Letters to the Editor

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Diversity and inclusion at Iowa State University

As a graduate and former faculty member of the Iowa State University (ISU) College of Veterinary Medicine (CVM), I read with great interest the recent JAVMA News story1 “Veterinary colleges continue to face diversity, inclusion challenges,” which discusses the recent censure of the ISU CVM administration by the ISU Student Government Senate (SGS).2 The article highlights the difficult issue of social equity but fails to consider the need for a CVM to pursue a carefully crafted mission and vision. There must be a balance between the two.

The ISU CVM has a strong program and excellent reputation in the area of production veterinary medicine and is home to several related centers of excellence.3 The ISU CVM mission and vision statement declares, in part, that the college “aspires to be a preeminent institution recognized for excellence in professional and graduate education and the application of knowledge to promote animal and human health with significant influence on society's food supply.”4

The SGS resolution censuring the CVM administration cites “an overwhelming lack of diversity and inclusion” at the college, stating that the “ISU CVM had 7.4% racially and underrepresented students in their student population.”2 However, I would challenge whether this truly represents an overwhelming lack of diversity. The ISU CVM, like most state-supported veterinary colleges in the United States, is required to reserve a high percentage of its admission slots for in-state students or students from states with which the college has contracts. Iowa has one of the least diverse populations among all states that currently have colleges of veterinary medicine,5 and surrounding states with which the ISU CVM has contracts also have populations with relatively low diversity. In Iowa, it is estimated that > 95% of racially and ethnically underrepresented persons live in large metropolitan areas or in smaller cities with meat-processing plants.6

In pursuing its commitment to production veterinary medicine, it seems likely that the ISU CVM will draw students from more rural portions of the state, where typically < 2% of the population is nonwhite.5 Thus, the fact that 7.4% of ISU CVM students belong to racially underrepresented groups does not reflect a lack of diversity, compared with the population from which the college draws its students.

Nevertheless, in seeking to fulfill its mission, the ISU CVM needs to select the most qualified applicants, without regard to race, ethnicity, gender identification, sexual preference, or other identity characteristics. If questions of diversity and inclusion need to be addressed at the ISU CVM, this needs to be done in other ways.

That said, there is no excuse for actions of CVM faculty or students that have bigoted, xenophobic, racist, or other prejudicial motives, and there should be, as the SGS resolution states, “high expectations for professionalism and respect within the CVM community.”2 As individuals and as members of the veterinary profession, we must treat each other with the dignity and respect we all deserve.

John J. Andrews, dvm, phd

Grand Junction, Colo

Veterinarians' role in preventing the next pandemic

The recent JAVMA News story1 by Scott Nolen regarding the current COVID-19 outbreak asks the question, “Can veterinarians prevent the next pandemic? ”

In short, the answer is yes. In the article, experts such as Dr. Christopher W. Olsen from the University of Wisconsin-Madison School of Veterinary Medicine, Dr. Linda Saif from The Ohio State University College of Veterinary Medicine, and Dr. Donald Noah from the Lincoln Memorial University School of Veterinary Medicine discuss the unique nature of SARS-CoV-2, the novel coronavirus that causes COVID-19. One thing they all agreed on was that the question of another zoonotic pandemic is not a matter of if, but when.

For our country to be prepared for the next infectious disease event, there needs to be a seamless coordination of efforts at the federal level. Instead of maintaining the tendency of organizations to silo their information and research, the medical community and federal agencies must collaborate openly in a shared effort. By increasing coordination, there will be a greater wealth of information available to build a foundation for stronger collaborative efforts to prevent the next outbreak before it happens or to test and treat patients if it does.

I want to bring your attention to two pieces of legislation that will address concerns raised in this article. Rep. Kurt Schrader and I, two of the three veterinarians currently serving in the US House of Representatives, have introduced the Advancing Emergency Preparedness Through One Health Act (H.R. 3771). This bill would require the Department of Health and Human Services and Department of Agriculture, in coordination with other departments and agencies such as the Department of Defense, CDC, and Environmental Protection Agency, to establish a framework that encourages collaborative efforts to help better prevent, prepare for, and respond to zoonotic disease outbreaks. This would ensure an orchestration of efforts to streamline research and raise the essential funds needed to achieve quicker and more accurate diagnosis, treatment, and prevention.

