For more information
Dr. Sykes directed attendees to a document from the Centers for Disease Control and Prevention that details which forms of protective equipment are recommended when handing companion animals, and offers guidelines for testing.
SARS-CoV-2: Why, when, and how to test veterinary patients
Answers from experts to the COVID-19 questions on every veterinary professional’s mind.
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As testing for SARS-CoV-2 becomes more widespread among the American population, it’s only natural to wonder whether veterinarians should be testing more of our patients. If the answer to that question is yes, then how should we decide which patients should be tested? And what are the recommended testing procedures?
These issues were addressed during a recent webinar panel discussion sponsored by Idexx Laboratories and hosted by the University of California, Davis, School of Veterinary Medicine. The session featured Jane Sykes, BVSc (Hons), PhD, MBA, DACVIM, chief medical officer at the William R. Pritchard Veterinary Teaching Hospital at the UC Davis School of Veterinary Medicine, and J. Scott Weese, DVM, DVSc, DACVIM, professor in the Department of Pathobiology at the University of Guelph Ontario Veterinary College, and public health and zoonotic disease microbiologist for the university’s Centre for Public Health and Zoonoses.
What’s the real disease risk for pets? Do pets pose a risk to humans?
Disease risk should be a consideration when deciding whether to test. But despite active research, questions about the true risk of SARS-CoV-2 in pets, and whether pets can spread the illness to other pets or humans, remain unanswered. Worldwide, millions of people have been diagnosed with SARS-CoV-2, but so far there have been only a few reports of positive test results in companion animals. Case reports and experimental studies have suggested that cats, dogs and ferrets can test positive for SARS-CoV-2, but field study data are still limited. Dr. Weese warned that surveillance studies are critically important when trying to answer these questions. “Experimental studies are interesting, but we can’t rely on that,” he said. “We need field data.”
As part of a surveillance study, Idexx Laboratories tested over 5,000 samples from sick dogs, cats and horses in South Korea, the United States, Canada and Europe. So far, all those samples have been negative for SARS CoV-2. Antech Diagnostics reported in late April that two feline samples from New York State tested positive in its surveillance program. These are the only known pet cases in the United States.
Of the samples tested by Idexx, Dr. Weese noted that “we don’t know how many, if any, of these animals had possible exposure to infected humans.” He added that surveillance testing itself poses a challenge, because samples from pets should be obtained soon after (ideally within 1 to 2 weeks) a human positive case is confirmed. Because a COVID-19–positive person is advised to remain at home, surveillance testing for pets requires either that investigators enter the homes of potentially infected humans to collect pet samples or potentially exposed pets must be brought into a practice or other facility for testing. Both procedures present important logistical challenges. “That’s why these studies are developing slowly, and results are trickling in,” he said. So far, SARS-CoV-2 in animals appears to be uncommon, but the extent to which clinical disease occurs in dogs and cats is still unknown.
The question of pet fur acting as a fomite was also addressed. Evidence for this type of transmission risk is limited. Dr. Sykes noted that the virus likely only lives on a pet’s coat for a few hours. However, Dr. Weese added that pets acting as fomites could be a potential concern for veterinarians. “If someone is infected and coughing on their cat, we (veterinarians) might be handing that cat a few minutes later. I think that’s where the main theoretical risk comes in. We just don’t know what the risk is. That’s one of the reasons to take extra precautions.”
Dr. Sykes echoed that advice, emphasizing that human-to-human interactions drive disease transmission. “We still have no evidence of animal-to-human transmission, but we also haven’t proven that it can’t happen. So, we still need to take precautions,” she said.
What should pet owners do if their pet develops signs?
Potential signs of COVID-19 in pets include respiratory disease, fever, vomiting, diarrhea and inappetence, especially if these signs are observed within seven to 14 days following exposure to a COVID-19–positive person. However, Dr. Sykes noted that pets presenting with these signs are more likely to be sick from something else, such as regular upper respiratory tract disease, so it’s important to consider other illnesses as part of a diagnostic evaluation.
