JAVMA News Digest

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Animal health laboratories aid testing for COVID-19 in people

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Courtesy of Oklahoma State University College of Veterinary Medicine

Citation: American Journal of Veterinary Research 81, 7; 10.2460/ajvr.81.7.532

Veterinary diagnostic laboratories are helping overwhelmed public health laboratories identify COVID-19 in people.

The U.S. had conducted 17,717 tests through March 12, according to COVID Tracking Project estimates. By April 12, the total was up to 2.8 million. As of May 3, the project estimated the U.S. had run 7 million tests.

One veterinary laboratory—the Oklahoma Animal Disease Diagnostic Laboratory at Oklahoma State University—conducted polymerase chain reaction-based assays on more than 10,000 nasopharyngeal swabs in three weeks.

Dr. Jerry Ritchey, interim director of the Oklahoma State laboratory, said state public health authorities had trouble keeping up with the volume of incoming samples. The OADDL worked with the governor's office, state public health department, and partners in the OSU Center for Health Sciences to become eligible to accept samples from humans.

“At our diagnostic laboratory, we had the equipment and expertise to perform high-volume testing because that's what we do normally,” Dr. Ritchey said.

That typical work includes testing for animal disease outbreaks and conducting disease surveillance. But Dr. Ritchey and other laboratory directors said working in human health care involves additional procedures and standards for processing individual tests as well as meeting the documentation and privacy requirements for each patient.

Testing at OSU began at the end of March, and about 4% of the samples sent from human health facilities tested positive for SARS-CoV-2, Dr. Ritchey said.

The Centers for Medicare and Medicaid Services, a federal agency within the U.S. Department of Health and Human Services, regulates all diagnostic testing on humans in the United States—with exceptions for research—through the Clinical Laboratory Improvement Amendments program. The agency certifies about 260,000 laboratory entities through that program, according to CMS.

Veterinary diagnostic laboratories usually have no need for CLIA certification. The laboratory directors at OSU and veterinary diagnostic laboratories at Colorado State University and Oregon State University, instead, formed partnerships with human health care laboratories to work under their existing certifications.

Dr. Ritchey said Anil Kaul, MD, from the OSU Center for Health Sciences, was working as clinical director for the veterinary college's COVID-19 diagnostic testing, meaning reports from the laboratory bore his name as the person responsible for those test results.

A CMS spokesperson said a veterinary degree meets the education requirements to direct a CLIA-approved laboratory conducting high-complexity testing, although a veterinarian also would need certification by one of the HHS-approved boards that evaluate the qualifications of individual laboratory directors.

The Louisiana State University School of Veterinary Medicine hosts the River Road Testing Lab, a facility set up during the pandemic to process COVID-19 virus tests in people. It processed about 2,500 samples in its first month.

Dr. Kristy Pabilonia, interim director for the Colorado State University Veterinary Diagnostic Laboratories, said her laboratory accepted its first 60 nasopharyngeal swabs for testing in early April. Dr. Mark R. Ackermann, director of the Oregon Veterinary Diagnostic Laboratory, said physicians and physician groups near the university asked for help processing samples at a time when he and others at the laboratory were looking for ways to contribute.

The Indiana Animal Disease Diagnostic Laboratory, located at Purdue University College of Veterinary Medicine, was working this spring with the human hospital Parkview Health to start conducting COVID-19 tests for human patients.

Dr. Ritchey said that, when health departments catch up, he assumes his role will quietly shift back to solely working in animal health.

“It's been tough,” he said. “It's long hours many days—every day, actually. But, overall, it's been rewarding.”

Condensed from June 1, 2020, JAVMA News

Though COVID-19 cases rare in pets, testing is available

Veterinarians can test for the COVID-19 virus in animals, but whether and when they should still remain issues.

Routine testing of animals for COVID-19 is not recommended by the AVMA, Centers for Disease Control and Prevention, U.S. Department of Agriculture, American Association of Veterinary Laboratory Diagnosticians, National Assembly of State Animal Health Officials, or National Association of State Public Health Veterinarians.

Guidance from the CDC is available at jav.ma/testingguidance, and more information from the AVMA on testing animals for SARS-CoV-2 is available at jav.ma/COVID19testing. Also, an FAQ by the USDA on testing is available at jav.ma/animalsCOVID19.

