What has it been like for veterinary hospitals to see patients?

Curbside service, a recent norm in the food and retail industry, has also become a reality for many veterinary offices. But how can veterinarians see patients that can’t describe their symptoms without their owners in the room with them to explain what’s going on?

How vet offices are operating

Dr. Ellen Lowery, hospital director of Purdue Veterinary Medicine, said in an email “in late March and throughout April, cases were restricted to urgent and emergency only.” However, she said the hospital has since resumed scheduling routine appointments as well, in compliance with Back on Track Indiana guidelines. It is now taking all cases based on both availability of staff and personal protective equipment.

Lowery said Purdue’s hospitals are offering “car-side services” as a way to decrease human interaction and prevent the spread of COVID-19. Through this method, owners drop pets off and wait in their cars while the animal is seen and receive appointment updates via text, call or email.

She encouraged clients to wear face masks upon arrival to the hospital, something all employees are required to wear as well. Lowery said the hospital is also taking precautions such as “social distancing, diligent hygiene and sanitation procedures” to protect the health of clients and personnel.

Dr. Lisa Blair, owner of Blair Animal Clinic in West Lafayette, said Purdue’s process is similar to that of her facility.

The Purdue graduate said that while “everything has really been restored back to normal” in terms of the services her clinic offers, its treatment process looks much different than in the past.

Blair said her office never fully closed, but rather was deemed an essential business and required to continue to administer vaccines to animals. She said this reaffirmed her perspective on the importance of procedures she had started to regard as second-nature. Blair said she was reminded that veterinarians are responsible for instances like the lack of rabies in Indiana and vaccinating animals to ensure they don’t contract diseases that could be spread to humans.

Besides vaccinations and emergency visits, however, Blair said business became noticeably slower at the beginning of the stay-at-home order. She said her staff refrained from performing surgeries on animals if possible in case personal protective equipment and even some anesthetics from the clinic were needed for nurses and doctors battling COVID-19 cases in hospitals across the state.

Blair said at one point a survey was issued to all veterinarians by the Indiana Veterinary Medical Association gauging their willingness to work with human patients if necessary.

“I thought, ‘I don’t even know what I would do with humans, like what kind of skills do I have that would really work with humans?”

But now that people have started to venture out of the house more, she said, business has surged and curbside visits are underway.

Detailing the mechanics behind the concept, Blair said on the day of their appointment, a client will park at the office and check in over the phone, disclosing any necessary medical information for the visit.

A technician then greets the owner at the car and encounters the first hurdle: retrieving the animal.

With cats, she said the process is relatively simple: the owner places its carrier on the ground and gives the technician proper distance to retrieve and bring it inside. For dogs, however, things become more complicated.

Blair said the owner is instructed to exit the car with the dog on a leash. The technician approaches the animal while maintaining a six-foot distance as best as possible and attaches a leash from the clinic to the dog’s collar. The technician then moves away, allowing the owner to approach and unclip the original leash leash, at which point the technician leads the dog inside.

“So it’s cumbersome,” Blair said. “And thankfully we haven’t lost any dogs yet but I’ve already heard stories of animals being shifty and they’re able to get away.”

Once the animal is in the office, though, difficulties are far from over. Blair said she performs an initial examination on the animal based on the technician’s information and calls the owner to report her findings and allow them to ask questions or raise additional concerns. Blair then re-examines the animal if necessary with these in consideration.

“Sometimes it’s a couple of different phone calls for me to be really thorough and examine what the owners want,” she said, “versus when I’m in the room with them they can just point it out.

“It’s kind of like a picture paints a thousand words type of thing, you lose the thousands of words because you’re not looking at the same thing.”

“Medici,” a doctor-patient communication app has been incredibly useful for the office, according to Blair. This allows clients to message vets with questions about their animals’ behavior to determine if they need to schedule an appointment or not.

She also said certain state laws had been lifted because of COVID-19 to make client-doctor interactions easier. Blair said regulations such as requiring owners perform physical examinations on animals before vaccinations and not allowing veterinarians to prescribe medication to animals if they had not been seen in their office for more than a year have currently been suspended.

Blair said she doesn’t plan to allow clients into the waiting room any time soon, even though she said she felt she probably could at this point. She identified three distinct client demographics for the clinic: Purdue students; what she referred to as “normal families and residents;” and elderly clients.

“Keeping those populations separated is important to me personally,” she said. She continued, saying she sees the clients’ health and well-being as her responsibility and doesn’t want to compromise that, especially as her exam rooms are not large enough to allow for a six-foot distance between herself and clients.

