As we move forward in the COVID-19 era, a lot of things need to be done differently. We’ve written a lot about procedures in veterinary clinics to maximize distancing and protection while minimizing the impact on patient care. Many ancillary issues have also come up, including limiting or managing people other than clients going into vet clinics. One such group of people is industry reps (e.g. from pharma and pet food companies) who normally visit clinics on a regular basis to discuss clinic supply needs, product questions, new products, etc.  The Canadian Animal Health Institute has developed recommendations for companies in order to provide guidance to their employees who typically do these kinds of site visits. It’s also relevant for veterinarians to review, so they understand what to expect. As I discussed yesterday on our CVMA national veterinary COVID-19 weekly townhall webinar, the guidelines are voluntary, but they help set reasonable expectations for everyone. Clinics can set their own bar higher, if they want, and individual companies can do the same. However, these guidelines outline the core issues and minimum expectations, to help protect industry personnel and clinic staff.  Click on the links below for the summary or complete set of guidelines.

CAHI COVID-19 Industry Guidance (Jun-2020) – Summary of Recommendations

CAHI COVID-19 Industry Guidance (Jun-2020)

A non-COVID post for a change.

Well, not completely, I guess. COVID is an example of what can happen when a new disease emerges and spreads. There are lots of new diseases lurking out there, mainly in wildlife. Some threaten humans. Some threaten animals. Some do both. Anytime we move ourselves into new environments or move animals from those environments into proximity with us, we create risk. The more we move ourselves and animals, the greater the risk.

We’re working on a few projects involving importation of dogs, in part because of the infectious diseases these animals bring with them. It’s pretty easy to import dogs into many countries (and especially into Canada). Most regulatory hurdles relate to movement of food animals and restricted wildlife, with limited consideration of issues related to dogs.

Importation rules for the US are pretty lax too, but some measures have been taken to tighten them up a bit in recent years. One was banning importation of dogs from Egypt because of rabies concerns (and issues with falsified vaccination certificates).

Now, there’s new proposed legislation in the US.  The “Healthy Dog Importation Act” (H.R. 6921) has been introduced to by Congressman (and veterinarian) Dr. Ralph Abraham. He states, “In light of the current health issues our country faces, it is important that we don’t import infectious diseases from animals that could have a devastating impact on food supply and our health as Americans. The Healthy Dog Importation Act is a common sense public health measure, and as a veterinarian, I’m proud to introduce this bill alongside Congressman Yoho and Congressman Schrader.

The proposed legislation doesn’t include anything too dramatic that I can see, but would turn some recommendations into requirements and add some logical restrictions:

  • All imported dogs must be permanently identified (e.g. microchip), healthy and vaccinated, with certification of vaccination by a licensed vet. It’s not clear what those requirements are as it states “all necessary vaccinations and demonstrated negative test results required by the Secretary” so presumably the actual vaccination requirements would be sorted out later and could vary.
  • Importation of dogs for “transfer” is restricted, i.e. dogs that are sold or otherwise transferred (adopted) after arrival. Dogs imported for resale/transfer must be at least 6 months of age and must be accompanied by a USDA import permit (which means no importation of puppies younger than this for resale/transfer). There is an exception made for Hawaii (not sure why…), where it would be legal to import puppies as long as they don’t leave the state for resale before 6 months of age. Hawaii’s other state importation rules would still apply.
  • There are also exceptions for research dogs and dogs that enter the US for veterinary care.  Dogs regularly cross between Canada and the US for veterinary care, particularly for specialty care when the closest referral hospital might be on the other side of the border.
  • Breaching these rules could result in quarantine, return or forfeiture of the dogs, and importers can be on the hook for any required healthcare costs.
  • The new act would also “streamline federal oversight, ensuring documentation and import permits are shared electronically between APHIS, CDC, and Customs and Border Patrol, while clarifying APHIS’ key enforcement authority.” If this results in better data about canine importation, that would be great, since the lack of reliable information hampers risk assessments and the ability to follow up on disease introductions.

The legislation outlines the framework, and the details would come later.  I have no idea what the odds are of it being passed before this session ends, but it’s good to see this on the US legislative agenda.

