Guidance for Veterinarians

What do we currently know about animals and COVID-19?

SARS-CoV-2, the virus that causes COVID-19 in humans, is thought to be spread primarily through respiratory droplets from coughing, sneezing, or talking. Airborne transmission over long distances is unlikely. The virus has been shown to survive in aerosols for hours, on cardboard for up to one day, and on plastic or steel for up to three days. There are also reports that people may be able to spread the virus while pre-symptomatic or asymptomatic. We are still learning about this novel zoonotic virus, and it appears that in some rare situations, human to animal transmission can occur.

CDC is aware of a small number animals, including dogs and cats, reportedexternal icon to be infected with SARS-CoV-2 after close contact with people with COVID-19. The United States Department of Agriculture (USDA) recently reportedexternal icon a confirmed infection of SARS-CoV-2 in a tiger with a respiratory illness in New York, which is the first confirmed case of SARS-CoV-2 infection in an animal in the United States, as well as the first confirmed infection in a tiger in the world. Several other big cats (tigers and lions) in a neighboring enclosure at the zoo also developed a mild respiratory illness, but all are expected to recover. Officials believe this tiger was likely infected by a zoo employee, suggesting person to tiger spread. Further studies are needed to understand if and how different animals could be affected by SARS-CoV-2.

Limited information is available to characterize the spectrum of clinical illness associated with SARS-CoV-2 infection in animals. Clinical signs thought to be compatible with SARS-CoV-2 infection in animals include fever, coughing, difficulty breathing or shortness of breath, lethargy, sneezing, nasal discharge, vomiting, and diarrhea.

Advise veterinary clinic staff who are sick to stay home

Follow CDC’s guidance on what to do if you are sick. Ask staff to stay home if they are sick.  Employees who appear to have symptoms (i.e., fever, cough, or shortness of breath) upon arrival at work or who become sick during the day should immediately be separated from other employees, customers, and visitors and sent home. Inform the staff’s team members if they have been exposed to a potential COVID-19 case, while maintaining confidentiality as required by the Americans with Disabilities Act. Notify the local health department of the potential exposure as well. Ill staff should not return to work until their fever (defined as ≥ 100.4°F) is absent for at least 72 hours without the use of fever reducing medication, other symptoms have improved, and at least 7 days have passed since symptom onset.

Implement sick leave policies for veterinary clinic staff that are flexible, nonpunitive, and consistent with public health guidance, allowing employees to stay home if they have symptoms of respiratory infection.

Follow CDC guidelines for cleaning and disinfecting areas the sick employee visited. If possible, staff should each have their own workspace/equipment and avoid sharing desks/work tools. If these items must be shared, they should be frequently disinfected.

Critical workers, like veterinarians and their staff, can be permitted to continue to work following a potential exposure to COVID-19, provided they remain asymptomatic and additional precautions are implemented to protect them and the workplace. Consider having everyone who enters the clinic, including employees and visitors, wear a cloth face covering over their nose and mouth to contain respiratory secretions, unless engaged in an activity that requires some form of PPE.

Postpone elective procedures, surgeries, and non-urgent veterinary visits

Many jurisdictions recognize veterinary practices as essential and are allowing them to operate during the COVID-19 pandemic, but considerations should be made to protect human and animal health. To protect staff and preserve personal protective equipment (PPE) and supplies during the COVID-19 pandemic, veterinary clinics should postpone elective procedures, surgeries, and non-urgent visits, and prioritize urgent and emergency visits and procedures until regular business operations resume in your community.

The greatest risk of COVID-19 exposure to staff at veterinary clinics comes from person-to-person transmission through respiratory droplets from coughing, sneezing, or talking, which is the main way SARS-CoV-2 spreads. Clinic staff should be screened daily, at the beginning of shifts prior to interacting with staff and clients and should practice social distancing. Clinics should take precautions to minimize staff contact with all pet owners. Examples of actions to take to minimize contact with pet owners or other people include:

• Postponing non-urgent or routine procedures (spays, neuters, elective procedures) and appointments. Veterinarians should use professional judgement when determining whether a case is urgent or non-urgentexternal icon.
• Using telemedicine for consults or to help triage patients. Consult your state requirements for telemedicine and veterinary-client-patient relationship (VCPR) requirements.
• Scheduling drop-off appointments or receiving animals from their owners’ vehicles (also called curbside).
• Communicating via telephone or video-chat to maintain social distancing.
• Using online payment and billing to reduce handling credit cards or other potential fomites.

Have a plan in place to handle animals with confirmed or suspected COVID-19 exposure, or potentially compatible clinical signs. Veterinarians should contact their state public health veterinarianpdf iconexternal icon or state animal health officialexternal icon for guidance on testing animals for SARS-CoV-2 infection.

Screen pets for exposure to people with COVID-19

Before scheduled appointments or upon arrival, a staff person should ask if the pet has had any exposure to a person with suspected or confirmed COVID-19.

