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Veterinarians Urged to Conserve PPE

The following important information regarding COVID-19 was e-mailed by AVMA the evening of March 18, 2020.

Today we had a call with the US Secretary of Agriculture Sonny Perdue, who expressed his appreciation for the veterinary community and all the contributions the nation's veterinarians make to our daily lives. The numerous ways in which we contribute become even more apparent during difficult times such as these. We shared with the Secretary the multiple roles veterinarians are playing as we work to address the COVID-19 crisis. It is wonderful to know that our nation's leaders recognize the value that veterinarians deliver as we protect animal health and welfare and public health.

The COVID-19 situation continues to evolve rapidly, and we know that you have many questions. The AVMA is working around the clock to get the answers you need and to respond to emergent proposals in ways that support veterinary medical teams, patients, clients, and their communities.

Of utmost importance at this critical time is the conservation of Personal Protective Equipment (PPE). Federal and state officials are urging healthcare providers and others who use PPE to take actions that will help conserve supplies to increase their availability on the human health side. The veterinary profession will need to do its part, so it is critical that veterinarians think strategically about how to conserve.

As an example, because of the need to conserve PPE, and within the context of professional judgement, veterinarians should consider postponing elective surgical procedures as long as doing so is medically appropriate.

To help veterinarians respond to this critical need to conserve PPE, while continuing to protect their patients and their teams, the AVMA is preparing a guidance document that will be based on recommendations from the FDA, but with some additional commentary to identify those recommendations that may be more directly applicable to veterinary medicine. That document will be posted to the AVMA website and sent to you when it is completed.

We understand that over the longer term, there are implications of applying such conservation practices that could impact your ability to adhere to current standards of care and we have worked with the American Association of Veterinary State Boards (AAVSB) to encourage some flexibility. On March 17, the AAVSB sent a letter to the US and Canadian veterinary state boards, recommending that "to the extent PPE supplies should be inadequate to supply the needs of veterinary practices, Member Boards should consider such shortages when called upon to review the standard by which such care has been provided during the time of such shortage. Member Boards are encouraged to allow greater deference to the veterinarian's professional judgment for unique circumstances that arise during these times of quarantine and resource conservation."

In addition, these same federal and state officials and our human medical colleagues are beginning to reach out to us requesting donations--of both PPE and ventilators. This is our opportunity to share the great work of our veterinary medical teaching hospitals in collaboration with the Association of American Veterinary Medical Colleges. Already, on campuses where there are both veterinary teaching hospitals and human medical teaching hospitals, our veterinary teaching hospital staff are reaching out to see how they can collaborate with their human medical colleagues to help fill gaps in equipment, sharing available PPE as well as sharing ventilators and repurposing anesthetic machines that might be used as ventilators. While this collaboration is happening, we anticipate there will be an opportunity for you to participate as well. We've reached out to the Veterinary Medical Association Executives (VMAE) to ask them to work with state veterinary medical associations to identify local needs and what opportunity there may be to meet those needs. Your state associations may be reaching out to you accordingly. Please know that we are incredibly grateful for any support you might be able to provide.

During this time, it is also vitally important that you protect your staff. If you or one of your staff becomes ill or is known to be exposed to COVID-19, in addition to concerns about your and their wellbeing, there is the possibility that you will be asked by public health officials to temporarily close your practice for personnel isolation and facility cleaning. With this risk in mind, we are increasingly seeing state veterinary medical boards issue advisories that veterinarians should work to reschedule all nonessential appointments so as to limit public exposure. In addition, veterinary clinics should be aware that limits on statewide gatherings (e.g., 10 people) could apply to activity in their clinics. In most cases, these will not apply to employees in the clinic, but they may apply to clients in waiting rooms. Please check with local officials for clarification. Telemedicine and emergency teletriage within the context of an existing VCPR can be extremely helpful in limiting your staff's exposure, and enable you to support and monitor the health of your patients and conform to local requirements, while preventing the potential spread of COVID-19. Conducting pre-visit triage can help protect you and your staff as you prioritize and determine which patients need to be seen at the clinic. It can also help you manage personnel resources.

Related to our concerns of potential clinic staff exposure, we are also working to share guidance on what to do in the event that a clinic staff member contracts COVID-19 and will provide that for you as soon as possible. These materials will be added to the AVMA website, which you can check frequently for updates at avma.org/coronavirus. Also, at that same website, you'll already find helpful guidance on caring for veterinary patients and managing visits.

Another critical area we are working on is to ensure that veterinary medicine is classified as an essential business. With various jurisdictions limiting provision of goods and services to those that are "essential," AVMA has been advocating strongly on your behalf for veterinary clinics to be considered "essential businesses."

On March 17, the AVMA shared a statement urging federal and state lawmakers to consider veterinary practices "essential businesses" and thereby allowed to continue to provide critical services in our communities. This is very important in cases where non-essential retail facilities are asked to close or repurpose personal protective equipment (PPE) due to COVID-19. Veterinary teams provide essential care for ill and injured animals, play a critical role in protecting the health of animals that enter the food supply, and serve as trusted members of the local community in disaster situations.

We are also working diligently with Congress to advocate on behalf of the profession on many fronts to address the needs of veterinarians related to COVID-19, whether as owners or employees of veterinary practices. Today, the Senate advanced the Families First Coronavirus Response Act (H.R. 6201). The bill includes provisions to support individuals in light of the COVID-19 outbreak and includes new paid leave requirements for employers. After much debate over the impact to small businesses, the package now awaits the President's signature to become law. Throughout the deliberations, AVMA advocated for a workable solution that would support individuals in need of paid time off without overly burdening small businesses and risking their financial viability. AVMA remains engaged in the ongoing deliberations. Further legislative measures are expected as Congress responds to the ripple effects and financial impact of the outbreak.

The veterinary community is strong and we are all in this together. We can do our part for the common good, while making sure we continue to provide the needed medical support to our patients and protect the nation's food supply.

The AVMA will continue to work with multiple organizations and agencies on these issues as COVID-19 continues to impact the profession and the world around us. We are committed to you and will continue to provide you with information and resources as soon as they are available.

Sincerely,

John Howe, DVM President, American Veterinary Medical Association
Rena Carlson-Lammers, DVM Chair, Board of Directors, American Veterinary Medical Association
Janet D. Donlin, DVM, CAE Chief Executive Officer, American Veterinary Medical Association