COVID-19 Pandemic: Veterinarian Perspective

COVID 19 Pandemic

Coronaviruses are a large family of viruses, out of which some cause cold-like illnesses in people, while others cause illness in certain types of animals, such as cattle, camels, and bats. The name “coronavirus” is derived from the Ancient Greek word korone meaning crown or halo, which refers to the characteristic appearance of the virus particles: they have a fringe reminiscent of a crown. Some coronaviruses, such as canine and feline coronaviruses, infect only animals and do not infect humans. Typically most of the coronaviruses cause mild infection, though rarer forms such as SARS (including the one causing COVID-19) and MERS can be lethal. Few coronaviruses that infect animals can sometimes be spread to humans and then spread between people, but this is rare. Severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) are examples of diseases caused by coronaviruses that originated in animals and spread to people. Health officials all over the world are working hard to combat COVID-19. This collected information is committed to providing factual, up-to-date information and resources to support the veterinary community in performing essential work during the pandemic. The whole information is collected from published recent researches, reports and advisory from renowned international organizations like WHO World Health Organization, OIE The World Organisation for Animal Health, formerly the Office International des Epizooties (OIE) is an intergovernmental organization coordinating, supporting and promoting animal disease control., CDC The Centers for Disease Control and Prevention, US and American College of Veterinary Medicine, etc.

In late December 2019, unusual pneumonia emerged in humans in Wuhan, China, and rapidly spread internationally, raising global public health concerns. The causative pathogen was identified as a novel coronavirus that was named Severe Acute Respiratory Syndrome Coronavirus 2 (SARSCoV-2) on the basis of a phylogenetic analysis of related coronaviruses by the Coronavirus Study Group of the International Committee on Virus Taxonomy; the disease it causes was subsequently designated COVID-19 by the World Health Organization. The exact source of the current outbreak of coronavirus disease 2019 (COVID-19 is still unclear but horseshoe bat and pangolin are suspected. The first infections were linked to a live animal market, but the virus is now primarily spreading from person to person. The COVID-19 virus appears to have high transmission rates, and shedding of the virus appears to occur before the infected person develops symptoms.

IDEXX Laboratories, which is a global leader in veterinary diagnostics and software, after evaluation of around 4000 of canine and feline specimens, announced not a single positive result in pets to date of SARS-CoV-2, the coronavirus strain responsible for the coronavirus disease 2019 (COVID-19) respiratory outbreak in humans. Their study align with the current expert understanding that COVID-19 is primarily transmitted person-to-person and supports the recommendation against testing pets for the COVID-19 virus. For dogs or cats presenting with respiratory signs, the recommendation is to contact a veterinarian to test for more common respiratory pathogens. That said, currently, there is no evidence that pets become sick. Infectious disease experts, as well as the CDC, OIE, and WHO indicate there is also no evidence to suggest that pet dogs or cats can be a source of infection with SARS-CoV-2, including spreading COVID-19 to people.

COVID-19 and Domestic Felines

During the 4^th OIE Advisory Group on “COVID-19 and Animals” on 31st March 2020, Belgium provided information of a cat testing positive for SARS-CoV-2, which had close contact with its owner who was COVID-19 positive. The cat was showing clinical signs of diarrhea, vomiting, anorexia, followed by coughing and superficial breathing. Consecutive vomit and stool samples from the cat tested positive (on RT-PCR and sequencing) for SARS-CoV-2. However, as the samples were taken from the environment (and not directly from the animal) and by the owner (who is not a technical expert), contamination of samples from the environment/owner cannot be ruled out. Therefore, even after proximity of cat to infected owner, clinical information and positive RT-PCR results, productive infection cannot be confirmed. It is well known that RT PCR test is highly sensitive, specific, and does not cross-react with other coronaviruses of dogs and cats.