The Public Health Agency of Canada (PHAC) has announced an outbreak of E. coli O157 infections in people linked to Carnivora brand raw pet food, and Health Canada has issued a recall of a number of Carnivora products due to potential contamination with E. coli O157. Illnesses have been reported in four individuals in total, from British Columbia, Alberta and Manitoba.  All affected individuals had exposure to Carnivora brand pet foods, and two were hospitalized due to their illness.  The concern is that the majority of infections might be overlooked, as commonly occurs in such outbreak. The outbreak once again highlights the importance of querying animal contact and contact with high risk (raw) pet foods when foodborne diseases are investigated. While people were presumably not eating the pet food, there is the potential for cross-contamination of human food when handling raw pet food, as well as potential for exposure to pathogens through things like contact with pet food bowls and pet feces.

The main concern with raw pet food tends to be Salmonella; however, E. coli O157 is another significant concern because of the  potential severity of disease. A death was reported in a UK a couple years ago from exposure to E. coli O157 from contaminated pet food.

People who have had contact with the recalled food should be aware of the risk. The odds of a problem are low in most cases and there’s nothing to do if everyone’s healthy. However, it’s critical that healthcare providers be informed of potential exposure to E. coli O157 if someone gets sick (e.g. diarrhea). That’s particularly important for this bug because use of antibiotics (not usually needed for people with diarrhea, though they’re over-prescribed anyway) is a major risk factor for inducing hemolytic-uremic syndrome (HUS), a potentially fatal complication of infection with E. coli O157.

While most dogs and cats that eat raw diets are fine, and most owners don’t get sick, it’s clear that feeding raw diet or raw animal-based treats (e.g. pig ears) is associated with risks to the pet and any human contacts. I’d rather people not feed raw diets to their pets, particularly when the pet or household members are very young, elderly, pregnant or have compromised immune systems. If none of those risk factors are present and someone wants to feed a raw diet, I’d still rather they didn’t, but there are some things that can reduce the risks, as outlined on the Worms & Germs infosheet on raw diets available on our Resources – Pets page.

Oh, and don’t go to the company’s website for accurate information about risk and risk mitigation. They bury some good prevention recommendations in a pile of often out-of-context dialogue to try to deflect any concerns and the typical raw diet misinformation. Some other raw pet food companies are up front about the risks and prevention measures – I have a lot more confidence in companies like that.

Lots of things you can get at a convenience store aren’t great for your health, but I wouldn’t have thought we’d have to add rabies to the list of concerns.

Public health officials in Niagara Falls, NY, are trying to track down nine baby raccoons that were handed out by someone outside a 7-Eleven store. Rabies is the big concern, raccoons being an important rabies reservoir species in this area. However, the list of potential diseases that could be transmitted by these raccoons is longer than that, with leptospirosis and the raccoon roundworm (Baylisascaris procyonis) being two other important issues.

As of the last report I saw, seven of the nine (too bad there weren’t eleven… that would have been funnier to report) baby raccoons had been recovered.

The list of reasons that handing out (or accepting) baby raccoons is bad is long, but to name just a few:

  • Wildlife belong in the wild.
  • Often, “rescued” baby wildlife are actually animals that were perfectly fine and temporarily left alone by their parents. Baby wildlife rescued by the public rarely survive and make it back to the wild.
  • Possession of wildlife is illegal in many areas, including New York state. Only licensed wildlife rehabilitators can posses wildlife, so that they are cared for properly and, when possible, re-introduced to the wild.
  • Baby raccoons are cute. However, they grow up to be large, curious and destructive adult raccoons that often end up being abandoned – but then they think they belong with people which makes them even bigger nuisances.
  • Baby raccoons rescued by members of the general public are often handled a lot in the process, leading to a lot of potential rabies exposures.
  • Wildlife belong in the wild.

More information about rabies (as well as leptospirosis) can be found on the Worms & Germs Resources – Pets page.

Here’s a bit of an odd-and-ends post covering some common questions I’ve been getting about COVID-19 and infection control in veterinary clinics. As always, answers are based on little or no evidence, but on principles of infection control, and they may change as we learn more and as this pandemic continues to evolve.

