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One Health, COVID-19, and veterinary medicine

October 4, 2021

One Health, COVID-19, and vet med: How the COVID-19 pandemic highlights veterinarians’ role in public health

Part 1

This is part 1 in a 2-part series. Read part 2 here.

By Erica Tramuta-Drobnis, VMD, MPH, CPH

What is One Health?

Simply put, One Health is the interdisciplinary cooperation of various professions, stakeholders, individuals, and institutions (academic and otherwise). The concept encompasses both public and private entities working towards the common good of global health. This includes human, animal, and environmental health and a variety of related topics.1–3

Veterinarians familiarize themselves with infectious diseases throughout their studies and career. As a profession, we understand the interconnectedness the environment plays with our patients and pet parents and the interaction risks that ensue.

Additionally, we recognize and understand the value and importance of the human-animal bond. Our goal is to strengthen that bond by providing a safe environment, preventative medicine, owner education, and more to safeguard a long and healthy life. But does our job stop there? Should it?

What role do veterinarians play in public health?

Veterinarians, both in practice and in the public health arena, are pivotal in preventing future pandemics.

The veterinary profession can help to educate society on public health matters, including zoonotic and reverse zoonotic diseases, parasite protection, preventative medicine, vaccinations, and the list continues.

This education can occur one-on-one with a client or via a blog on a veterinary website. Furthermore, it may be as a participant in various public health activities, including administering human vaccines, such as during a global pandemic.

Has the COVID-19 pandemic (SARS-CoV-2) made the role veterinarians can play in protecting worldwide health more apparent to public health professionals? Yes and no. Though the government is starting to see the bigger picture, much needs to be addressed and recognized.

One win for the veterinary community on the federal side highlights the importance of disease surveillance. On August 24, 2021, the U.S. Department of Agriculture agreed to commit $300 million to fund the American Rescue Plan Act. This act establishes surveillance activities for susceptible species to COVID-19.

It also seeks to detect new and re-emerging zoonotic diseases in vulnerable animals while building an early warning system. This approach hopes to alert various stakeholders and partners in the public health arena to upcoming threats. This will allow the One Health community to act earlier, hopefully preventing if not constraining the impacts of the next global pandemic.

Note, there will be another pandemic. One Health experts are unified in expressing this. It is not a question of if it will happen, but when.4–7

This emphasizes the concerns about the role that animal reservoirs (wildlife, companion animal, and livestock) have in zoonotic disease transmission. Additionally, it will allow for the monitoring of reverse zoonotic transmission and diseases.

But the role of veterinarians and associated professionals in One Health encompasses much more than just the field of infectious diseases. However, the recognition by the federal government of the importance of this surveillance effort will have a significant impact on the prevention of future pandemics moving forward.

Remember that surveillance doesn’t have to be active. Passive surveillance veterinarians perform regularly. Each time we screen for Lyme Disease, Anaplasmosis, or Ehrlichia and obtain a blue dot, we have an obligation to discuss the significance of the disease in their pet and the exposure risks to them too. If pets are exposed to ticks and other harbingers of disease, so are the owners.

With 75% of all emerging new infectious diseases originating in animals and over 60% of human diseases originating in animals, it is imperative to properly monitor these diseases and those that emerge.3,8,9

This surveillance starts with veterinarians at the local level and should trickle up to the federal level. Thus, use client education whenever possible to help them keep all family members safe. If dogs need tick prevention, should the humans not need protection as well? Surveillance thus starts at the individual level and works up from there.

Read more: Surprisingly human: How vet care is also people care

COVID-19 and small animal medicine

This pandemic required a lot of paradigm shifts in human and animal medicine practices alike. Many of these shifts seem positive on the human side, with telehealth becoming a prevalent means to improve healthcare access both during and after the pandemic subsides.

Telehealth has been helpful on the veterinary side. Still, the legal concerns abound and are not consistent from one state to another. Have COVID-19 impacts been as positive for the veterinary profession? Yes and no.

Sadly, since the start of the pandemic in 2020, the veterinary profession has dealt with increasing demands, diminishing staff pools, and shortages in supplies and medications.