One of the key takeaways, as highlighted by Nature, on April 1, 2020, that cats can be infected with the coronavirus that causes COVID-19, and can spread it to other cats, but dogs are not really susceptible to the infection, say researchers in China. The team, at Harbin Veterinary Research Institute, also concludes that chickens, pigs and ducks are not likely to catch the virus. Virologist Linda Saif at the Ohio State University in Wooster didn’t find direct evidence that the infected cats secreted enough coronavirus to pass it on to people. The team, led by virologist Bu Zhigao was able to create experimental infection in cats and subsequent isolation of viral RNA, as well as infectious virus particles, in their upper respiratory tracts. And these experimental cats were found to cause infection to uninfected felines and team later detected viral RNA in one out of three of these exposed healthy cats, which was kept together in cage with experimental cats, which suggests that it contracted the virus from droplets breathed out by the infected cats.  But as only one out of three cats got infection, this suggests the virus may not be highly transmissible in cats. The researchers inoculated five young dogs with SARS-CoV-2 and found that two excreted viral RNA in their faeces, but none contained infectious virus.  These findings suggest that none of these species plays a part in the epidemiology of COVID-19. The team, at Harbin Veterinary Research Institute in China, found that cats are highly susceptible to COVID-19 and appear to be able to transmit the virus through respiratory droplets to other cats. However, it should be remembered that cats are not playing much, if any, role in the spread of this virus,” he said. “Human to human transmission is clearly the main driver, so there is no need to panic about cats as an important source of virus. Obviously, if you think you have COVID-19 and share a house with a cat, then it would be sensible to limit close interactions with your furry friend until you are better.”

COVID-19 and Canines

Hong Kong’s Agriculture, Fisheries, and Conservation Department (AFCD) has indicated that a 17-year-old Pomeranian pet dog whose owner had contracted COVID-19 had been tested for SARS-CoV-2 on February 27 in samples from its nasal and oral cavities and that after five tests had come back “weak positive.” “Weak positive” suggests a small quantity of SARS-CoV-2 RNA in the samples. It doesn’t distinguish whether the samples contain intact viruses, which are infectious, or only fragments of the RNA. To better understand what this finding means, additional testing has been, and continues to be, conducted.  Part of that testing is serology to see if the dog is mounting an immune response to the virus. An acute phase sample was negative, indicating there are currently not measurable amounts of antibodies to the virus in the dog’s blood. This does not mean the dog is not infected with the virus, because it is not uncommon to have a negative result in earlier stages of infection. It can take 14 days or more for measurable levels of antibodies to be detected. Hong Kong officials advised that a second “convalescent” phase sample will be obtained later for further testing. In addition, gene sequencing of the SARSCoV-2 virus from the dog and its close human contacts has been done and the viral sequences are very similar. These pets were living with infected human owners, and the timing of the positive result demonstrates human-to-animal transfer.  Jacqui Norris, a veterinary scientist at the University of Sydney in Australia stated that virus culture on these pets was negative, meaning that an active virus was not present. In the mean time neither of the two dogs from Hong Kong, which were positive for SARS-CoV-2 showed clinical signs of COVID-19 infection.

Based on the findings, it was highlighted that so far, positive findings in companion animals were ‘isolated cases’ associated with close contact with humans positive for SARS-CoV-2.

COVID-19 and Primates: Investigators have shown that rhesus macaques can be infected with SARS-Cov-2. Chuan Quin, an experimental pathologist at the Institute of Laboratory Animal Sciences, Chinese Academy of Medical Science and his team experimentally infected adult rhesus macaques with SARS-Cov-2 and found high concentration of the virus in nose and throat. Monkeys showed reduced appetite, weight loss and increased breathing rate. However, the illness did not progress to acute respiratory distress as in humans.  One animal sacrificed showed interstitial pneumonia and presence of virus in many body tissues. The remaining animals developed neutralizing antibodies against spike protein of SARS-Cov-2, a surface protein required in virus-cell attachment in 3-4 weeks of infection. The infection was cleared in one month’s time. Further, the animals resisted re-infection of second challenge of the virus, suggesting that the infection with SARS-Cov-2 in monkeys has resulted in protective immunity, atleast in the short-term. These animals may help in developing vaccines, drugs, and antivirals for human use. No clinical case of SARS-Cov-2infection in monkeys and monkeys-to-human transmission has been reported so far.

COVID-19 and Big Cats: Previously, in China – animals from fur farms (including mink, foxes, raccoon dogs) have been tested for SARS-CoV-2 by RT-PCR has been found negative. However, On April 5, 2020, as per information released by the Wildlife Conservation Society’s Bronx Zoo, a 4-year-old tiger at the Bronx Zoo in New York has tested positive for COVID-19 as confirmed by USDA’s National Veterinary Services Laboratory, based in Ames, Iowa. According to the Wildlife Conservation Society, this cat was infected by a care taker, who was not displaying any symptoms of the disease.

COVID-19 and other Animals Including Birds

Studies by Shi and his associates from Chinese Academy of Agricultural Sciences reported that pigs, chickens and ducks are not susceptible to SARS-Cov-2infection. Viral RNA was not detected in experimentally infected animals and birds and they were seronegative for SARS-Cov-2infection when testedby using ELISA with sera collected on day 14 post infection.