Would it be safe to let one client per pet into our building, if they have to wear a mask and use hand sanitizer on entry?  And only letting a client in that has to see a veterinarian.  Not to buy merchandise.

“Safe” is subjective and a moving target. Realistically, we’re looking at gradations of risk. There’s always some, and the closer and more prolonged the contact, the greater the risk. Having a client in the clinic is riskier than having them outside, undoubtedly. If they come into the clinic, the measures described (especially mask use) can help minimize that risk. There’s no way to say how much risk is present because we still have limited data, and where you are would be a major factor, based on the local epidemiology of the virus (which also changes). In some places, community disease activity is very low, so the odds of any single person who comes into your clinic being infected are exceptionally low. That’s not true everywhere, though.

Ultimately, our goal is to keep people out of clinics as the default. If there’s a solid reason for them to come in, then the risk goes up, but that can be mitigated through minimizing the closeness and duration of contact, wearing masks and good hygiene. It comes down to the cost-benefit… how important it is for the client to be in the building vs the risk you (and all the staff) are willing to take (and the ability to make sure preventive measures get done).

That’s a bit of a non-answer but there isn’t really a yes/no response to a question like that, unfortunately.

Some people recommend to use a coffee filter or towel sheet with reusable masks. What do you think about that and if it’s a good idea, is it okay to use in surgery and how many hours does it last?

For surgery, I’d rather use a proper surgical mask, if you have access to them. Their performance is more predictable, and surgery is a higher risk environment. If you’re low on surgical masks, then a cloth mask is a tolerable backup (although I’d be a bit wary of using a cloth mask for a surgical procedure involving an implant). I haven’t seen anything that indicates those extra filters in masks do much. I assume they don’t make anything worse (unless they make it harder to breathe or are so resistant to airflow that they direct more unfiltered air out the sides of the mask), but I don’t recommend them over regular cloth masks.

What should we do about dental procedures on small animals? (I’ve had dozens of variations of this question.)

Cat dentals are the big question, and a lot of the uncertainly relates to a lack of understanding of the prevalence of SARS-CoV-2 in cats, particularly cats from households that are not flagged as high-risk based on querying the owner’s health status. Risk also varies geographically, since the risk from cats directly parallels the risk of people being infected in the same region. In many areas, the odds of a cat from a purportedly healthy household being infected are probably exceptionally low. However, we don’t have enough data to say much more, and as disease activity varies, the risk will vary. We’re trying to answer some of those questions with PCR-based surveillance as well as an upcoming seroprevalence study. In the interim, there’s a realistic “life has to go on” component, since we will be dealing with this virus for a long time.

For now, a key step is screening the owners for current or recent respiratory disease. It’s not a guarantee, but restricting these procedures to pets from healthy owners should help drop the risk a lot. Beyond that, it’s mainly PPE. Aerosol generation is an inherent issue with dentistry, but exposure can still be minimized with appropriate PPE, cleaning and disinfection and other basic infection control practices. I think we can look to human dentistry here, since they are dealing with even greater risks.  Below is a table from an Ontario guidelines document. In this table, “positive” and “negative” refer to syndromic screening, the same as we would do for owners of animals coming to a veterinary clinic. They recommend N95 respirators for aerosol generating procedures (AGPs), regardless of screening status, presumably based on the risk of asymptomatic shedding in the general population. However, they give the option of surgical masks for lower risk patients and procedures. Our risk as veterinarians is presumably lower than theirs, so the decision of whether to wear an N95 plus eye protection vs a surgical mask plus eye protection may come down to mask availability, understanding of COVID-19 activity in the area, and risk aversion. The key is to wear A mask of some kind, and to wear eye protection as well (the latter in particular is not consistently done in veterinary medicine).

If N95 masks are used, they would only be required for those in close proximity to the AGP.  It’s debatable whether technicians and anethesiologists would need this level of protection (vs a surgical mask), especially when surgical masks are considered tolerable for AGPs in low-risk human patients. People coming in and out of the dental suite (which should be minimized in any case), or who are farther from the patient’s mouth would be much lower risk for exposure.

