Will We Ever Come in from the Curb? And When We Do, What Will It Look Like?

Veterinary staff will come in from the curb, and clients with them. Things will return, if not to normal, then to something that looks closer to the way they used to be. But what will that look like? And how long will it take?

by Tony McReynolds

ONE DAY, THIS PANDEMIC WILL BE OVER.

Veterinary staff will come in from the curb, and clients with them. Things will return, if not to normal, then to something that looks closer to the way they used to be.

But what will that look like? And how long will it take?

“It’s not like we’re going to throw a switch and go from lockdown to fully open,” says J. Scott Weese, DVM, DVSc, DACVIM. “We’re going to have [to] scale back.”

Weese, director of the Center for Public Health and Zoonosis at the University of Guelph in Ontario, Canada, and a veterinary internal medicine specialist at the Ontario Veterinary College, is a contributing reviewer of the 2018 AAHA Infection Control, Prevention, and Biosecurity Guidelines. He’s authored a series of in-depth guides on how to safely reopen a veterinary hospital on behalf of the Ontario Veterinary Medical Association, and knows what coming in from the curb is likely to look like.

The word “gradual” comes to mind.

And Weese believes that’s a good thing, because hospitals need to assess the enormous changes they’ve had to make to cope with the pandemic—changes initially made to protect the health of patients, clients, and staff alike—that have had the unintended consequence of forcing them to run leaner and more efficiently.

As to what those changes are going to look like, Weese says that’s likely to be hospital specific.

Curbside, for instance.

“Some hospitals like curbside because it’s less of a hassle” than having clients come inside, says Weese. Especially hospitals that are busy and tight on space.

“One of the things we’ve been trying to do as we work through COVID is reduce the number of people in the hospital overall, and reduce the length of time that they’re there,” Weese points out. In other words, offering curbside can increase a practice’s efficiency, so expect to see a lot of practices continuing to offer the service postpandemic. In addition, many clients say they like the scheduling flexibility of curbside because they can drop off their pets and go run errands. So, it has the added bonus of making clients’ lives more efficient.

Hybrid Appointments

Telemedicine is likely here to stay as well, Weese says.

The pandemic saw a lot of hospitals embrace telemedicine to help keep their doors open. Telemedicine also allowed at-risk staff to work from home, which reduced the number of employees in the building, making it easier for those who remained onsite to socially distance. In the process, many veterinarians were forced to get up to speed on telemedicine technology fast.

In particular, Weese sees value in the hybrid appointment—which combines curbside and telemedicine—as a way to increase hospital efficiency and improve patient care: Veterinarians (or staff) can do some things, such as getting patient history or explaining treatment options, via telemedicine, then follow up with the in-person appointment for the actual exam. “You could spend the morning at home doing all the calls, answering all the client’s questions,” says Weese, “and then the next day, all the client has to do is show up curbside [and] drop off the patient, and all you’re doing is physical exams and vaccinations.”

So, instead of having people coming in and tying up exam rooms for half an hour, their pets are coming in for five minutes, and follow-up appointments can be done by phone. This option can be particularly attractive to busy practices with limited space.

The combination of curbside and telemedicine makes a much more flexible appointment model, says Weese, although he concedes that it could complicate scheduling: “Hospitals will have to figure out what works best for their space and their personnel.”

While that may be the biggest long-term change, it’s also likely just one of many.

“We need to think about all the things we’re doing differently, really think about the reasons we would keep doing it, and keep the stuff that works.”
—J. Scott Weese, DVM, DVSc, DACVIM

Weese says we’ll continue to see improvements in things like ventilation and CO2 monitoring, “just airflow stuff in general, which is going to help us if COVID becomes a chronic, endemic disease, which it may well. But those things will also help hospitals better weather any pernicious infectious illness.”

“We need to think about all the things we’re doing differently, really think about the reasons we would keep doing it, and keep the stuff that works.”

As to when we can expect these changes to take root as the new postpandemic reality, that won’t happen until the pandemic ends. And no one knows when that’s going to be.