Veterinarians should contact their state public health veterinarian or state animal health official to discuss the need before testing pets for SARS-CoV-2, according to the CDC, the USDA, and other federal agencies. Practitioners also are encouraged to rule out other, more common causes of illness in animals before considering SARS-CoV-2 testing.

The agencies have suggested that laboratory testing for SARS-CoV-2 could be considered for animals that have clinical signs of a new, concerning illness suggestive of an infectious disease in conjunction with a history of close contact with a person suspected or confirmed to have COVID-19 or a history of exposure to a high-risk environment where a human outbreak has occurred, such as a nursing home, prison, or cruise ship.

Human and animal health organizations agree that there is currently no evidence that dogs or cats in a home environment can be a source of COVID-19 infection in other animals or humans.

Condensed from June 1, 2020, JAVMA News

Business as un-usual

With the number of human COVID-19 cases and deaths continuing to rise in the United States at press time in early May, some states were already planning on easing strict shelter-in-place measures.

The Trump administration, over the objections of public health officials, issued guidelines in April for governors to take a phased approach to reopening their states.

Speaking during an April 22 webinar, the AVMA's chief economist, Matthew Salois, PhD, referenced a Harvard Business Review article laying out three potential recovery scenarios for the U.S. economy, from best- to worst-case scenario.

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The best scenario for recovery of the U.S. economy in a post-COVID-19 world is depicted as a V-shaped graph, with a sharp decline in economic activity and a quick recovery.

Citation: American Journal of Veterinary Research 81, 7; 10.2460/ajvr.81.7.532

The first and most preferable scenario is depicted as a V-shaped graph indicating a sharp decline in economic activity followed by a quick recovery. The least desirable, Great Depression model is an L-shaped graph showing economic activity declining and not recovering to its previous level.

“Obviously, this is not what you want to happen, and we need to make sure that the right actions and decisions are made to prevent that happening to our economy,” Dr. Salois said.

Between those two scenarios is the U-shaped model, which looks a lot how the Great Recession of the late 2000s played out, when the economy declined, remained depressed for a time, then recovered.

“This is more like a blow to the kneecaps,” Dr. Salois expiained. “It hurts. You heal, but not without some sustained injury. There is some economic loss and productivity declines, and some practices won't survive.

“My hope is the veterinary profession is somewhere between the V and U models. I don't think the worst-case scenario is necessarily the most probabilistic scenario, but I do think we've got to take the appropriate actions to ensure that we have the quickest, most painless recovery possible.”

Condensed from June 1, 2020, JAVMA News

Veterinary practices find relief in Paycheck Protection Program

In early May, the Trump administration announced that more than 2 million loans totaling $175 billion had been made to small businesses during the second round of the Paycheck Protection Program. Some veterinary practices are weathering the COVID-19 pandemic with the help of these loans.

Created by the Coronavirus Aid, Relief, and Economic Security Act to help struggling businesses during the pandemic, the PPP is a loan program designed to incentivize small businesses to keep their workers on the payroll.

When the initial $349 billion that Congress appropriated to the program ran out in April, lawmakers allocated an additional $310 billion to the PPP. Nearly 4 million loans, totaling over $500 billion, have been made since the program's launch.

Dr. Ray Cahill, owner of SeaPort Veterinary Hospital in Gloucester, Massachusetts, applied and was approved for a PPP loan during the first round of funding in April. As a result, Dr. Cahill said, he was able to retain his 14 employees, including three veterinarians.

The most immediate impact of the pandemic and Massachusetts' safety protocols was apparent in staffing at the hospital. A third of the staff members started working from home because they had underlying conditions that put them at higher risk of severe illness or needed to look after a sick family member.

“Going from 15 people running the hospital to 10 people was huge,” Dr. Cahill said. “We had to limit our capacity for what we could handle in the course of a day. The phone was still ringing, but we had to dial back according to what was reasonable for us to handle.”

Condensed from June 15, 2020, JAVMA News

Telemedicine: Once a novelty, now a necessity

Conventional wisdom prior to the COVID-19 pandemic was that the number of veterinarians incorporating telemedicine into their practices would gradually increase over the next decade.

No one could have anticipated how the outbreak of a novel coronavirus would fast-track that increase by several years. “Veterinarians looked at telemedicine as a novelty before this. Now it's become a necessity,” said Dr. Jessica Vogelsang, veterinary journalist and Pawcurious blogger.