Cleaning and disinfection of areas potentially contaminated by aerosols is also important.  People generally do a good job on disinfecting tables and countertops, but don’t think about the other areas or surfaces that get contaminated by aerosols, like the anesthetic machine for example. That also highlights the need for a good OR/dental suite environment with limited open storage. We don’t want aerosols contaminating things that people will use for subsequent procedures (e.g. gauze sponges, suture packs), so if an AGP is being performed, it’s best to make sure that the area is as barren as possible.

With some basic practices like that, the risk of SARS-CoV-2 transmission related to doing a cat dental is probably much greater from the transfer of the animal to/from the owner, than from the cat during the procedure itself. That’s why we need to focus on physical distancing from owners as much as possible.

I’ve had countless questions about the potential for scent detection dogs to be useful for COVID-19 surveillance. It’s an interesting idea, but it’s dependent on COVID-19-infected people producing some volatile compound detectable by the dogs than uninfected people do not.  (The virus itself is not likely to have a detectable odour.)

A recent pre-print paper on bioRxiv provides a rambling description of a pilot study about the potential for dogs to sniff out COVID-19 in people based on their armpit sweat.  This one can probably be filed under the “not likely to ever be published in a journal, but an interesting story” category.  (It may also be another paper in the “let’s get something online first, who cares about the depth and editing” category. Sixty-one authors is a bit extreme too, but I digress.) As I’ve said before, pre-prints can be useful, but there has to be at least a modicum of effort…

Anyway, they collected armpit sweat samples from people with COVID-19 and patients without signs of COVID.

They used 18 dogs that had been trained for explosive detection, search and rescue and colon cancer detection, but their table also lists an arson detection dog.  Further, they say that “We did not decide to work with drug detection dogs as there is always a possibility that COVID-19 positive or negative people use prohibited substances that would let catabolites be excreted by the axillary sweat.” And yet, their table lists a drug detection dog.

After training, the dogs were tested to see if they could differentiate sweat samples from COVID-19 patients in scent boxes, from the samples from the non-infected patients.

  • Three of the 18 dogs flunked out of COVID-19 detection school as they were “unable to adapt to an olfactive search on a line of sample”.
  • Eight others were removed because they were “late in their testing period due to this necessary basic “retraining”. I’m not really sure what that means. I guess they weren’t completely kicked out of school but had to repeat the year, and no one wanted to wait to rush out the pre-print.

The authors say that left 8 dogs whose results they used for the analysis; however, my math says that 18-3-8=7, not 8.

Numbers aside, results were interesting, as the remaining dogs seemed to have fairly high detection rates (84-100%).

It’s hard to say what this means and whether it’s relevant. I guess it means that there’s potential for some dogs, but you have to find the right dogs, and train them.  The authors make a fair point that they were looking at effective dogs, not whether it worked in the whole dog population.

Is this of any use?

It’s hard to say. They tested samples from people with overt COVID-19 disease, and that’s likely not very relevant. If someone has signs of COVID-19, we want to treat them like they have COVID-19 at least until they are definitely tested, regardless of what the dog thinks. Where this would be more useful is for detecting asymptomatically infected people, in which case the dog might provide an early warning of infection. The downside is that it requires a dog and a person to be in close proximity to the patient being screened. Dogs are low (but not no) risk for picking up SARS-CoV-2, but there’s also reasonable concern about handlers. The practical nature of this is also questionable. The study mentions that armpit sweat is “easy and safe to collect”, but if the “test” relies on people taking samples of their own armpit sweat, it’s no longer a quick, easy detection method. It’s more appealing if the dog can, for example, be used to screen people coming into a building or workplace.

The authors have a few excuses for some of the false negative results, which seem to be a bit of a stretch, or indicate potential issues applying this to a real world situation (e.g. distraction by a “too zealous television team”). Some other discussion points are a bit hard to follow. They attributed false positives to two male dogs and a young woman that “had been sampled during her fertile period”… they’d better sort that problem out since that’s a reasonably common subset of the population.  The paper’s discussion devolves considerably from there: “In Shakespeare’s day, a woman in her fertile period used to hold a peeled apple under her arm until the fruit became saturated with her armpit scent ; then she presented this “love apple” to her lover to inhale in order to provoke his sexual excitation. Pheromones are defined as substances produced by on animal which conveys information to other individuals by olfactory means. And in such a situation androsterone and molecules like benzoate derivates, excreted in axillary sweat, enhance sexual attraction by men toward women near the end of follicular phase of the menstrual cycle when fertility is at highest.”

