Walking the line between the service industry and essential service
It’s March 20th 2020, I’m finishing cases for the day at our small animal veterinary hospital and I’m finally getting ready for the week to be finished. I check my group chat with some friends before I head out of the office. Everybody is discussing what they did all day. Needless to say there are lots of “#WFH” (#Workfromhome) or “homelife” or some variation of this. I slump back into my chair in front of my office computer glancing at the schedule. Back to back appointments from 2-530 all 15 minutes. Hmm, “My schedule hasn’t changed at all,” I think to myself. Jealousy pushes into the forefront of my brain. It wasn’t right, but the first thought that I had was not about what all my friends’ companies were doing to try to slow the spread of the Coronaviral infection at great cost to themselves. Instead, my first thought was a selfish one, “I wish I could work from home for a few days!”
There are far worse things than having to work your normal schedule during a pandemic and I certainly understand that, but it didn’t stop that first guilty thought. Beyond that; however, I worried about my own health and those of the dozens of people I contacted each day. I had the potential of seeing 16 different pets in the morning and 16 different pets in the afternoon. In general, seeing a minimum of 32 people a day is not too big of a deal. But, when you factor in that city regulations had already shut down schools, and owners were now bringing additional, less furry, family members; my daily contact list began growing rapidly. I was surprised when my state of New Mexico, like many neighboring states, had decided to shut down school for a period, but it was more and more looking like it was not going to resume this year at all. The more I looked around, the more I saw other businesses closing their doors and sending their workers to do their jobs remotely or in a limited capacity. My favorite breweries were instructed to limit the number of people that could dine it at a given time. I felt at times like the veterinary field was less responsive to the response efforts in spite of being a medical institution.
Everyone at the clinic was on a different page regarding what we needed to be doing during this pandemic. New Mexico hardly felt like a high-risk area. We are just SO far from Wuhan, it almost felt like it would never reach us- never affect us. Each state had a different set of regulations for service industries, but Veterinary medicine fell into a gray area where service met essential medicine. It was hard to find where we fit in the measures that were being taken in neighboring states and around our country, let alone around our city. So, for a while our clinic, and most of the others in town did absolutely nothing. It’s almost humorous in a way looking back at the beginning of it all. Our breweries and restaurants forced to take the reins on implementing pandemic control measures while there was little to no guidance as to what accessory medical establishments, such as a veterinary hospital should do. The first New Mexico government Stay At Home order came the following Monday, March 23rd; however, many industries had already been encouraged to be making significant changes to the way they were serving. Restaurants were asked to cancel large events, separate tables by at least 6 feet, and various other measures. As medical professionals (yes, I realize we are not MDs, not claiming to be) we have the duty to be at the forefront of public health rather than sitting in the bleachers waiting to see what happens. I felt that we did a poor job at distancing ourselves from the people we were seeing and an even poorer job keeping ourselves safe. Our slow response may have even conveyed a false sense of security to our clients. Instigating thoughts such as, “My veterinarian doesn’t seem concerned, why should I be?” We waited to make changes and began implementing curbside visits on March 23rd, only after the Stay at Home order was implemented. I can’t help but feel that we should have been at the forefront of change. We could have implemented measures to educate and protect our clients, and to discourage non-essential visits much earlier. The changes I saw in local Veterinary medicine came nearly two weeks after the first case of Coronaviral infection was diagnosed in New Mexico.
There were many mixed feelings throughout the clinic about how this should be handled.
There were statements ranging from, “Wow, this is a huge overreaction,” to “I’m literally so afraid to get this virus, I have to take care of my grandfather.” At first, it was a daily occurrence to hear an exasperated sigh from clients when told to wait outside (our lobby at times can house, not exaggerating, upwards of 50 people). “You guys are making these changes too, huh?” Or “Don’t worry, I’m not sick,” were practically hourly phrases we heard. What people didn’t understand is that we were (and still are) protecting them as much as we are protecting ourselves, and we should have been doing it all along. As our preparations became more and more of a constraint on daily business, I began to realize that over preparation is far better than under preparation. Essential services, like veterinary medicine, have to see multiple people and animals each day by necessity. The sheer number of people we interact with in a day means we are much more likely to serve as transmission vehicles or asymptomatic carriers than somebody who is able to work from home and only pop out for a half hour because their dog is sick. A vehicle of transmission for an infection is essentially what it sounds like. The vehicle does not need to actively be infected; it simply transports the infectious agent. Now, at the time I’m writing this, there have been studies isolating virus as well as demonstrating antibody formation to the virus in both dogs and cats. However, transmission directly from a dog or cat to a person has not been demonstrated. There is a relatively high likelihood that an animal could serve as a vehicle of transmission. At its simplest form, the worst thing that could happen by starting social distancing and other measures early is that we are over prepared. The worst-case scenario, at least at this time, felt like it would be laughable that we had taken it so seriously. Of course, there are economic impacts as well, but if we are focusing on stopping transmission of infectious disease the worst case is that the disease doesn’t kill or infect as many people as we thought it would, and we altered our way of doing business for “no” reason.
