COVID-19 and Companion Animal Health and Welfare: Impact and Considerations for the UK

8th June 2020

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The COVID-19 crisis has severely challenged health care systems across the globe. The pandemic has also presented challenges to delivering veterinary health care effectively and safely. On 23rd March 2020, the UK Government announced new restrictions including an effective lockdown and social distancing measures to slow the spread of virus¹. The provision of veterinary care is considered an essential service in the context of protecting public health with food safety and security (e.g. farm veterinary work allowed to continue) and for companion animal emergency care and urgent treatment². Government guidance, applicable for vets, is now available so employers can review and implement changes needed to help keep vets and veterinary support staff safe³. Current veterinary professional body guidance asks vets to take a risk-based approach to clinical decision making⁴ and temporarily allows remote consultation and prescribing⁵. Despite these measures and adjustments, and because of the nature and protracted duration of restrictions, companion animal and equine services are experiencing the greatest impact.

1. COVID-19 impact: veterinary practice and companion animal consultations
   • The Government’s social distancing measures, and their implementation, e.g. keeping face to face consultations to an absolute minimum⁶ and cancelling routine and non-urgent appointments⁷, has resulted in immediate and dramatic changes in the provision of companion animal veterinary care.
   • Research published by the Small Animal Veterinary Surveillance Network (SAVSNET) at the University of Liverpool showed a rapid and relatively sustained reduction of consultation volumes of 80-90% recorded within 2 days of the 23rd March 2020 Government announcement on enhanced social distancing measures⁸. This trend has continued; the second follow on SAVSNET report, published 5 May 2020, noted that compared to median 2019 data, there remains a marked decrease in the number of consultations recorded by SAVSNET throughout all enhanced social distancing phases⁹.
   • These data on the significant reductions in consultations are also supported by an RCVS survey on the initial economic impact of coronavirus on veterinary practice, published 17 April 2020, which stated that 97% of practices reported limiting the service they provide to emergencies or emergencies and urgent cases10. The majority (71%) of premises remained open but 5% of respondents had closed their main premises and 24% had closed branch premises. 62% of respondents had furloughed or intended to furlough veterinary surgeons, compared to 64% for veterinary nurses and 78% for other support staff. 66% of practices reported their weekly turnover being reduced by more than half¹⁰.
   • A more recent follow-on RCVS survey, published 13th May 2020, reported that the majority of respondent practices (69%) were seeing a reduced caseload, including some routine work, whilst 26% had limited their caseload to emergencies only. 46% reported a fall in practice turnover of between 25% to 50%¹¹. The RCVS CEO reflected that “…veterinary businesses are still struggling financially, with some of them reporting a very acute impact of the coronavirus and the associated restrictions on their businesses”¹².
   • In the UK press, concerns about the ability of veterinary practices to remain viable have been raised¹³.
   • Taken together, these data illustrate the sudden, severe, and now protracted impact of COVID19 restrictions on the provision of companion animal veterinary care in the UK.
2. COVID-19 impact: companion animal health and welfare
   • Throughout the crisis there remains an enduring veterinary and pet owner responsibility to care for the health and welfare of our companion animals.
   • A survey by Pegasus on over 600 veterinary professionals (with 90% from the UK), showed that 67% were concerned about a negative impact on animal health and welfare¹⁴. The survey also showed that most (71%) believe owners are concerned about not being able to keep up with routine treatments (like vaccines and parasite control) and not being able to access routine medicines (64%) versus access to emergency medicines (29%)¹⁴. 81% believe there will be an escalation in certain animal conditions and 60% think that owners will place less value on preventative health practices (e.g. vaccines, parasite control) if they have had a break from treatment plans¹⁴.
   • These concerns are reflected in some immediate impacts that have been captured e.g. vaccination consultations were a reduced proportion of all consultations⁹. Additionally, the number of vaccine preventable disease diagnostic tests performed in April 2020 was relatively reduced compared to previous months across all diseases explored and this reduction was more pronounced in cats compared to dogs⁹. This reduction in testing may indicate that sick animals are not being presented for treatment and investigation rather than a reduction in disease incidence.
   • The second SAVSNET report rightly states that as the UK adjusts to a ‘new normal’, understanding of population level longer term impacts remain important⁹.
   • Despite the best efforts of vets and practice staff, it is reasonable to assume that given the dramatic reductions in consultations, there will be pet owners that during the protracted period of COVID-19 restriction, will not have sought appropriate veterinary advice and care.
   • This may mean that some conditions that are not recognised as emergency or obviously urgent, could naturally progress with a potential for poor health and welfare outcomes. These include animals with chronic conditions requiring ongoing monitoring and those with conditions associated with poor welfare. For example, the diseases that have been identified by VetCompass as having the most impact on dog welfare overall are dental disease, osteoarthritis and obesity¹⁵. Animals suffering from dental disease or elderly animals showing stiffness or a reluctance to walk as much as usual, may well not be receiving appropriate veterinary assessment and treatment. It is too early in the cycle of the pandemic to assess the full impact of restricted access to companion animal veterinary services but the early indications are that prolonged missed diagnoses or treatments will lead to the development of health and welfare problems in the future.
   • These concerns are underlined in a report by the Animal Welfare Committee (AWC), which warned that “Restrictions to face-to-face treatment are likely to result in a backlog of routine procedures such as small animal vaccinations (such as parvovirus for dogs), regular health checks and neutering. This delay is being reported as leading to more acutely ill animals being seen when the condition has become more advanced. This will result in greater pain and suffering, increased risk of animals not responding to treatment, and as a result an increased likelihood of the use of euthanasia”¹⁶.
   • Remote consultation and prescribing are useful adjuncts to regular clinical consultations and help to increase the opportunities for pet owners to access veterinary care. The second RCVS survey noted that 90% of respondents reported using remote consulting as a result of social distancing measures, and of those, 30% were using it for existing clients and animals only, whilst 70% were using it for both existing and new clients/animals¹¹. These helpful developments cannot fully replace the need for pets to undergo physical examination and diagnostic investigation where appropriate. It is also the case that a proportion of the population will not be able to access remote consulting platforms. The health and welfare needs of their animals must not be overlooked.
   • There remains a need for pets to have greater access to a full range of veterinary care services, and in a manner that protects the safety of veterinary staff and clients alike.
3. Recovery Phase: steps for Government, academia, and pet owners

