In my earlier blog, I discussed the rationale and direct roles that can be assigned to veterinarians in COVID patient management. In this blog, I will discuss the third question. Can veterinarians play larger roles in human epidemic management?
Undoubtedly, the medical education is oriented towards clinical practice and 99% of their practice revolves around treating sick patients. Looking at their syllabus and talking to medical graduates I have a perception that even in clinical practice rarely their attention goes to advise patients on prevention. I do realize there must be exceptions. Medical students regard Preventive and Social Medicine as non-glamorous and non-money spinning. I also realize that at the national level in the medical institutes there are specialists and experts in preventive medicine, but at the municipal, block and district level such an orientation is missing. The focus of my blog is how veterinarians and medico at the field level cooperate to handle epidemics, at least in emergent situations. How veterinarians can help in handling epidemic data and do small local validation studies to reinforce the local decision support.
It is a fact that compared to medical, the veterinary curriculum heavily focuses on disease prevention, hence even while treating a clinical case, the idea of preventing the disease in herd mates is always on the top of their mind. The veterinarians have experience in handling infectious diseases of all sorts in different specie and adept at collecting sterile samples, reading culture plates, doing and interpreting ELISAEnzyme-linked Immuno-sorbent Assay- A test to measure antigen or antibodies in biological materials., PCRPolymerase Chain Reaction and other biochemistry laboratory results. Veterinarians have to pass an extensive course in epidemiology hence their knowledge in outbreak investigations and infectious disease management is far superior. They are educated in data-led profiling of epidemics, tracing the infection source (hot spot), ring vaccination, analysis of the data to calculate important indices such as, incidence rates, morbidity and mortality rates and have the necessary skills to establish causation and risk associations. These are critical aspects of epidemic management. In my opinion the veterinarians could be a contributing soulmate to the medicos during medical emergencies.
In the current COVID epidemic, it is heartening to see that the state Governments are using laboratory facilities and the trained manpower available in many veterinary institutes. A study at a later stage should be carried out to document their contributions and the satisfaction levels of the medical fraternity on them. This will help in institutionalizing the future collaborations. Merely testing and communicating the results to the state is rather underutilizing their talents and skills. Unless at each district and Taluka (block) level the testing data is analyzed to understand patterns of transmission, associated risk factors and impact of the implemented measures, the testing data would not be of much use. I vividly remember Dr. Alan Meek of Population Medicine and Epidemiology of the Ontario Veterinary College, elaborately discussing his analogy that the epidemics are ‘Natures Experiment in Real Environment’, hence a lot should be learnt from them compared to experiments carried out in laboratory animals. The data emanating from epidemics is very valuable data and should be analysed during the epidemic as well as retrospective.
I am sure the epidemic profiling is being done at the state and the national level by ace epidemiologists but analysis on aggregated data at the state level might not throw important lessons. My point is given the confounding variables such as climate, culture and human behavior the analysis should also be done at the district and block level. Another factor that is neglected is investigating associated ‘risk factors’ during the epidemic since disease causation and transmission is multifactorial. During the Cholera epidemic in England, an experiment carried out by a plumber establishing the source of water supply as the cause of the epidemic is a classic example of how simple investigations can be of immense use in disease control. An example Wayne Martin used to describe in the class was “Bruce County” Experiment, wherein his group found that not mixing different age groups of calves in the sales yard prevented the occurrence of shipping fever. There is need to do simple but useful studies in the present scenario. For example, a dynamic comparative study on mortality and hospital-stay duration in private Vs public Vs home, done at the local level, would throw useful information for the planners. An interesting experiment reported in social media is worth noting. The management committee of a residential building in Malad in Mumbai converted vacant flats/rescue areas into a COVID management facility equipped with basic care facilities.
The residents took upon themselves to provide food and entertainment material. This helped in saving the family members from exposure. All the persons recovered without hospitalization. Doing such quick community-supported and owned experiments at the local level and evaluation of their efficacy and impact, can lead to evolving practical approaches. Such studies can be entrusted to the veterinarians. I need not reiterate that data-led decisions give transparency and confidence not only to the policy makers but also to the general public, if shared with them.
The veterinarians can also be involved in strategic health monitoring and administering of kit-based oral medication as part of the team providing home treatment. They can also collect vital health data for analysis, including lung and heart auscultation, as they are trained in identifying abnormal sounds. It is painful to read that in some states the veterinarians have been asked to perform unrelated work which could have been done by any science or arts graduate, such as managing burial grounds and incinerators. I don’t mean to belittle the noble work of the persons working at such places, but the objection is about wasting talent by allocating unrelated work. This is only suggestive of administrators’ arrogance or negligence of knowing the real worth and expertise of the veterinarians.
It will be germane to discuss the iron-curtain approach adopted by the veterinary institutes in India, which has become an impediment to the fresh air coming from the other sides. In many Canadian and American Universities, Professors could come from diverse faculty backgrounds. A person with Ph.D. in Statistics or Mathematics is essentially a part of Epidemiology or Population Medicine Department. In medical colleges there are number of faculties with DVM and Ph.D. degrees in teaching departments. My own research guide at the University of Guelph, Ontario Veterinary College was a Ph.D. in Chemistry posted in the College of Physical Sciences, but his entire research was on biochemical approaches to drug targeting in infectious diseases. He was made adjunct professor in the Ontario Veterinary College to guide veterinary researchers. This association changed my approach to understanding of the diseases process and my research orientation. I knew a Physics Professor who was appointed as adjunct professor in the Department of Veterinary Surgery to work on the physics of imaging in animals. When I was taking courses in epidemiology, few mathematic students had registered as non-credit students and the epidemiology major students taking courses in statistics and maths. If it is not possible to create a substantive post for non-faculty staff, such experts from diverse faculties can be appointed ‘Adjunct Professors’. Why a cardiology professor from medical college not be requested register and jointly run a course on canine cardiology or radiology or imaging? The medical and veterinary facilities and the state Departments need to do brainstorming and come up with a working document.
From the news published recently, it is learnt that the Indian Military Establishment has sought the help of the RVC veterinarians in managing military hospitals and the Haryana Government’s request to the veterinarians to provide help in ICU, should wake up other states to trust the expertise of the veterinarians. I am sure many retired veterinary professionals would more than willing to assist in this time of crisis.