Lauren Brown, an employee at Wildcat Valley Animal Clinic in Lafayette also said she isn't sure when her clinic will return to examinations with owners present. Wildcat Valley is operating strictly through curbside services for all of its services, including wellness checks and dental appointments.

Another veterinary office in West Lafayette, Creekside Animal Hospital, also isn’t allowing owners inside. Allie, an employee at the hospital that declined to give her last name, said the hospital only took sick patients for a while, but is now taking all cases, including new and existing clients.

Effect on pets

While a few animals have reportedly contracted COVID-19, obtaining the disease is not the biggest concern for pets during the epidemic.

Both Blair and Lowry said they had not seen any patients they suspected of having the virus. Lowry said routine testing was not recommended for animals according to organizations such as the American Veterinary Medical Association, Center for Disease Control and United States Department of Agriculture.

Lowry said the current understanding in the veterinary community is that this particular strain of coronavirus plaguing the globe is transmitted primarily between humans, and no evidence has been found for animals playing a significant role in its spread. Additionally, she said the cases of person-to-animal spread of the disease have resulted from animals being in close contact with people that have the virus.

Niwako Ogata, a professor of Veterinary Behavioral Medicine, said many animals are suffering from mental health and behavioral complications because of changes in their routine caused by COVID-19.

She said the Behavioral Clinic, where she works, in the Purdue Small Animal Hospital remained open during the entirety of the national crisis, as professionals predicted an increase in pet behavioral problems would result from such widespread disruptions in their owners’ daily lives.

“Generally speaking,” she said, “50% of the population of pets (already) have anxiety or fear-related disorders,” which was only amplified by COVID-19 complications.

She said when stay-at-home order went into effect, many people experienced lifestyle changes as they switched from working the majority of their time in offices to working almost exclusively from home. This lifestyle change in turn affected pets as well, whose entire worlds consist mostly of their owner’s home.

“You might not think your animal has anxiety or has been impacted by COVID,” she said, “but if you actually watch and observe them … then you might actually see they are equally as anxious.”

Ogata said summer is already a stressful time for animals, with its frequent thunderstorms, increased number of people outside and around the animal’s house and loud fireworks displays. She did say, however, that she has noticed an increase in two specific behavioral issues in animals: social conflicts between family members -- both animals themselves and animals and humans -- and lifestyle-change-related issues, in the past few months.

Blair, as well, said her staff at Klondike Training Academy, a service offered through her clinic, have been able to identify a distinction among some animals adopted during the stay-at-home order whose owners didn’t have as many opportunities to socialize their new pets.

“We did notice a difference in some of the puppies, that they were a little bit more afraid than usual, than puppies we had seen in the past,” Blaire said, “but we’ll be able to turn that around, I’m not worried (about socializing them).”

Moving forward

Besides the hospital and the training academy, Blair also operates Klondike Kennels which along with the academy, have since reopened after brief closures during the stay-at-home order.

She said many new animals were adopted during the stay-at-home order, which was “wonderful to see,” but meant the return of training classes was necessary.

In the past, Blair’s training school ran playgroups four times a week, which she said were “like a social event,” with dogs and their humans allowed to roam the yard and socialize with different individuals of both species. Upon reopening, however, alterations had to be made -- first to “doggy-only” time, under the watchful eye of playtime moderators, but Blair said she is starting to gradually allow people back into the area as well.

“Each week we’re probably going to try to add more and see how we can maintain that six-foot distance.”

Klondike Kennels is also expecting to expand soon, thanks to extra time Blair had in the past months to work on a “doggy daycare,” something she said she’s been wanting to do for years.

“I’ve realized there’s going to be even more people staying at home,” she said. “And people are trying to be on zoom calls and their dogs are barking or running around in the background.”

Starting around the end of July, she said she will be opening up some of the yard space on the clinic’s property for day or half-day boarding as people start returning back to work. She said this will allow people to attend their virtual meetings in peace.

For owners leaving their pets at home when returning to work, Ogata recommends giving animals a two to four week “transition time” if possible before actually going back into the office.

“You can stay home still,” she said, “but you may intentionally pretend (to your pets) ‘this is my work period. I will not cuddle you, I will not help you because this is my working hour.’”

Ogata said this will allow owners to have less trouble with their animals when they return to work.

Blair said she wasn’t sure what the future of her clinic held. If distancing restrictions become a long-term norm, she said, she may look into expanding the size of her exam rooms so clients can accompany their pets at appointments while maintaining appropriate space.

“I’ve learned to take it a day at a time,” she said. “Just every day say ‘well, if tomorrow’s the same type of scenario we have today, how can we do that better?’”

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