Owners who suspect their pet may be ill should call their veterinarian. If the pet needs to be seen, someone else should bring the pet to the practice. Optimally, clinics should offer car-side or telemedicine consultations to initiate evaluation of these pets. In-contact physical exams may not always be required. “The need for examination should be based solely on the clinical status of the pet, not because of fears about COVID-19,” Dr. Weese said.
Regarding risk assessment and the need for an examination, Dr. Weese contrasted two patient scenarios. “If a dog that lives in a household with a COVID-19–positive human and routinely visits a dog park (being walked by someone else in the home) presents with a low-grade fever and mild cough, I’m not terribly worried about that dog having COVID-19. If the dog is otherwise healthy, it may not need to be seen," he said. "But if I see an indoor cat that has been very close with owners who are COVID-19 positive, and that cat develops acute-onset, severe respiratory disease, I’m more concerned about COVID-19 because that cat’s illness is less likely to have another infectious cause. That cat should probably be seen.”
What are the recommended handling procedures?
To test patients, veterinarians need to decide how to handle potentially infected pets without risking exposure of staff members.
Pets from COVID-19–free households
For pets coming from a non–COVID-19 household, the presence of pet owners inside the veterinary practice should be minimized. Dr. Sykes said exceptions can be made for things like euthanasia, or if handling a working animal that is difficult to manage without the handler or owner being present. Otherwise, car-side consultations are advised (if possible), and staff members conducting these consultations—and handling pets that come into the practice—should wear appropriate protective equipment.
Pets from COVID-19–positive households
For pets coming from known or suspected COVID-19–positive households, someone else should bring the pet in to be seen. Car-side consultations are still appropriate, but higher-level protective equipment should be worn, including an N-95 mask (if available), face shield, full gown, etc. After the pet is removed from the owner, wiping the pet down with a disinfectant wipe, such as a hydrogen peroxide wipe, is a good precaution. Exam rooms and surfaces should be disinfected properly. And if hospitalization is needed, these pets should be cared for in isolation.
What are the recommended testing procedures? Which pets should be tested?
Idexx Laboratories has made its polymerase chain reaction (PCR) test commercially available to veterinarians. Several university laboratories and research facilities also have PCR tests available for animals. Nasal, oropharyngeal and rectal swabs can be submitted for PCR testing.
Despite testing being more readily available, it’s not prudent at this point to test all patients. According to Dr. Sykes, routine testing of asymptomatic animals is not currently recommended unless the testing is part of a collaborative research project. Dr. Weese cautioned that “testing an animal involves risk—either entering a household to test the animal or bringing the animal to a facility for testing.” Does the test result add enough value to justify the risk of moving people and animals around to perform the testing? In many cases, the answer is no.
If a pet presenting with signs suggestive of COVID-19 needs to be tested, this process must be conducted in coordination with public health officials, following USDA-specified criteria. Dr. Sykes noted that “any veterinarians who want to do testing should contact their local public health officials as soon as possible to organize the logistics of performing these tests.”
Testing recommendations include wearing appropriate protective equipment, and disinfecting carriers and surfaces. Clinicians are reminded to consider other diagnostic rule-outs, such as feline upper respiratory tract disease or canine infectious respiratory disease complex, when trying to determine if a patient’s respiratory illness might be related to SARS-CoV-2.
Dr. Todd-Jenkins received her VMD degree from the University of Pennsylvania School of Veterinary Medicine. She is a medical writer and has remained in clinical practice for over 20 years. She is a member of the American Medical Writers Association and One Health Initiative.
Articles in this issue
Setting the table for service
How will COVID-19 transform veterinary practice?
COVID-19 and the polio parallel
The other heartworm patient
An open letter to my fellow 2020 graduates
New York dog tests positive for SARS-CoV-2, but pet cases remain rare
PrideVMC announces student award winners
FDA approves generic topical parasiticide for cats
Survival mode: practicing veterinary medicine during a pandemic
Final words on the ‘whitest profession’
Is a ‘hero award’ appropriate for front-line veterinary staff?
What are you scared of?
Update: AAEP parasite control guidelines
The shift in virus-aware veterinary economics
Dogs can detect differences in thermal energy
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