In addition, I have co-led a legislative effort with Rep. Ami Bera, MD, from California to authorize federal funding contributions for the Coalition for Epidemic Preparedness Innovations. This multilateral organization has already received multiple multimillion-dollar investments from the United Kingdom, Germany, Japan, Norway, and other nations aimed at discovering and monitoring emerging pathogens in animals and humans that are likely to spark the next zoonotic diseases. Ideas and research are shared openly with the goal of developing diagnostic tests, identifying modes of transmission, determining risk minimization approaches, and generating vaccines so that treatment and prevention methods are ready when needed. By sharing the cost between like-minded nations in a collaborative effort, no single nation bears an outsized burden to fund necessary research. The few hundred million dollars in funding we seek for the United States' participation in the Coalition for Epidemic Preparedness Innovations pales in comparison to the trillions of dollars we have spent so far in responding to the current COVID-19 pandemic.

Veterinarians can and will be instrumental in diagnosing and preventing the next zoonotic pandemic. I thank Scott Nolen for his excellent article highlighting the need for these important pieces of legislation. However, the fact remains that Congress must act now. Everyone can help ensure their future health security by insisting your members of Congress are educated on the issues and support these initiatives.

Rep. Ted S. Yoho, dvm

Washington, DC

1. Nolen RS. Can veterinarians prevent the next pandemic? J Am Vet Med Assoc 2020;256:852855.

The AVMA responds:

We applaud Congressman Yoho's leadership on one health and his efforts with Rep. Schrader to advance the bipartisan Advancing Emergency Preparedness Through One Health Act. This legislation will improve federal preparedness against emerging and reemerging zoonotic disease outbreaks.

Now, more than ever, it is important that lawmakers understand the critical role veterinary medicine plays in protecting the health and safety of animals, people, and the environment. The AVMA is a leading voice on one health in Washington, DC, and will continue to focus on educating lawmakers on how investing in animal health research, surveillance, and diagnostics can improve public health and pay economic dividends. Members of the AVMA can help advance these efforts by using AVMA's Congressional Advocacy Network to write their members of Congress and ask them to support the One Health Act.

Congressman Yoho, a recipient of the 2019 AVMA Advocacy Award in recognition of his contribution to advancing the veterinary profession, will be retiring at the end of this Congress. We are very grateful for his service and his leadership.

John A. Howe, dvm

AVMA President Grand Rapids, Minn

Rena K. Carlson, dvm

AVMA Board of Directors Chair Pocatello, Idaho

The role of the veterinary profession in the COVID-19 pandemic

The COVID-19 pandemic has caused unprecedented losses and disruptions, placing great stress on governments and businesses alike. Medical evidence to date indicates that the preponderance of new infections result from person-to-person transmission and contact with contaminated surfaces. However, SARS-CoV-2—the virus that causes COVID-19—appears to have originated in animals, emphasizing the important role the veterinary profession must play during this pandemic. As COVID-19 continues to spread, veterinarians will be vital in supporting food animal production that maintains a safe, healthy, and abundant food supply, applying population medicine concepts that increase our understanding of the spread of the disease, and conducting and facilitating animal research and development of vaccines and therapeutics.

A potential treatment for COVID-19 is convalescent plasma therapy, which involves giving patients an infusion of antibodyrich plasma from people who have recovered from SARS-CoV-2 infection.1 Plasma therapy is not a new concept, but rather a modified version of an old therapy applied to a current problem. Physicians used convalescent plasma as far back as the 1890s, and this was the only treatment option for many infectious diseases prior to the introduction of penicillin in the 1940s. In fact, physicians successfully used convalescent serum to stop an outbreak of measles in 1934. More recently, researchers investigating convalescent plasma found that it had positive effects against the coronaviruses that cause severe acute respiratory syndrome2 and Middle East respiratory syndrome3 as well as the H1N1 influenza virus.4 Plasma collected from hyperimmunized horses has also been the source of antibodies for snake antivenoms5 and botulinum antitoxins.6

People will not be safe from the COVID-19 pandemic until we develop effective population immunity against SARS-CoV-2, either through natural exposure or vaccination. Vaccines take time to develop and administer, but is it possible for the veterinary profession to maintain the equipment and animals needed to more quickly mass produce potentially life-saving plasma the next time we fight a pandemic?