Nationwide, veterinary visits are climbing. As a result of backlog, staff shortages, and client demands, the overall mental health and well-being of the profession have become more and more of a concern as suicide rates for veterinarians are at their highest.10–12

So, while increased vet visits seem like a great thing financially and for the animal health community, the consequence of this increase brings significant concerns for the profession moving forward.

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COVID-19 response in clinics

From creating a new normal, pets without owners, car checkouts and phone call appointments, to face masks 24/7, the veterinary clinic model shifted and adapted as the pandemic dictated.

First, there were limitations in what practices were allowed to do primarily because of the availability of personal protective equipment (PPE) and risk benefits for staff and animals.

Then there were staffing shortages, new staff competency concerns, clinician and staff burnout, client outrage at wait times, and new procedures. These, coupled with a significant uptick in the number of pets seen on an average daily basis, especially in the emergency room settings, have been potentially crippling to the clinical side of veterinary medicine.

Many in the veterinary profession are type A personalities. We adapt, make do and think about the emotional and physical consequences after the fact. While this helps our patients and clients in the short run, it ultimately leads to burnout, compassion fatigue, decreased quality of life, and mental illness when left unchecked.13,14

COVID-19 likely has improved most practicing veterinarians’ bottom lines. But at what cost? From mental well-being concerns, burnout, compassion fatigue to worsening suicide rates, should we be concerned about the toll COVID-19 has had to date and will continue to have on the profession?

All have had to step up and adapt from the front staff to veterinary assistants, technicians, and veterinarians.

Now we are seeing, as in human medicine, worsening access to care. Veterinarians and staff cannot keep up with the demands. More people, in general, may have pets. Still, with more people home, they are more aware of a disease state earlier on and seek care.

One may think this is good for business, but veterinarians and the veterinary industry cannot sustain this indefinitely. Something will have to give.

COVID-19 and veterinary suicide rates

Suicide is a public health concern and a serious one at that. Suicide rates in the profession were on the rise before the pandemic.14,15 Steps were needed at that point, but it wasn’t until the pandemic that concerns were openly brought to light.

The American Veterinary Medical Association (AVMA) and other entities such as NOMV (Not One More Vet) have taken the lead in establishing outlets for veterinarians and veterinary staff with mental health concerns of any kind.

They help act as a sounding board, offering a means to provide critical incident stress debriefings. Basically, if you had a tough case, awful client, are the butt of cyberbullying or anything else, you have an outlet, and a means to talk it out without judgment.

Training courses have been developed for people to learn to recognize signs of depression and suicidal tendencies in coworkers, friends, and family members. The goal is to prevent suicide and mental breakdown. Finally, the resources are becoming available, though a bit too long in coming.

Sadly, suicide is the epitome of a public health concern. It takes a multi-disciplinary approach from coworkers, other veterinary staff, public health professionals, mental health professionals, and others to help enact positive change.12

Positives from COVID-19 encompass the breadth of the veterinary profession, a revelation towards the future of One Health

Despite the concerns with rising suicide rates in the profession, veterinarians continue to remain at the forefront of the pandemic response. Clinics remain open and, despite staffing shortages, burnout, and other concerns, continue to provide care to pets and, furthermore, support the human-animal bond.

Veterinarians are accustomed to educating clients while keeping our patients’ overall health in mind. We address public health issues quite often, though we may not label them as such.

Moving forward, the profession as a whole should advocate for preventative measures in a One Health Framework. We can do so by discussing with clients risks to their families and friends and the safety of the pet.

By discussing the environmental contamination risks or sources of infection, we bring the One Health concept to light. We demonstrate the importance of animal, human, and environmental health components to establish better global health by educating others. This simple measure can go a long way towards improving the human, animal, and environmental balance and is one step out of many in supporting a One Health Framework.

Erica Tramuta-Drobnis, VMD, MPH, CPH is the Founder & CEO ELTD of One Health Consulting, LLC, as well as a freelance writer, consultant, researcher, public health professional and small animal veterinarian.