Overall, it’s an interesting pilot study that shows more study might be warranted. In particular, it’s important to figure out whether dogs can be good detectors of COVID-19 infected people in situations like busy, high risk places in the community.  Criticisms aside, it would be really cool to have a dog hanging out at the entrance of busy places, picking out infected people, to help curb further spread of SARS-CoV-2 in the community.

I said I’d probably stop reporting on individual animal cases if they’re just repeating what we already know. So, I hesitated on this most recent feline case, but there’s an interesting timing component that’s worth discussing.

SARS-CoV-2 was identified in a cat with respiratory disease in Minnesota. The owners were infected first, the cat then got sick and the cat recovered after a few days of illness.

  • That’s not surprising. This seems to be the standard pattern in terms of timing and severity in cats that have tested positive, and we’re probably markedly underdiagnosing infected cats.
  • The cat is being isolated at home for 14 days.

The noteworthy component of this case is the timing. The onset of the cat’s illness was after its owner had recovered. Our messaging has been to keep animals away from others for 14 days after their last chance of exposure. That would be 14 days after the date the owner was believed to have eliminated the infection. This approach means restrictions on animals would go past restrictions on their owners, and a case like this shows why that may be prudent. If the household was considered COVID-free after the person’s illness resolved, SARS-CoV-2 infection (and infectivity) in the cat might not have been considered.

The SARS-CoV-2 situation in the Dutch mink industry continues to evolve. Dutch authorities are now reporting outbreaks of SARS-CoV-2 on 8 mink farms (with one more suspected), as part of their broader investigation of the industry. After identifying outbreaks on multiple mink farms, the infection was declared a reportable disease national surveillance was initiated, including routine testing of any captive mink that die unexpectedly.

Today, it was apparently decided that all mink on affected farms in the Netherlands will be culled. That’s been under discussion for a while, and it’s not overly surprising given the large numbers of affected mink and identification of mink-to-human transmission of SARS-CoV-2. I wouldn’t be completely surprised to see all mink farms depopulated in the Netherlands, since the industry is being closed down in the country anyway, with all mink farms required to shut down by 2024. Opting to speed up that time frame wouldn’t be surprising if the virus continues to spread to and on farms. I’ve heard that the impending ban has largely resulted in shifting production to some eastern European countries where there are fewer restrictions (so probably no better, if not worse, for the mink overall). Transportation of mink has been banned in the Netherlands, so presumably it will just be mink farmers, not mink, that migrate to these other regions. What’s going on on Chinese mink farms is also a concern, since China is the largest producer of mink globally.

Fortunately, not many people or other animals have contact with mink. Mink seem particularly susceptible to SARS-CoV-2, and this is a good reminder of why we need to pay attention to emerging diseases and consider potential host ranges. If other domestic animals or wildlife were as susceptible as mink, that would create an even bigger problem than we have now.

The USDA has issued announced the first confirmed case of SARS-CoV-2 infection in dog in the US. The affected dog was a German Shepherd from New York state, and unsurprisingly its owner had COVID-19. Interestingly, this dog did have signs of respiratory disease,  a finding that hasn’t been reported in dogs to date. It tested positive for the virus by PCR, and also had antibodies against SARS-CoV-2. Another dog in the household was healthy, but also had antibodies, indicating it had been infected too.

This case is noteworthy for a couple of reasons:

  • The positive dog was sick, though that still doesn’t necessarily mean the illness was due to the infection with SARS-CoV-2. The dog could have had other underlying disease due to some other cause.  Hopefully more information will come to clarify that. However, if this dog was sick because of SARS-CoV-2 infection, it would run contrary to the evidence to date that indicates dogs can be infected but don’t (typically) get sick.
  • Both dogs in the household were infected, even though only one got sick and tested positive by PCR.  The assumption has been that human-to-dog transmission is uncommon, and that still might be the case, but finding transmission to multiple dogs in a household is interesting.

Overall, it doesn’t really change our main talking points, but it highlights the need for more study.