COVID-19

Considering the current pandemic of COVID-19 caused by SARS-CoV-2, particular measures such as proper social distancing, frequent hand washing, eliminating face touching, diligent self-monitoring of symptoms and temperature checks, and limiting community exposures should be introduced. Veterinary practices/hospitals should implement guidelines on how to perform patient care whilst keeping their veterinary staff and pet owners safe. The below information is meant to provide the VDOS community with resources and links. However, given the fluid nature of the situation and how quickly the science is evolving, what is presently thought to be accurate may likely change.

 
 

General Recommendations

  • Patient triage: Elective procedures should ideally be postponed and appointments reduced to urgent, medically necessary care. These include emergencies and patients who are stable but there are concerns for deterioration of clinical signs.

  • Essential personnel: Only staff who perform critical practice/hospital procedures/processes should be coming on-site. Teams should be formed to distribute staffing. Non-essential staff should work remotely from home.

  • Symptom screening: All staff should be screened for cough, shortness of breath, and other symptoms (fever, chills, muscle pain, sore throat, headache, new loss of taste or smell), ideally at the beginning and end of their work shift. Staff reporting symptoms or having known exposure to a COVID+ co-worker or pet owner should be sent home and self-monitor with twice daily temperature and symptom checks for 2 weeks.
  • COVID-19+ staff: They should report to their supervisors for the purpose of contact tracing so that others can be alerted if suspected exposures occurred. All involved parties should work together to determine the risk of exposure level and take appropriate actions as determined by local, state or federal agencies.

  • Building access: Access to the practice/hospital should be limited to one or two doors. Staff should complete a building access log at the end of each on-site shift, also listing each room, hallway, staircase, elevator, etc. they have been while at the practice/hospital. Symptomatic or COVID-19+ staff should report all co-workers with whom they had come across to allow for contact tracing.

  • Visitor restriction: Practice/hospital visits not related to patient care should be discontinued. Pet owners who are self-quarantining for being COVID-19+ or are asymptomatic with high-risk exposure to SARS-CoV-2 within 14 days should not be permitted within the practice/hospital.

  • Client instruction: Pet owners should be given advanced information for how their visit to the practice/hospital will be handled. They may also be asked about their COVID-19+ risk status (travel history, exposure to SARS-CoV-2, and symptoms).

  • Social distancing: Staff should maintain at least 6 feet distance from all persons when possible and avoid meeting in groups or confined, poorly-ventilated spaces. They should instead use phones or virtual means for clinical consults and rounds.

  • SARS-CoV-2 testing: Local, state and federal guidelines should be followed with regards to testing of staff for SARS-CoV-2. Test results do not predict whether a person will become ill or contagious in the future.

  • Personal hygiene: Staff should change into clean scrubs upon arrival, which are removed before leaving the building and washed before reuse. Lab coats, sweaters, jackets, etc. used over scrubs should be treated the same as scrubs.

  • Hand hygiene: Staff should continue diligent and frequent hand washing with an alcohol-based hand rub or soap and water for at least 20 seconds and never touch their eyes, nose or mouth.

  • Face masks: Universal masking should be considered for all staff. Before putting on a mask, the hands must be cleaned. Both the mouth and nose must be covered with the mask, and there should be no gaps between the face and mask. The outer surface of the mask should not be touched. Masks that are torn, wet, visibly soiled or hard to breathe through must be discarded. Recommendations for the safe conservation of masks to address supply limitations should be followed. Textile masks are not a substitute for medical grade masks, must be changed after 3-4 hours of use, and be washed by the user daily.

 

Curbside Triage

  • Practices/hospitals should consider curbside triage to prohibit pet owners from entering the building during the COVID-19 outbreak. Teletriage prior to arrival may be performed. The owners should be informed that the veterinary staff will be wearing personal protective equipment (PPE; at least a mask and gloves) and maintaining 6 feet of social distancing to ensure safety for all people involved.

  • A guard should ideally be stationed outside to obtain the pet owners' last name and pet name, communicate with the frontline staff, direct the owners where to park (if arriving by car, they should remain in the car), and provide them with an information leaflet detailing the process. The owners should already be wearing a face mask or other covering over their mouth and nose during this process. If the owners feel that their pet is in a life-threatening situation, the guard should let the veterinary staff know to come out and assist them.

