, changing office space).
How will these changes be received by staff, and by clients? Some people will complain about anything new. However, there’s enough awareness now that these measures won’t likely look odd to the average person. If anything, I think people are more likely to raise concerns about failure to take steps like this, since they will be the norm in many situations outside of veterinary medicine too. We’re less likely to hear “my vet is doing some really strange things at their clinic”. Rather, if we don’t take reasonable measures, we’re likely to hear “why isn’t my vet doing the things my doctor, dentist, physiotherapist and everyone else is doing?” In addition to creating risk, failure to act may actually drive clients away.