“It really depends on vaccine coverage,” Weese says. If you have a lot of vaccine-hesitant people and, say, 40% of your population won’t get vaccinated, then COVID is going to keep circulating because there are so many infectious people out there. “But if you can hit herd immunity—65% to 70% of the population vaccinated—then COVID becomes this minor disease that pops up periodically, but isn’t going to be rampantly endemic.”

“So getting that vaccine coverage is really the key,” Weese adds.

Although Christine Petersen, DVM, PhD, director of the Center for Emerging Infectious Diseases at the University of Iowa and an associate professor of epidemiology, thinks it’s too soon to predict what veterinary hospitals will look like in a postpandemic world, she knows they’re going to look different.

And, like Weese, she thinks curbside is likely to be a big part of it.
“The convenience of just driving up and swiping your credit card,” after someone brings your pet out and tells you what happened during the appointment, says Petersen, is something that appeals to a lot of people.

As does telemedicine, she says: “Those clients may not want to go into the exam room and watch their animal be scared.” They might be more comfortable dropping their pets off curbside and talking about treatment over the phone. “And that could just become a service that hospitals offer.”

That’s why Petersen thinks hybrid appointments will be the wave of the future, which she describes as a combination house call and traditional office visit. “You’ll have hospitals that choose to do them consistently.”

Lessons Learned

A newfound awareness of how easily infection can spread inside a hospital is something else that isn’t likely to go away, says Petersen; the pandemic has forced many hospitals to confront the problem and we’ll continue to see more hospitals upgrading environmental engineering controls so that there’s better infection control within the hospital. “Whether we’re protecting the humans or the animals, I think that’s just smart.”

She notes those changes aren’t just good for helping to control COVID, they’re good for helping to control any infectious disease: “Whether it’s something that can only spread within one species, like dogs or cats, or it’s something that’s truly zoonotic.” She says that in terms of little things like hand sanitizer in every room, people are going to be more conscious of safety in general in their interactions with other people. “I’m hoping at least maybe some of the hand sanitation–based stuff will stick around. At least for a while.”

Another reason it’s difficult to say what COVID-related changes hospitals can expect to see in a post-COVID world is that COVID could be here to stay, at least in some form: “We’re [still] going to have COVID next year,” Petersen says, “[although] it’s probably going to be more of a child-based disease.” She says that’s because once we reach herd immunity, the people who are going to be most susceptible to COVID are going to be the children who were born during the pandemic who haven’t been vaccinated or exposed.

“COVID is going to become like the flu,” Petersen added. “Something we see every year.”

Like many epidemiologists, Petersen thinks epidemics of infectious diseases like COVID are going to become more and more common: “I think we’re going see one of these every 5 to 10 years,” she predicts. “Not quite to the extent of COVID, hopefully. But I think that drumbeat is going to keep going.” She mentions the rash of epidemics since 2000 that include outbreaks of the Zika virus, Ebola, and avian influenza. “So I think it’s in our best interest to try to remain a little bit more vigilant and not slip all the way back.”

“If curbside is working to deliver good patient care and protect the safety of those who work in the practice, continuing to deliver service curbside may be the ideal decision for time being.”
—Meghan Davis, DVM, MPH, PhD

Meghan Davis, DVM, MPH, PhD, an associate professor in the Department of Environmental Health and Engineering at Johns Hopkins Bloomberg School of Public Health, says that even though vaccines are being deployed, new variants of the virus—such as the UK, South African, and Brazilian variants—may be more resistant to the vaccine than the original virus, and it’s hard to know how this will impact hospital safety protocols: “For example, viruses that survive longer in the air or on surfaces might need to be addressed through more frequent cleaning and greater attention to air filtration.”

Davis says that at minimum, practices should continue to focus on how their existing COVID-19 safety protocols are being implemented: “Everyone (staff and clients alike) has fatigue around consistent use of social distancing, wearing of masks and other PPE, and adherence to administrative controls, such as those around how many people are allowed in rooms.”