  • The veterinary staff responsible for seeing the case should call the pet owners when they are ready to see the patient. History and other information can be obtained at that time.
  • The pet owners should drive (or walk) to the building entrance where they will be met by the veterinary staff. Cats should be kept in the carrier and placed 6 feet away from the veterinary staff. Owners are provided a leash for their dogs that will then be handed to the veterinary staff. No discussion should take place during the transfer.

  • The veterinary staff should take the pet and bring it into the practice/hospital for examination.

  • The veterinary staff should communicate with the pet owners via phone about physical examination findings to help them make diagnostic and treatment decisions. All consent to diagnose and treat should be given verbally over the phone.

 

COVID-19+ and High-Risk Pet Owners

  • COVID-19+ and high-risk pet owners should have another person bring their pet to the practice/hospital.

  • Veterinary staff should wear PPE (cap, gown, mask, and gloves) to wipe down the patient’s coat with hypochlorous acid (0.01%; i.e., Vetericyn); if this product is not available, ProShield spray may be used.

  • All haired surfaces should be lightly sprayed and allowed to air-dry; the agent should be wiped onto the face with a gloved hand, but the patient's eyes must be avoided!

  • If the patient is hospitalized, the above PPE and melt-away bags for hospital laundry should be used for the first 24 hours during patient care. The patient may be handled without PPE afterwards.

 

Cat and Ferret Contact Precautions

  • The cat and ferret patient handling protocol is enhanced as a precaution, whilst awaiting additional scientific data, to provide guidelines for care of these patients during the COVID-19 pandemic and provide a potential contact precaution for personnel handling them.

  • Staff should wear a mask and gloves when handling these patients.

  • At least one empty cage should be maintained between all these patients.

  • If the patient has no respiratory signs, but is from a COVID-19+ or high-risk household:

    • Use a face shield or other eye protection (i.e., safety glasses, goggles) in addition to a mask.

    • House the patient in a restricted area with appropriate PPE (bouffant, level 3 face shield/mask, gown/coverall, and gloves) for the duration of hospitalization.

    • Have the cage of the patient and all cages immediately surrounding the patient enclosure disinfected at the time of patient discharge.

  • If the patient has upper or lower respiratory signs (not of cardiac/neoplastic origin or due to other known respiratory disease condition):

    • Use a face shield or other eye protection in addition to a mask.

    • House the patient in a restricted area with appropriate PPE (bouffant, airtight goggles, N95 mask, gown/coverall, shoe covers, and gloves) for the duration of hospitalization.

    • Have the cage of the patient and all cages immediately surrounding the patient enclosure disinfected at the time of patient discharge.

 

Patient Discharge

  • Upon arrival to the practice/hospital, the pet owner should be instructed to approach the curbside or proceed to the parking lot, park, remain in the car (or - if walking - wait in front of the building entrance), and call the frontline.

  • A veterinary staff member should gather the pet for discharge to the owner.

  • Payment should be made at this time. A frontline staff member should collect credit card information via phone.

  • An invoice and receipt of payment made should be emailed directly to the owner at the time of discharge.

  • Medications required should accompany the pet at the time of discharge.

  • Discharge instructions should be emailed directly to the owner.

  • When the pet is in the lobby, the owner should receive a call to drive or walk to the entrance of the practice/hospital to receive the pet.

 

Euthanasia

  • Only one pet owner should be permitted in the practice/hospital for the euthanasia process.

  • The pet owner must be wearing a mask.

  • The veterinary staff should be kept to the minimum number possible to complete the procedure and utilize appropriate PPE as suggested above.

  • One room should be designated for euthanasia, affording the best social distancing.
  • An extension set should be used to ensure appropriate social distancing.

  • Recording of the euthanasia process should be prohibited.

  • The housekeeping staff should be notified of a client's presence so that the room can be sanitized following the procedure.