Soren Rodning, dvm, ms

Rüdiger Hauck, dvm, phd

Paul H. Walz, dvm, phd

Kenneth S. Macklin, phd

Robert A. Norton, phd

Departments of Animal Science, Pathobiology, Poultry Science

Alabama Cooperative Extension System

Auburn University

Auburn, Ala

  • 1. Shen C, Wang Z, Zhao F, et al. Treatment of 5 critically ill patients with COVID-19 with convalescent plasma [published online ahead of print Mar 27, 2020]. JAMA 2020. doi:10.1001/jama.2020.4783.

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  • 2. Cheng Y, Wong R, Soo YO, et al. Use of convalescent plasma therapy in SARS patients in Hong Kong. Eur J Clin Microbiol Infect Dis 2005;24:4446.

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  • 3. Ko JH, Seok H, Cho SY et al. Challenges of convalescent plasma infusion therapy in Middle East respiratory coronavirus infection: a single centre experience. Antivir Ther 2018;23:617622.

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  • 4. Hung IF, To KK, Lee CK et al. Convalescent plasma treatment reduced mortality in patients with severe pandemic influenza A (H1N1) 2009 virus infection. Clin Infect Dis 2011;52:447456.

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  • 5. Morais JF, de Freitas MC, Yamaguchi IK, et al. Snake antivenoms from hyperimmunized horses: comparison of the antivenom activity and biological properties of their whole IgG and F(ab')2 fragments. Toxicon 1994;32:725734.

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  • 6. Li D, Mattoo P, Keller JE. New equine antitoxins to botulinum neurotoxins serotypes A and B. Biologicals 2012;40:240246.

Chloroquine and hydroxychloroquine intoxication in dogs during the COVID-19 pandemic

Chloroquine and hydroxychloroquine are used in human medicine to treat malaria, rheumatoid arthritis, and amebiasis, and hydroxychloroquine has been approved by the US FDA for use as an immunomodulatory agent. In veterinary medicine, these drugs have been used to treat lymphoma1 and cutaneous lupus erythematosus2,3 in dogs and certain diseases in fish.

The FDA has warned against using these drugs without medical oversight.4 Unprescribed use in humans has increased following a suggestion that they might be efficacious in treating COVID-19, even though clinical trials have not substantiated these claims. The National Poison Data System noted a 42% increase in reports of human exposures this year, compared with the same period last year. The current rise in unprescribed human use may translate to increased exposure in pets; therefore, veterinary professionals must be aware of the risk of animal intoxication. Recently, we examined a dog that had accidentally ingested its owner's hydroxychloroquine. Decontamination (emesis and activated charcoal) prevented development of clinical signs. Nevertheless, we are concerned about the lack of published data regarding chloroquine and hydroxychloroquine intoxication in companion animals.

In humans, oral bioavailability of chloroquine and hydroxychloroquine is > 75%, with nearly complete absorption within 2 to 4 hours. The drugs are sequestered in tissue (rendering serum concentrations uninformative), metabolized in the liver, and excreted in urine and feces. Chloroquine is predominantly excreted via the kidneys, more so than hydroxychloroquine. Those compounds have a long half-life of 40 days in people.5 In dogs, chloroquine has a half-life of 12.6 to 14.5 days, depending on the route of administration, and wide tissue distribution.6

In humans, clinical signs of toxicosis include coma, seizures, and visual disturbances. Respiratory depression or apnea can be observed. Cardiovascular findings include hypotension, bradycardia, QRS and QT prolongation, ventricular tachycardia, ventricular fibrillation, and torsades de pointes. Hypokalemia due to intracellular shifting is common. Nausea, vomiting, diarrhea, hypoglycemia, hemolytic anemia, and methemoglobinemia may be seen.