In April 2018, she created the Veterinary Telemedicine Association as a private group on Facebook, figuring veterinarians would one day need an online support group. For two years, that community consisted almost entirely of Dr. Vogelsang and a friend for a lack of interest. Things changed with the COVID-19 outbreak and subsequent safety regulations limiting human interactions, however.

“I saw veterinarians in Facebook groups asking how to use telemedicine.” Dr. Vogelsang said. “They knew they needed telemedicine, but they had no clue what that meant.

“People were sort of running around in panic mode, signing up for platforms but not understanding what they wanted to do with it, and then getting really frustrated because they weren't getting the outcome that they wanted. So there was this huge gap between knowing that they needed the technology and actually understanding what they needed that technology to do.”

Dr. Vogelsang renamed the Facebook group as the Veterinary Telemedicine Community in March, and the number of members has swelled to more than 3,000. “If it wasn't for COVID, we'd probably still be at least five years out of where we are now,” she said.

Condensed from June 15, 2020, JAVMA News

Donation station

Seventy-six volunteers at North Carolina State University College of Veterinary Medicine are donating their time and sewing cloth masks.

“We're the Face Mask Brigade,” said Dr. Lysa Posner, a professor of anesthesiology and assistant department head of molecular and biomedical sciences at the veterinary college.

The group originally planned to provide at least three cloth masks to each staff member working at the NC State Veterinary Hospital. Having accomplished that goal, they started to divert extra masks to veterinarians in the area.

“We've distributed about 50 to 75 masks to local veterinarians in the state,” Dr. Posner said. “Most veterinarians in North Carolina have donated their PPE to human hospitals, so this is a way for us to help them get protection for themselves and their patients.”

The Face Mask Brigade isn't alone in its efforts. JAVMA News spoke with several veterinarians who are donating their time and energy in similar ways.

Dr. Sherilynn Burkman, a veterinarian at Alta Animal Hospital in Idaho, isn't much of a seamstress.

“Personally, I am much more comfortable suturing flesh than I am sewing fabric,” she said.

But when Dr. Burkman, who is chair of the Idaho VMA One Health Committee, spoke with people in public health about the shortage of personal protective equipment because of the COVID-19 pandemic, she decided to do something.

Dr. Burkman cold-called friends, family members, and acquaintances she thought might sew. By the end of April, she was working with about 20 volunteers who had produced over 400 masks for veterinarians across the state.

Condensed from June 15, 2020, JAVMA News

Social work expands in veterinary hospitals

Before Lori C. Harbert built a social work program in a Pittsburgh veterinary hospital, she studied every department. She even spent weeks sitting in the lobby to see what clients experienced.

When BluePearl bought Pittsburgh Veterinary Specialty and Emergency Center in late 2017, the new parent company asked her to turn her local program into a national one. The licensed clinical social worker sees it as a chance to fight stigma about mental health care, give people the desire to stay in veterinary medicine, and even save lives. “That's a huge advancement in the field of veterinary medicine,” Harbert said.

Veterinary clinics have been slow to hire social workers, she said, and only a few hundred people in the U.S. are trained in veterinary social work. The University of Tennessee College of Veterinary Medicine and College of Social Work established the country's first veterinary social work program in 2002.

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Lori C. Harbert

Citation: American Journal of Veterinary Research 81, 7; 10.2460/ajvr.81.7.532

Elizabeth B. Strand, PhD, founding director of veterinary social work and associate professor at Tennessee, said about 170 social workers who enrolled in her program had earned or were earning certificates in either veterinary social work or the related field of veterinary human support. Another 200 earned continuing education through her program.

As the COVID-19 pandemic added uncertainty and instability, veterinary social workers say their expertise is needed now more than ever.

Condensed from June 15, 2020, JAVMA News

Specialty organizations reshape training and examinations

Veterinary specialty organizations are temporarily reshaping their certification programs for new diplomates to fit the changing dimensions of the COVID-19 pandemic.

In an April 17 letter to representatives of specialty organizations, the AVMA American Board of Veterinary Specialties stated that “training program requirements for credentialing must still be adhered to. Deadlines to fulfill the requirements can be extended but the training requirements cannot be waived. Note that, in some cases, requirements may be fulfilled by alternative methods.“

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Dr. Maureen Griffin, a surgical resident at the University of California-Davis School of Veterinary Medicine, stands in an empty waiting room at the Veterinary Medical Teaching Hospital. (Photo by Dr. Amy S. Kapatkin)

Citation: American Journal of Veterinary Research 81, 7; 10.2460/ajvr.81.7.532

For example, the American College of Veterinary Radiology described how residents in diagnostic imaging have the ability to use old case material for training. According to the ACVR, “We can ask residents to go back into the hospital digital imaging files and dictate most of the cases made on that date (e.g., March 27, 2011). One advantage is that we may have known diagnoses on many of these cases because they occurred in the past.”

The ABVS letter also stated, “As always, certification requires examination of individuals; however, the date and time of such examination can be altered, and the method of delivery may be modified.”

The ACVR purchased video proctoring software to offer the preliminary examination for diagnostic imaging remotely if the college cannot hold the examination in person during the last week of August in Las Vegas.

On May 15, the ABVS met virtually to review plans by all 22 veterinary specialty organizations to ensure continuance of training programs and examinations during the COVID-19 pandemic.

Condensed from June 15, 2020, JAVMA News

Young veterinarians bring unique perspective to ownership

Dr. Alli Reid knew she wanted to start a veterinary practice, but she didn't plan to open one during a pandemic.

In April, Dr. Reid started Muckalee Equine & Agri-Health Services, a mobile veterinary clinic in De Sota, Georgia.

“In my area, there are not many veterinarians who are doing mobile, large animal practice,” she said. “I wanted to fill that void.”

But Dr. Reid, who graduated in 2018 from the University of Georgia College of Veterinary Medicine, is not your typical practice owner.

According to 2019 AVMA survey data, the mean age of a practice owner varies across specialties, but owners of companion animal-exclusive practices average 62 years old and owners of food animal-exclusive practices average 61 years old.

Dr. Reid isn't really worried about her age, though. In fact, she said, being two years out of veterinary college makes her more excited and optimistic about the future of veterinary medicine.

She isn't alone in that train of thought. Dr. Rob Trimble, director of the Veterinary Entrepreneurship Academy, said recent graduates bring a unique perspective and innovative ideas to a changing industry.

Some young veterinarians see ownership as a risky move considering high educational debt and the potential time commitment of owning a business, but JAVMA News spoke with veterinarians who said ownership is still the best path to financial security and fulfillment.

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Dr. Alli Reid, who earned her veterinary degree in 2018, started Muckalee Equine & Agri-Health Services, a mobile veterinary clinic, in April in De Sota, Georgia. (Courtesy of Dr. Reid)

Citation: American Journal of Veterinary Research 81, 7; 10.2460/ajvr.81.7.532

“Your perspective is valuable as a young veterinarian or a recent graduate, and the value goes beyond your ability to diagnose and treat animals,” Dr. Trimble said.

Condensed from June 15, 2020, JAVMA News

TAMU 2+2 program receives approval

Texas A&M University College of Veterinary Medicine & Biomedical Sciences received approval from the AVMA Council on Education in April to develop a 2+2 program with West Texas A&M University.

The 2+2 program will be run through the Veterinary Education, Research & Outreach program, a partnership between the TAMU veterinary college and WTAMU. The VERO facility, projected to be completed in the fall, is being built adjacent to WTAMU's new Happy State Bank Academic & Research Building in Canyon, Texas. That's where veterinary students will complete the first two years of a four-year veterinary curriculum. The first cohort of up to 18 first-year veterinary students from TAMU will start taking classes on the WTAMU campus in 2021.

The following year, there will be two cohorts cycling through the Canyon campus, bringing the total number of enrolled students within the veterinary college to 180. The WTAMU campus location will grant veterinary students more exposure to livestock and rural veterinary medicine, according to a university press release.

Dr. Paul S. Morley, an epidemiologist and director of research for the VERO program, spoke at the 2019 AVMA Economic Summit about how the number of private-practice veterinarians who work with food animals dropped 30% from 2008 to 2018 (see JAVMA, Dec. 15, 2019, page 1321).

TAMU System officials also announced a $5 million commitment to the 2+2 program in January, which is in addition to a $90 million commitment to build the VERO facility. The new funding will be used to increase faculty members from five to 23 for the VERO program, according to TAMU.

Condensed from June 1, 2020, JAVMA News

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