More from IndeVets:

One Health, Covid-19 and vet med — Part 2

Changing your mindset to become a happy, healthy vet

Weird Case Files with Dr. Amy: George

Results of the 2021 Covid-19 veterinary impact survey and what they mean for animal hospitals

Four key trends for animal hospitals in 2021

References

  1. McCloskey B, Dar O, Zumla A, Heymann DL. Emerging infectious diseases and pandemic potential: status quo and reducing risk of global spread. Lancet Infect Dis. 2014;14(10):1001-1010. doi:10.1016/S1473-3099(14)70846-1
  2. Torres de Melo R, Rossi DA, Monteiro GP, Fernandez H. Veterinarians and One Health in the Fight Against Zoonoses Such as COVID-19. Front Vet Sci. 2020;7:756. doi:10.3389/fvets.2020.576262
  3. Tramuta-Drobnis E. The One Health Conceptualization of public health practice: Veterinarians in Public Health: Looking outside the two-legged box. Lehigh Cty Health Med Off Publ Lehigh Cty Med Soc. 2019; Fall 2019:25-27. https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHM_Fall19/index.php?startid=24
  4. U.S. Department of Agriculture (USDA). USDA Announces Proposed Framework for Advancing Surveillance for SARS-CoV-2 and Other Emerging Zoonotic Diseases through the American Rescue Plan. U.S. DEPARTMENT OF AGRICULTURE. Published August 24, 2021. Accessed August 26, 2021. https://www.usda.gov/media/press-releases/2021/08/24/usda-announces-proposed-framework-advancing-surveillance-sars-cov-2
  5. Iserson KV. The Next Pandemic: Prepare for “Disease X.” West J Emerg Med. 2020;21(4):756-758. doi:10.5811/westjem.2020.5.48215
  6. Dyer J. Ready for the Next Pandemic? (Spoiler Alert: It’s Coming). Infection Control Today. Published March 1, 2021. Accessed August 31, 2021. https://www.infectioncontroltoday.com/view/ready-for-the-next-pandemic-spoiler-alert-it-s-coming-
  7. Frutos R, Gavotte L, Serra-Cobo J, Chen T, Devaux C. COVID-19 and emerging infectious diseases: The society is still unprepared for the next pandemic. Environ Res. 2021;202:111676. doi:10.1016/j.envres.2021.111676
  8. Monath TP. Vaccines against diseases transmitted from animals to humans: A one health paradigm. Vaccine. 2013;31(46):5321-5338. doi:10.1016/j.vaccine.2013.09.029
  9. Hinchliffe S. More than one world, more than one health: Re-configuring interspecies health. Soc Sci Med. 2015;129:28-35. doi:10.1016/j.socscimed.2014.07.007
  10. Knight J. An Examination of Suicide Rates in the Veterinary Profession and the Effect of COVID-19 on Exacerbating the Problem. The Top Shelf. Published December 22, 2020. Accessed September 1, 2021. https://medium.com/the-top-shelf/an-examination-of-suicide-rates-in-the-veterinary-profession-and-the-effect-of-covid-19-on-966e77cc92e2
  11. Todays’ Veterinary Nurse. Veterinary Suicide Rates Are Higher, Including Veterinary Technicians. Today’s Veterinary Nurse. Accessed September 1, 2021. https://todaysveterinarynurse.com/articles/veterinary-suicide-rates-are-higher-including-veterinary-technicians/
  12. McReynolds T. A year into the pandemic, the profession is feeling the strain. AAHA. Published March 11, 2021. Accessed September 1, 2021. https://www.aaha.org/publications/newstat/articles/2021-03/a-year-into-the-pandemic-the-profession-is-feeling-the-strain/
  13. American Veterinary Medical Association (AVMA). Work and compassion fatigue. American Veterinary Medical Association. Published 2021. Accessed September 3, 2021. https://www.avma.org/resources-tools/wellbeing/work-and-compassion-fatigue
  14. BluePearl Media. Veterinarian Burnout and Fatigue | BluePearl Pet Hospital. BluePearl. Published September 26, 2019. Accessed September 3, 2021. https://bluepearlvet.com/articles/when-caring-hurts-burnout-and-compassion-fatigue-among-veterinarians/
  15. Niedziela K. CDC reports elevated suicide rates among veterinarians. Today’s Veterinary Business. Published December 22, 2018. Accessed September 2, 2021. https://todaysveterinarybusiness.com/cdc-reports-elevated-suicide-rates-for-veterinarians/

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