General Advice on Delivering Veterinary Care during the COVID-19 Outbreak

1. Triage or treat as many cases as possible by veterinary telemedicine (e.g., using FaceTime or Skype). (Telemedicine presumes an existing veterinary-client-patient relationship, i.e., it is appropriate only for a client/patient you have previously seen in person.
2. Limit clients in the clinic to perhaps end-of-life care only OR switching to providing emergency care only (in person).
3. Remove all items in the waiting room people can touch like magazines, leaflets, coffee machine etc.
4. Prefer contactless payments.
5. Any contact with other animals possibly living in the market ( i.e. stray dogs , cats, bats, birds, rodents) should be avoided.
6. Non-essential visits like of veterinary students or pharmaceutical representatives must be avoided.
7. Veterinarians should not use commercially available corona vaccine in the face of the current outbreak thinking that there may be some form of cross-protection against COVID –19.
8. You must ensure that the technology you are using is sufficient and of appropriate quality to provide accuracy of remote assessment and diagnosis of the patient. You must also ensure that medical information obtained via VTM is recorded completely in your patient’s medical record and meets all applicable requirements of current medical recordkeeping requirements.
9. Prioritize patients that need to be urgently seen over ones that need only routine care or surgery that could be delayed.
10. For cases that have to be seen (e.g., an acutely vomiting dog), nothing should move from an infected/quarantined household to a clinic without approval and clear delineation of a plan for that clinic (what, who and how you would see the case).
11. If a client has a fever, cough, sore throat, or possible exposure to COVID-19, arrange for someone else to bring the sick animal to the clinic or use telemedicine for an evaluation of the animal. Contact the local health department for advice on how to safely deliver veterinary care to the animal.
12. At this time, there is no evidence that the virus that causes COVID-19 can spread to people from the skin or fur of pets. However, Precautions should be taken to avoid contact with animal waste or fluids on the soil or surfaces.
13. Raw meat, milk or animal organs should be handled with care to avoid potential cross- contamination.
14. Ensure trash is removed daily and disposed of safely.
15. It is still recommended that people sick with COVID-19 limit contact with animals until more information is known about the new coronavirus.
16. Designate your veterinary premises as a temporary NO HANDSHAKE ZONE. Ask colleagues and clients to refrain from shaking hands and other unnecessary direct contact.
17. Wash hands often with soap and water for at least 20 seconds, especially after using the restroom; before eating; after blowing your nose, coughing, or sneezing; and between client/animal patient visits.
18. Use an alcohol-based hand sanitizer with 60%-95% alcohol to supplement but not replace regular cleansing with soap and water.
19. Place hand sanitizer, sanitizing wipes, and tissues in all exam rooms, meeting rooms, restrooms, break rooms, lobbies, and other common areas.
20. Avoid frequent touching your eyes, nose, and mouth.
21. Cough or sneeze into your elbow or use a tissue to cover your nose and mouth, then throw the tissue into the trash can and wash your hands.
22. Encourage staff hygiene (frequent hand washing).
23. Prohibit sick or febrile staff from working in your clinic. Any staff who becomes ill with symptoms of respiratory disease, such as fever, cough, shortness of breath, sore throat, runny or stuffy nose, body aches, headache, chills or fatigue, should stay at home.
24. Sick individuals remain at home until they have had no fever for at least 72 hours (three full days of no fever without the use of medicine that reduces fevers) and other symptoms have improved (for example, cough or shortness of breath have improved) and at least 7 days have passed since onset of symptoms.
25. Standard cleaning and disinfection products can be used at recommended concentrations and contact times. All surfaces in exam rooms and public areas should be wiped down following each use.
26. Frequent cleaning of high contact surfaces is recommended.
27. Health crises can lead to anxiety among veterinary staff that compromise professional and personal well-being. Ensure that all veterinary staff are provided support during these stressful situations.
28. It is recommended that people infected with COVID-19 avoid contact with their pets, including petting, snuggling, being kissed or licked and sharing food. Another person in the household should feed and care for the pet. If the ill person must provide the care, the person should wash hands before and after interacting with the pet and wear a face mask.
29. Hospitals should put up posters etc. to increase awareness amongst visitors on DO’s and Don’ts regarding COVID 19.
30. It is recommended that animals specially cats that have been recently imported from high risk area, as with any animal introduced into a new environment, should be observed daily for signs of illness. If the animal becomes ill, the animal should be examined by a veterinarian and let them know that the animal was imported from an area identified as high- risk for COVID – 19.