Know actions to take if a pet owner has suspected or confirmed COVID-19

If a pet owner currently has respiratory symptoms or is a suspected or confirmed case of COVID-19, they should not visit the veterinary facility. Consider whether a telemedicine consult is appropriate. If possible, a healthy friend or family member from outside their household should bring the animal to the veterinary clinic. The clinic should use all appropriate precautions to minimize contact with the person bringing the animal to the clinic. If there is an emergency with the animal, the animal should not be denied care.

• If a pet owner is suspected or confirmed to have COVID-19 and must bring their pet to the clinic, the following actions may be taken:
  • Communicate via phone call or video chat to maintain social distancing.
  • Retrieve the animal from the owner’s vehicle (also called curbside) to prevent the owner from having to enter the clinic or hospital.
  • Maintain social distancing and PPE recommendations when interacting with clients.
  • Request smaller animals be brought in a plastic carrier to facilitate disinfection after use. Also advise the owner to leave all non-essential items at home to avoid unnecessary opportunities for additional exposure.

• Every effort should be made to prevent ill persons from entering the clinic, without negatively impacting animal welfare
  • If an ill pet owner must enter the clinic, consider the following preventive actions:
    • Ask that the person wear a cloth face covering to cover his or her nose and mouth. Be prepared to provide a face covering to the ill person if they do not have their own.
    • Direct the pet owner and patient to a single exam room or isolation room.
    • Limit the number of veterinary staff that enter the room, handle the animal, or interact with the pet owner and wear appropriate PPEpdf icon as described below.
    • Clean and disinfect the room, surfaces, supplies, floor, or equipment located within 6 feet of ill pet owners after they leave.
• If you are a mobile or house call veterinarian and are called upon to evaluate a sick or injured animal in the home of a COVID-19 patient:
  • Enter the home only if absolutely necessary. AVMAexternal icon suggests that mobile and house call veterinarians consider examining animals in their vehicle, outside, or seek the assistance of a local clinic. If you must enter the home where someone is sick with COVID-19, wear appropriate PPE.
  • PPE should be donned before entering the home and removed only after leaving the home, following appropriate donning and doffing procedurespdf icon.
  • If there is a sick person in the home, ask the sick person(s) to confine themselves to another room in the house if possible. If not possible, ask them to wear a cloth face covering and maintain a distance of at least 6 feet (2 meters). Be prepared to provide a face covering to the ill person if they do not have their own. Minimize contact with other household members, even if they appear healthy, as person-to-person transmission can occur before symptom onset.
  • Wash hands immediatelypdf icon after removing PPE, handling the animal, or interacting with a sick person or household contact. If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.

• Critical workers, like veterinarians and their staff, can be permitted to continue to work following a potential exposure to COVID-19, provided they remain asymptomatic and additional precautions are implemented to protect them and the workplace.

Clinical signs in animals

The clinical spectrum of illness for the SARS-CoV-2 virus remains largely undefined in animals. Animals may present with respiratory or gastrointestinal clinical signs based on the presentation of other coronaviruses more commonly found in animals as well as other emerging coronaviruses, including SARS-CoV-1 infection.

Clinical signs expected to be compatible with possible SARS-CoV-2 infection in mammalian animals may include:

• Fever
• Coughing
• Difficulty breathing or shortness of breath
• Lethargy
• Sneezing
• Nasal/Ocular discharge
• Vomiting
• Diarrhea

Personal protective equipment (PPE)

Given current limitations in knowledge regarding COVID-19 and companion animals, these PPE guidelines use a cautious approach. Recommendations may change over time, as new information becomes available.

Minimum Personal Protective Equipment (PPE) Recommendations Based on Animal History

¹PPE Standard Precautions should be applied in any setting where veterinary care is delivered and may include use of gloves or protective eyewear depending on the type of procedure and if exposure to fluids, exudates, feces, saliva, or other animal fluids is possible.

²A SARS-CoV-2 or COVID-19 exposure in this context refers to the following conditions within the 14 days prior to presenting for veterinary care:

• Being within approximately 6 feet (2 meters) of a person with suspected or confirmed COVID-19; close contact can occur while an animal is living with, being pet, snuggled, giving kisses or licks, and/or sharing food or bedding with a person.
• Having direct contact with infectious secretions from a person with suspected or confirmed COVID-19 (e.g., being coughed, sneezed or spit on, sharing food or consuming an object that was recently contaminated with an infected person’s mucous or saliva).

³Reusable (i.e. washable) gowns are typically made of polyester or polyester-cotton fabrics. Gowns of these fabrics can be safely laundered according to routine procedures and reused.

⁴Respiratory protection that is at least as protective as a fit tested NIOSH-certified disposable N95 filtering facepiece respirator is recommended.

• If an N95 respirator is not available, use a combination of a surgical mask and a full face shield.
• Respirator use should be in the context of a complete respiratory protection program in accordance with OSHA Respiratory Protection standard (29 CFR 1910.134), which includes medical evaluations, training, and fit testing.

⁵ Clinical signs expected to be compatible with possible with SARS-CoV-2 infection in mammalian animals may include: