Thoughts from a COVID-19 Epicenter

Fast Moving Policy Changes as COVID-19 Spreads 

When I published a blog on COVID-19 and preventing disease spread a few weeks ago, I did not predict where we would be today.

Wednesday morning, my daughter’s history teacher told their class that there would be no way that Seattle School District would close.  His reasoning was that child care services, access to free breakfast and lunch for low income students, and health resources were too important to families to risk a closure.  At the end of his talk, a student raised his hand and let the teacher know that the superintendent had just cancelled school.

On Wednesday afternoon, it was a 2-week closure with individual superintendents making decisions.  By Friday, it was 6-week closure mandated by the governor of all schools and colleges in the state.

We now have, as stated in this morning’s Seattle Times, “Silence in Seattle.”  First, all events over 250 people were banned.  Libraries, museums, zoos, farmers markets, movie theaters, and even the Space Needle closed. Sporting events, concerts, symphonies, and plays are cancelled or postponed.  Tonight, Governor Jay Inslee closed all restaurants, bars, and recreational facilities in Washington state.   We are not confined to our homes yet but it could happen.

Veterinarians provide Essential Services

The AVMA is advocating that veterinarians provide essential services and should be allowed to remain open during this COVID-19 outbreak even if all other non-essential businesses are closed.  People rely on their pets in time of stress and it is critical that we find ways to continue to serve. In addition, the safety of our food supply is dependent on the work of veterinarians.  I believe that it is important that we continue to provide services in this time of need.

Veterinarians and their staff are at risk of infections

On the other hand, we need to make sure we are doing everything possible to keep our staff, our clients, and our communities safe.  I found this graph from the Institute for Disease Modeling especially illuminating.  It shows why decreasing contacts between people matters to try to stop disease.

Recommendations for Veterinarians during the COVID-19 Pandemic

• Attempt to find remote work options for as many staff as possible. This is crucial for those employees most at risk.  Those most at risk include those over 65 years of age, those who are pregnant, those with diabetes, or those with respiratory or heart disease.  Can your inventory person order from home?  Can call backs or appointment scheduling be done from home?  Can discharge instructions be discussed with clients over the phone? Can your weekly staff meeting be done as a conference call or video chat?
• Ask every client if they or any family members have been sick PRIOR to arrival at your hospital. If the answer is yes, ask if someone else can bring their pet for care or delay care if it is elective.  If the pet is critical and they have to come, ask them to call from the parking lot so someone in PPE can collect the pet, examine the pet in the hospital, and then talk to the client on the phone.
• Consider limiting appointments to emergent patients only and delaying elective appointments. North Carolina State opted several days ago to not allow any clients inside the hospital and opted today to only see emergent cases.
• This is the moment to start looking at telemedicine options for patients in which you have a documented client-patient relationship (in Washington state, you have seen them in the last year). Can you video chat to recheck the spay incision or tell if a rash really needs to be seen?
• If you allow clients in your hospital, try to limit the number of people in your waiting room to the smallest number possible. Do not shake hands. Consider only allowing one client in an exam room at a time and maintain the 6-foot social distance.
• Coronavirus appears to survive on surfaces for longer than originally thought but is inactivated by all common disinfectants. You need to clean your exam rooms, door handles, chair arms, front desk, etc. after EVERY client and patient.
• WASH YOUR HANDS and make sure your staff is also. Soap is very effective against coronavirus and hand sanitizer works as well.  Wash or gel:
  • When you arrive at work
  • Before and after handling every patient
  • Before and after eating
  • Before you leave for the day

Medical Supplies

              Currently, it is unclear if PPE supplies will be in short supply. One reason to consider limiting caseload to more emergent pets is to conserve medical supplies.  Dr. Scott Weese in his blog, Worms and Germs, has some good information about risks and considerations on re-use of surgical masks.

Our Responsibilities to Human Healthcare

One emergency and critical care veterinary hospital in our area received a call asking if their ventilator could be borrowed by the local hospital if needed due to high demand.  If you have a ventilator, make sure your local hospital knows that it could be available to them if needed.

Financial Ramifications

The financial ramifications of this crisis will be dramatic.  Luckily, local, state and our national government are starting to provide resources and information to help.  In Washington, check out this FAQ from the WSVMA on resources available to help and how to access.  For all, check out this update from the AVMA.

We will survive COVID-19

              We need to remember that although we shouldn’t high five, shake hands, and hug our clients or our colleagues, we still need to support each other.  Share ideas and suggestions in your communities, online, and on list serves.  Listen to your staff and your clients as they will often provide wisdom and options you didn’t consider.  Above all, remember to take a moment to breathe, to pause, and thank your team, your friends, and your family for being on this crazy journey with you.

Stay Safe.