Participation of Veterinarians in Assisting Medical Professionals During Pandemics
Today’s global world has also thrown serious challenges to human and animal health and environment. The most important challenge is serious communicable diseases transmitted from animals to humans. All the international agencies are seized with the situation and have realized necessity of implementing ‘One World, One Health A concept wherein scientific principles, art, skill of diagnosis, treatment and control is shared between human and animal health practitioners. strategies. Organizations such as FAO, OIE, WHO, UNICEF, UNSIC (United Nations System Influenza Coordination) and the World Bank have endorsed an integral approach to public health events involving physicians, veterinarians and other public health-related disciplines. To help the international community respond to public health events that have international ramifications, the WHO has established International Health Regulations (IHRs) that is binding on 194 countries and are duty-bound to report public health emergencies of international concern (PHEIC) in WHO managed Event Management System (EMS). Analysis of the EMS data shows that 61% of human pathogens recorded worldwide have a zoonotic origin and 75% of the emerging pathogens have been shown to have arisen from animals. A large number of these diseases are common to humans and animals with similar clinical and epidemiological profiles.
A question often asked is whether in situation of wide-spread public health emergencies were the medical personnel and resources are overwhelmed, can veterinarians participate in assisting the medical counter-part? Veterinarians go through a course curriculum covering all mammals (except human) and birds. They are adept in comparative pathology, microbiology, immunology, pharmacology, parasitology, laboratory medicine, clinical medicine and surgery, gynecology and obstetrics and epidemiology Science of study of occurrence, pattern and association of disease-causing factors.. There are a large number of veterinary institutes, central- as well as state-funded equipped with state-of-art diagnostic facilities, such as PCR, tissue culture, biochemistry and hematology, and serology, etc. They study pharmacokinetics, drug interactions, side effects, wound management. There does not appear to be any legal framework to seek their active participation in emergency situations. For example, in the event of earth quack in Maharashtra and Gujarat, the only job assigned to the veterinarians was disposing of dead carcasses and even looking after injured animals. Although non-medical volunteers are sought to help in taking care of injured people, but the help of veterinarians who are trained in taking care of orthopedic emergencies is ignored. There is a need to publish a regulatory framework for close coordination between the medical and veterinary professionals in preventing PHIEC and tackling national emergency situations.
The American Veterinary Medical Association has also recommended that during a catastrophic event, the veterinarian's training, and capability in emergency management, wound care/treatment, pharmaceutical, and medical supplies, and knowledge of the population and public health can be used to augment the capacity of the human healthcare system. The AVMA has also recommended to national authorities to address licensing, liability, policy and other related issues to adequately recognize and validate the opportunity and benefits of utilizing veterinarians as a supplementary source of knowledge and skills for human health care during mass casualty and other events following catastrophic emergency response.
In ancient times there was no difference between human and animal healers the branching came much later in the early 18th century when devastating diseases like cattle plague forced educating a specialized technical force focussed on research and treating animal diseases. In today’s era of complex legal framework, laws related to liability and professional ethics, it is difficult to imagine any law permitting veterinarians to treat humans independently. But there are a number of areas where veterinarians can assist the medical doctors in emergencies (when the doctor has not arrived at the scene) and catastrophic national emergencies, such as a pandemic, earth quack, large scale accidents, etc. wherein the veterinarians can be called upon to use their knowledge more than expected from a ‘Good Samaritan’. Following are some of the areas of potential collaboration:
- In a recent workshop on ‘One Health,’ I had suggested to the medical counterpart that in the patient history format there should be an addition to animal holding. Does the family hold any animal, and if the person undertakes animal care? All cases of refractive fever should be examined for animal-origin pathogen and a sample should be shared with the veterinary diagnostic laboratory.
- In human laboratories mostly the emphasis is on non-infectious disease investigations. Now, the time has to come to practice one health by establishing ‘One Health Infectious Disease Diagnostic Laboratory’ where both medical and veterinary laboratory professionals undertake disease diagnosis work. Aligning of the animal and human infection data will be helpful in monitoring emerging infections and possible zoonosis. Recently the Government of India has taken a smart step of using the PCR facilities in the veterinary institutes for COVID-19 diagnosis. There is a need to establish one such laboratory in a cluster of 4-5 districts.
- The veterinarians in an emergency should be sought to assist the medical doctors in:
- Wound management
- Administering i.m and i.v. drug administration and other ICU procedures (as the vets use such equipment and procedures in their clinical set up).
- Catheterization, passing of nasogastric tubes and feeding, taking and monitoring ECG and x-ray
- Intubation, CPR and other life-saving procedures
- Communicating patient clinical status with attending medical doctors and administration of drugs and monitoring of its effects.
- The veterinarians are also trained in epidemiology hence their help can be taken in gathering and organizing clinical data, analysis of data and communication of the same to the public health authorities. As a matter of fact, such data should be analyzed at each district level to understand the micro-regional pattern of the disease outbreak.
There is an urgent need to evolve a legal framework. It will also be helpful if the public veterinarians are given short-term training in assisting medical counterparts in emergency situations.
Now the time is ripe to work towards digitizing disease reporting data both from animals and humans, digitizing hospital case records and networking of the laboratories with a commonly accessible database. Disease reporting is something complex that requires a whole chain of responsible actions and feedbacks. This required addressing the ‘human concerns’ as digital platforms are already available.