Davis says that decisions to return to normal operations should be made on a case-by-case basis, driven by a variety of factors: “If curbside is working to deliver good patient care and protect the safety of those who work in the practice, continuing to deliver service curbside may be the ideal decision for time being.”

Even once hospital staff is vaccinated and, presumably, safe from infection, hospitals still should remain wary of letting unvaccinated clients into the building: “Moving from curbside to in-person visits means that clients could then have contact with each other in the hospital space and transmit the virus among each other.” She says this risk will be driven, in part, by rates of infection in the local community.

“The best advice I can give for practices that want to reopen is to watch the COVID rates in your area carefully, and be prepared to return to curbside if local cases start to surge,” Davis says.

Most importantly, Davis says, have a plan. “If a practice wants to reopen, it might do so for only one designated shift so that if there is an exposure and the staff needs to quarantine, it only affects that one group. This means that those who are doing the scheduling for the staff have to take care not to let any team members cross from a reopening shift to a shift designated for curbside; these groups have to be kept separate, each in their own work pod.”

Whatever changes COVID brings to the postpandemic veterinary landscape, they’re going to be physical as well as procedural.

“COVID is going to become like the flu, something we see every year.”
—Christine Petersen, DVM, PhD

“The pandemic has changed the way we think about healthcare facilities, including veterinary practices,” says architect Heather Lewis, AIA, NCARB.

Lewis is a partner at Animal Arts, a Boulder, Colorado–based architecture firm that specializes in designing veterinary hospitals and animal shelters from the ground up, and she says many practices are anticipating the kinds of changes that Weese, Petersen, and Davis discuss: “When we talk to veterinarians today about remodeling their practices, they most often ask us to reduce the size of waiting spaces and increase the number of exam rooms,” says Lewis, noting that this is both a healthy choice to prevent mixing people in a common space and a money-making choice for practices.

“Veterinarians are also more interested in options for creating a healthy indoor environment, including adding more indoor/outdoor space, making windows operable, and improving indoor air quality via supplemental exhaust, additional filtration, and air treatment,” Lewis adds.

Lewis says that in the wake of COVID, more practices understand that a flexible mindset is the best tool for changing times—and for deciding what changes they want to keep: “Practices can mix remote care options such as telemedicine with in-person care. They can reduce physical office space. They can reconfigure medical spaces via flexible furnishings to allow for more or fewer patients, and more or fewer staff.”

In the end, Petersen says it’s difficult to say what’s going to happen once the pandemic’s over.

“It’s like predicting the future almost to the point of fiction.” 

COVET Study

The COVET study is collecting opinions from veterinary and animal-care workers on disaster preparedness related to the COVID-19 pandemic, with the goal to develop and maintain a resilient animal-care workforce capable of responding to this and future crisis situations.

We know that veterinary medicine and animal-care workers provide a valued service of infection control to and from animals, and serve as a point of guidance on public health for their clients/visitors. Their important role is even more critical during this pandemic. Yet, like other essential workers, they are at risk of exposure and infection from COVID-19.

Because of this, we started the COVET study with the main objective to assess veterinary and animal care workers’ risk perception and ability and willingness to report to duty during COVID and uncover factors that affect these outcomes. We also captured perceptions on current and prospective organizational support systems to increase response willingness and mental health resilience before, during, and after the pandemic. Our end goal is to provide a needed evidence base for future planning and training efforts that can be implemented by public health agencies and decisionmakers in order to build an animal-care workforce that is not only capable, but willing, to respond during this and future crisis situations.

Those interested can find more information on the COVET study, and contact the research team.

—Kathryn Dalton, PhD, VMD, MPH
Postdoctoral Fellow, Davis Lab
AKC CHF Fellow
Environmental Health and Engineering
Johns Hopkins Bloomberg School of Public Health

Tony McReynolds
Tony McReynolds is AAHA’s NEWStat editor.

 

Photo credits: Vesnaandjic/E+ via Getty Images, andresr/E+ via Getty Images, yacobchuk/iStock via Getty Images Plus, andresr/E+ via Getty Images, Geber86/E+ via Getty Images

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