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One day after the U.S. Centers for Disease Control and Prevention urged Americans to begin preparing for a pandemic of COVID-19, N95 and other masks were out of stock at a Home Depot near Seattle.
With news that a dog in Hong Kong is quarantined after a "weak positive" test result for the novel coronavirus, and controls placed on sales of surgical masks and other protective medical gear, U.S. veterinarians are feeling the effects of the international health crisis.
Concerns that veterinary patients could be susceptible to the pathogen that causes COVID-19 heightened today with an announcement by Hong Kong authorities that "a pet dog had been tested weak positive to the COVID-19 virus."
The dog belongs to a person infected with the virus, according to the government statement. The pet is being kept for now by the Hong Kong Agriculture, Fisheries and Conservation Department. The "weak positive" results came from samples taken from the dog's nose and mouth. The dog has no clinical signs of illness.
The announcement says: "The Department will conduct close monitoring of the ... dog and collect further samples for testing to confirm if the dog has really been infected with the virus or this is a result of environmental contamination of the dog's mouth and nose. Repeated tests will be conducted for the dog and it will only be returned when the test result is negative."
The department is "strongly" advising that pet mammals belonging to people with confirmed cases of COVID-19 be submitted for quarantine and veterinary surveillance for 14 days.
In response to the Hong Kong announcement, the American Veterinary Medical Association posted that it has reached out to the U.S. Centers for Disease Control and Prevention for more information and will provide updates as it learns more.
Up to now, the focus on COVID-19 has been transmission among humans. The disease is caused by a virus named SARS-CoV-2. Symptoms of the illness are similar to colds and flu: sneezing, fever and cough. Unlike coronaviruses responsible for the common cold, the virus that causes COVID-19 attaches to receptors deep in the lungs and can cause viral pneumonia, which isn't helped by antibiotics. The virus passes from person to person mostly through coughing and objects contaminated with the pathogen.
COVID-19 first appeared in the Chinese city of Wuhan in December. As of Thursday, 46 countries in addition to China had at least one case, according to a tally by the World Health Organization. The count shows 78,630 confirmed cases and 2,747 deaths in China; and 1,573 cases and 57 deaths outside China.
Countries with more than 100 cases are China, Italy, Iran, Japan and Korea.
Fast-moving developments are compelling veterinary clinicians outside of hot spots to think about how local outbreaks could affect their daily practice. CDC officials said this week that community transmission of COVID-19 in the United States is just a matter of time. The first case of a patient suspected of contracting the disease locally — rather than from travel or contact with someone known to have traveled outside the country — was reported Thursday in Northern California.
Dr. Steven Valeika, a veterinarian in Asheville, North Carolina, with expertise in public health and epidemiology, posted on a message board of the Veterinary Information Network, an online community for the profession, that the clinic where he works is making sure to have "plenty of hand sanitizer and disinfectant to spray in rooms."
In an interview by email, he added: "Once there is widespread transmission, especially in the early days, I could imagine putting a sign up asking people not to come in for routine visits if they have a respiratory illness."
Further, Valeika said, "I’m encouraging everyone to wash hands when they’re dirty, and to otherwise use alcohol based hand sanitizers frequently, especially after being in a room with a client. I’ve told the staff that they should have flu shots if they haven’t already gotten them. This is to reduce [the] burden of respiratory illness so that people aren’t worried they have COVID when they actually have the flu. Also to keep people from having to go to the doctor. Additionally, it’s possible that being co-infected with COVID and influenza could lead to a worse outcome."
Regardless whether their community has seen any cases of COVID-19, clinicians are affected by surging demand for and resulting supply limits on disposable masks, gloves and gowns, a category of medical supplies known as personal protective equipment.
"Today our distributor told us we are on an allotment of X items a month for PPE products (gowns, masks, caps, etc). They also pointed out that allotted does not mean we will necessarily [receive] that amount," Dr. William Thomas, a neurologist, neurosurgeon and professor of small animal clinical sciences at the University of Tennessee, posted Wednesday on VIN.
"So we are currently trying to be as efficient as possible," Thomas recounted, "for example wearing the same surgery cap all day, minimizing students coming and going in the ORs [operating rooms]. We are saving surgery gowns if they are clean to use for isolation, chemotherapy, etc. We also went ahead and purchased some cloth gowns, which can be resterilized, just in case."
Other veterinarians on the message-board discussion noted that they, too, are finding items, especially masks, hard to come by or on backorder.
The problem apparently stems from a variety of factors: manufacturing interruptions in China, where factories have been closed as part of a broad attempt to contain the virus; greater demand due to greater existing needs for the products; surging purchases driven by anticipation of shortages; and sales limits by suppliers to forestall actual shortages developing.
At Patterson Veterinary, a large U.S. distributor serving veterinary practices, such products have been put "on allocation" and are being sold only to existing customers, Chief Commercial Officer George Henriques told the VIN News Service.
"We want to support our customers with consistent supply and discourage hoarding," Henriques said.
Premier Inc., a group purchasing organization and consultancy in human health care, reported Wednesday that "Most hospitals are experiencing delays of three to five days on orders of N95 respirators, the masks used to protect healthcare workers from the spread of airborne illnesses, and are receiving only partial orders."
Chinese companies are not the sole source of medical masks; the U.S. has domestic manufacturers in 3M and Prestige Ameritech. However, reports in the Minneapolis Star Tribune and Time suggest they cannot keep up with demand.
Thomas at the University of Tennessee Veterinary Medical Center said the small animal hospital is looking into purchasing washable masks. He recommends that other practitioners keep a supply of reusable caps and gowns on hand. "That way if disposable caps and gowns become unavailable, you have the option of resterilizing these items," he said.
The AVMA told VIN News today that as part of its efforts to monitor developments related to COVID-19 and its potential effects on animal health and the veterinary profession, it is collecting information on relevant supply issues.
"Veterinary professionals are encouraged to send information regarding any supply chain issues they face or anticipate to the AVMA via our website," the association conveyed by email. "Detailed information on the product impacted and the manufacturer/distributor will be helpful."
The U.S. Food and Drug Administration late Thursday posted an assessment of the supply chains for human and animal drugs; medical devices, including personal protective equipment; biologics and blood supply; and food.
Regarding animal drugs, the FDA said: "There are 32 animal drug firms that make finished drugs or source active pharmaceutical ingredients in China for the U.S. The FDA has contacted all 32 firms and no shortages have been reported at this time. However, six of those firms have indicated that they are seeing disruptions in the supply chain that soon could lead to shortages. The FDA is working with these firms to help identify interventions to mitigate potential shortages."
With the continued spread of COVID-19, hard-hit countries are sharply curtailing activities. In Japan, Prime Minister Shinzo Abe on Thursday asked all elementary, middle and high schools in the country to close until late March.
In the veterinary realm, the World Veterinary Cancer Congress, originally scheduled March 19-22 in Tokyo and meant to feature keynote speakers from U.S schools including Tufts University, the University of California, Davis, and Colorado State University, has been canceled or postponed, according to the conference website. Details on fee refunds will be posted and emailed later, the notice states, adding, "We wish everyone good health."
Veterinary event calendars also have been disrupted in other infection hot spots, including northern Italy, South Korea, mainland China and Hong Kong. The Chinese Veterinary Medical Association is urging practitioners in areas under quarantine to consider using telemedicine to assist clients in isolation.
Ross Kelly contributed to this report.