Now, we have 686 cases (KRQE.com as of 4/6/2020)* and the governor has extended the “Stay at home” order until at least April 30th as our cases increase by about 50 people every day. Our veterinary clinic has fortunately changed a lot surrounding how we handle cases coming in. We have discouraged clients from entering the building at all, and we are simply retrieving the animal and handling most of the visit over the phone. This mitigates risk to an extent, but certainly doesn’t eliminate it. We have limited our services to urgent, emergent, and public health exclusively (this includes Rabies vaccination efforts). The whole city is participating in social distancing measures, the streets are relatively empty compared to a normal day before this all began. We are still making the commute for our usual hours, deemed an essential service at least for now.
My clinic has always seen urgent and emergent cases, so it is not a big change, though things have definitely slowed down in terms of volume of caseload coming in. We’ve lengthened the allotted appointment time since we have to make multiple phone calls throughout the visit. We are currently working with one less doctor per day, trying to reduce necessary social contact for our employees and clients alike. Our technician and reception schedule has decreased as well. Initially when states around us were shutting down non-essential business, I wasn’t sure whether we would be counted. We aren’t advertised as an “emergency” center and do not see cases at all after hours. All of this really got me thinking what an essential service really is. I think the argument could be made both ways for practices like mine. Ultimately, I decided that my practice is an essential service. There are two emergency, 24/7 care, facilities near enough to my clinic that they would provide service to the same demographic as we do. We are not the only general practice clinic in this same area either. In fact, there are three others within a one-mile radius from us that are all consistently busy. The reason I feel general practices are still essential, is that if they were to close, it would have the undesired effect of increasing the case flow from these practices to nearby emergency clinics, and would thereby increase the risks to the staff in these clinics, and potentially overwhelm their healthcare capacity. If a staff member at one of these remaining open clinics became infected in this scenario it would almost certainly lead to a complete shutdown of that affected clinic, further propagating the effects of case distribution. In such a scenario, a further shut down of one emergency facility, in my area, would result in at least a 50% loss of capacity to provide medical care to pets. This would also have the unwanted byproduct of forcing the relatively diminished staff to work harder, longer hours which would also be deleterious in the long run. So, while general practice clinics, like mine, do not provide the same level of emergency service as the two referral centers that I mentioned, I do absolutely feel that all should remain an essential service, at least for the time being. Without all of these smaller clinics operating, albeit operating with limitations, the emergency centers would be overwhelmed and the entire system could shut down.
We are lucky being located in the United States, and a developed nation. Veterinarians are on the brink of what some would consider essential, as animal lives must obviously take the back seat to human ones. That being said, many, if not most, people would consider their pet to be a part of their family in the United States (95% per 2015 Harris Poll). So, we will keep driving to work on the relatively empty roads to see your furry friend and continue to treat whatever trouble they get into. It doesn’t appear that most animals have gotten the memo for social distancing and limiting exposure to the outside world. We are still seeing our fair share of dog bites and pulled muscles. And, just like with people, there’s never a guarantee against getting sick. Just in the last week there have been three separate patients that I’ve seen with cancerous masses that need to be addressed immediately. So, while many of us hunker down to weather the storm, there will still be a need throughout all medical fields to continue to work. Looking back towards the beginning of this outbreak, I wonder what measures we could have taken that would have perhaps helped our community take the disease more seriously earlier on. I wonder whether the changes we’ve made now are effective at protecting us, and I wonder where the future will lead. What I know for certain is that all medical services at this time are essential, and without them people’s lives will come to a standstill. We can’t eliminate our potential exposure fully, so we rely on everybody else- Those that have been asked to work from home and everybody else that’s socially isolated to keep on doing this. With each individual abiding these limitations, our risk of becoming infected decreases, so that we can continue serving your furry, feathered, and scaled family members. So, thanks to everybody for doing their part, and thanks for reading.
*As of April 19, 2020 the state of New Mexico is reporting 1,845 positive cases.