Limited data are available on chloroquine and hydroxychloroquine intoxication in dogs, and toxic doses of these drugs have not been established. However, chloroquine is reportedly more toxic to dogs than hydroxychloroquine and was associated with a mortality rate of 75% within 19 days when administered at a dosage of 20 mg/kg/d (9.1 mg/lb/d).7 Hydroxychloroquine administered to dogs at dosages ranging from 5 to 12.5 mg/kg/d (2.3 to 5.7 mg/lb/d) was tolerated with minor gastrointestinal signs.1,3

Reviewing records for the ASPCA Animal Poison Control Center, we found only 9 cases involving accidental ingestion of chloroquine and 234 cases involving accidental ingestion of hydroxychloroquine by dogs. Of the 9 dogs with chloroquine intoxication, 2 had ataxia and tremors, with tremors occurring at a dose of 22 mg/kg (10 mg/lb). In dogs with hydroxychloroquine intoxication, tremors occurred at a dose of 11 mg/kg (5 mg/lb), and arrhythmias and ataxia occurred at a dose of 58 mg/kg (26.4 mg/lb). When present, clinical signs occurred within 30 to 60 minutes after ingestion and persisted for 12 to 24 hours. The most common clinical signs were vomiting (18.8%), hypersalivation (9.4%), and trembling (7.8%).

An animal poison control center should be consulted following unprescribed ingestion of chloroquine or hydroxychloroquine by a dog. Treatment includes decontamination (eg, emesis and activated charcoal), monitoring (eg, ECG and serum electrolyte concentrations), and supportive care (eg, potassium administration for severe hypokalemia and anticonvulsants). Cardiovascular support might include IV fluid administration and antiarrhythmics. Sodium bicarbonate (1 to 4 mEq/kg [0.45 to 1.8 mEq/lb]) can be used to treat QRS prolongation or ventricular tachycardia while being careful to avoid worsening hypokalemia. Diazepam (2 mg/kg [0.9 mg/lb], IV over 30 minutes, followed by 1 to 2 mg/kg/d [0.45 to 0.9 mg/lb/d]) has been used in humans for its cardioprotective effects attributed to competitive binding in cardiomyocytes. Intravenous lipid emulsion also may be considered following life-threatening exposure.

Guillaume L. Hoareau, drvet, phd

Emergency Medicine Division, University of Utah, Salt Lake City, Utah

Critical Care Service, Advanced Veterinary Care, Millcreek, Utah

Tina Wismer, dvm

ASPCA Animal Poison Control Center, Urbana, Ill

Carine M. Laporte, vmd

Dermatology for Animals Millcreek, Utah

Alyrene Dorey, md

Emergency Medicine Division, University of Utah, Salt Lake City, Utah

Utah Poison Control Center, Salt Lake City, Utah

Justine Lee, dvm

ASPCA Animal Poison Control Center, Urbana, Ill

VETgirl LLC

Saint Paul, Minn

  • 1. Barnard RA, Wittenburg LA, Amaravadi RK, et al. Phase I clinical trial and pharmacodynamic evaluation of combination hydroxychloroquine and doxorubicin treatment in pet dogs treated for spontaneously occurring lymphoma. Autophagy 2014;10:14151425.

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  • 2. Mauldin EA, Morris DO, Brown DC, et al. Exfoliative cutaneous lupus erythematosus in German Shorthaired Pointer dogs: disease development, progression and evaluation of three immunomodulatory drugs (ciclosporin, hydroxychloroquine, and adalimumab) in a controlled environment. Vet Dermatol 2010;21:373382.

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  • 3. Oberkirchner U, Linder KE, Olivry T. Successful treatment of a novel generalized variant of canine discoid lupus erythematosus with oral hydroxychloroquine. Vet Dermatol 2012;23:6570.

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  • 4. US FDA. Hydroxychloroquine or chloroquine for COVID-19: drug safety communication—FDA cautions against use outside of the hospital setting or a clinical trial due to risk of heart rhythm problems. Available at: www.fda.gov/safety/medical-product-safety-information/hydroxychloroquine-or-chloroquine-covid-19-drug-safety-communication-fda-cautions-against-use. Accessed May 4, 2020.

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  • 5. Browning DJ. Pharmacology of chloroquine and hydroxychloroquine. In: Hydroxychloroquine and chloroquine retinopathy. New York: Springer, 2014;3563.

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  • 6. Aderounmu AF, Fleckenstein L. Pharmacokinetics of chloroquine diphosphate in the dog. J Pharmacol Exp Ther 1983;226:633639.

  • 7. McChesney EW. Animal toxicity and pharmacokinetics of hydroxychloroquine sulfate. Am J Med 1983;75:1118.

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