   The four Governments of the UK recently published their plans for easing lockdown restrictions. The British Veterinary Association followed with updated guidance issued to help vets work safely¹⁷. These tentative steps are just the beginning of what is anticipated to be a long and difficult journey. Meanwhile, the COVID-19 crisis continues to inflict an unprecedented impact on companion animal veterinary care. It has brought into sharp focus the need to support responsible pet ownership, to improve safe access to veterinary care and to monitor the impacts on animal health and welfare. To understand, and importantly, to attempt to mitigate against the ongoing impacts of this crisis, the animal health community needs to take steps to:

   1. Raise Awareness:
      • to encourage people to contact their vet with any new pet health concerns, allowing veterinary professionals to triage cases.
      • to encourage pet owners to continue routine treatments such as parasite control and vaccinations.
      • to encourage people managing pets with ongoing, chronic conditions to maintain their care, including veterinary monitoring throughout the crisis.
      • to help pet owners better understand their pet’s health and welfare needs.
      • to encourage the veterinary sector to develop new working practices and different ways of treating pets to meet the requirements of the ‘new normal’.
   2. Monitor and research the impact on pet health and welfare:
      • to understand the full impact of reduced consultations on timely diagnosis and treatment of conditions that are potentially life limiting or are associated with poor welfare.
   3. Take Government level responsibility for pet health and welfare:
      • recognising the benefits of pet ownership, how it has helped many people through the COVID-19 crisis, and how the impacts that ongoing reduced veterinary consultations could have on health and welfare, there is a need for a Government minister to have responsibility for both pet health and welfare.

References:

1. UK Government COVID-19 restrictions: www.gov.uk/government/publications/full-guidance-on-staying-at-home-and-away-from-others#history
2. Vets as critical workers and vet practices exempt for closure: www.gov.uk/government/publications/coronavirus-covid-19-maintaining-educational-provision/guidance-for-schools-colleges-and-local-authorities-on-maintaining-educational-provision and www.gov.uk/government/publications/further-businesses-and-premises-to-close/further-businesses-and-premises-to-close-guidance
3. UK Government guidance for employers: www.gov.uk/guidance/working-safely-during-coronavirus-covid-19
4. RCVS framework flowchart – guidance for clinical practices during COVID-19: www.rcvs.org.uk/setting-standards/advice-and-guidance/coronavirus-covid-19/flowchart-guidance-for-clinical-practices-during-covid-19/
5. RCVS FAQ for remote consultation and prescribing: www.rcvs.org.uk/setting-standards/advice-and-guidance/coronavirus-covid-19/
6. RCVS FAQ’s – can I keep my practice open? www.rcvs.org.uk/setting-standards/advice-and-guidance/coronavirus-covid-19/
7. BVA response to Government lockdown: www.bva.co.uk/news-and-blog/news-article/veterinary-practices-to-remain-open-only-for-emergency-care-and-to-maintain-food-supply-chain/
8. SAVSNET report 1: Impact of COVID-19 on companion animal veterinary practice, published 20 April 2020: www.liverpool.ac.uk/media/livacuk/savsnet/Impact,of,COVID-19,on,companion,animal,veterinary,practice,report,1,20apr20.pdf
9. SAVSNET report 2: : Impact of COVID-19 on companion animal veterinary practice, published 5 May 2020: www.liverpool.ac.uk/media/livacuk/savsnet/Impact,of,COVID-19,on,companion,animal,veterinary,practice,report,2.pdf
10. Coronavirus: economic impact on veterinary practice. Results from RCVS survey #1 from 3-7th April 2020, published 17th April 2020: www.rcvs.org.uk/news-and-views/news/rcvs-publishes-survey-results-on-impact-of-pandemic-on/
11. Coronavirus: economic impact on veterinary practice. Results from RCVS survey #2 from 1st-5th May 2020, published 13th May 2020: www.rcvs.org.uk/news-and-views/news/report-on-second-covid-economic-impact-survey-published/
12. Press release for 2nd RCVS survey report: www.rcvs.org.uk/news-and-views/news/report-on-second-covid-economic-impact-survey-published/
13. Coronavirus: Vets ‘may not survive’ without financial aid: BBC report, 19th May 2020: www.bbc.co.uk/news/uk-wales-52722029
14. Pegasus survey: COVID-19 and the veterinary profession: understanding current challenges and to best support and communicate with veterinary professionals, April 2020 (unpublished, personal communication).
15. RVC VetCompass study: new evidence for health-related welfare prioritisation of canine disorders, published 28 May 2019: www.rvc.ac.uk/vetcompass/news/new-evidence-for-health-related-welfare-prioritisation-of-canine-disorders
16. Animal Welfare Committee (AWC) Opinion on the Animal Welfare Issues related to Covid-19, published 4 June 2020: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/889858/WC_Opinion_on_the_Animal_Welfare_Issues_related_to_Covid-19.pdf
17. BVA guidance for working safely during COVID-19, published 28 May 2020: www.bva.co.uk/media/3500/bva-updated-guidance-for-veterinary-practices-on-working-safely-during-covid-19-final-28-may-2020.pdf