 

Risk of Pets to Humans

The current understanding is that SARS-CoV-2 is primarily transmitted person-to-person. There is increasing evidence that feline and canine species can be infected with SARS-CoV-2 via experimental inoculation and via human-to-pet transmission. However, routine testing of pets for COVID-19 is currently not recommended by the American Veterinary Medical Association (AVMA), Center for Disease Control (CDC), United States Department of Agriculture (USDA), and American Association of Veterinary Laboratory Diagnosticians (AAVLD). Because the situation is ever-evolving, public and animal health officials may decide to test certain animals. In the United States, the decision to test should be made collaboratively between the attending veterinarian and local, state, and/or federal public health and animal health officials. The CDC, USDA, and other federal partners have created guidance, including a table of epidemiological risk factors and clinical features for SARS-CoV-2 in animals, to help guide decisions regarding animal testing. The USDA would be responsible for reporting any animal that tests positive for SARS-CoV-2 in the United States to the World Organization for Animal Health (OIE).

 

Suggestions for VDOS

Special precautions should be taken and safety measures implemented so that the veterinary staff can be protected from unnecessary aerosols circulating during dental and oral surgical procedures:

  • Staff should be asking pet owners the following questions to determine COVID-19 risk status: "In the past 2 weeks, have you tested COVID-19+, experienced fever, cough, or shortness of breath, or had direct contact with/exposure to a person confirmed to be COVID-19+? If yes, someone who would not answer yes to any of these questions should bring your pet in for you. You will not have direct, in-person communication with the hospital staff. All communication and decision-making regarding your pet’s treatment will be conducted via phone. You will not be permitted inside the practice/hospital for any reason. Staff will be wearing full PPE when triaging/admitting your pet."

  • COVID-19+ cats and dogs (i.e., those tested positive) and cats and dogs showing COVID-19 symptoms (e.g., respiratory signs not of cardiac/neoplastic origin or due to other known respiratory disease condition) should be testing negative or be symptom-free for 4 weeks before treatment under anesthesia is considered.

  • High-risk patients are COVID-19-symptom-free cats and dogs that live with people that tested COVID-19+ or showed COVID-19 symptoms up to 2 weeks ago.

  • Anesthetized treatment should be performed in separate operatory rooms (OR). A maximum of 3 staff attached to the patient care team should be present in each OR.

  • Non-High-Risk Patients

    • Staff should wear level 3 face shield/mask, goggles, surgical bonnet, and gloves when inside the OR.

    • Aerosol-producing machines and accessories (ultrasonic scaler, high-speed handpieces, etc.) should be used at the lowest water setting when conducting dental and oral surgical procedures.

    • The use of the 3-way air-water syringe should be limited to using water only rather than the spray function to decrease aerosol production.

  • High-Risk Patients

    • An “infectious” sign should be placed on the OR door.

    • The OR entrance should be equipped with a red bio-hazard bag.

    • A transfer area should be taped off on the floor in front of the door for changing before entering or exiting the OR.

    • Personnel should wear bouffant, air-tight goggles, N95 mask, gown/coverall, shoe covers, and gloves while in the OR.

    • HVAC, 4-handed dentistry and oral surgery, and a disposable plastic tip air-water syringe should be used.

    • All autoclavable instruments should be placed directly on a metal sterilization tray in the OR after completion of the dental and oral surgical procedures and transferred to the flash autoclave. Add a small amount of enzymatic soap. Run a wash and sterilize cycle prior to normal cleaning process in the ultrasonic cleaner. Then autoclave again before packing.

    • All equipment inside or brought into the OR should remain in the room for proper cleaning and decontamination (e.g., anesthesia machines, dental radiography machine, scanner, etc.).

    • All trash (including PPE) should be disposed in the red bio-hazard bag provided in the OR. Housekeeping is responsible for removing waste from the OR.

    • The OR should be closed for use until two cleaning, disinfecting and drying cycles are completed. Housekeeping will remove signage/tape once room is reopened.

 

Other Information

​​PAVMA (COVID-19)

In Focus (COVID-19)

SARS-CoV-2 in pets (COVID-19)

Worms and Germs Blog (COVID-19)

Center for Disease Control (CDC) (COVID-19)

World Health Organization (WHO) (COVID-19)

American Dental Association (ADA) (COVID-19)

American Veterinary Medical Association (AVMA) (COVID-19)

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