How COVID-19 response would look different if vets were in charge
Nary a soul on this planet has been unaffected by the ongoing COVID-19 pandemic. In what is undoubtedly one of the most disruptive events in most of our lifetimes, we have all been asked to make sacrifices of varying degrees. Jobs have been lost; educations disturbed, graduations canceled, weddings postponed, deaths left un-grieved. To some, this virus is a deadly threat, to others, it is a mere inconvenience, and to all of us, an unprecedented time.
The veterinary world has, of course, not been spared the major changes that have accompanied lockdown protocol. A profession based on communication, education, and the human-animal bond has been forced to switch gears, and ‘parking lot medicine’ has become the temporary norm (I refuse to use the term ‘new normal’).
As the animal care world joins dozens of other industries in restructuring their operations and as citizens around the world suffer from both the pandemic and its restrictions, I cannot help but feel frustrated at what I feel is a very myopic response from our (human) health professionals. A large part of me believes that if the priorities of the veterinary field were applied by current leaders, our handling of this virus might look a little—or a lot—different.
1. Quality of life
I have seen countless online comments where the justification for strict lockdown procedures is chalked up to “better that than dead.” While I recognize that quality of life is a continuum unique to each individual, the welfare advocate in me is horrified at this school of thought. In perhaps the most heartbreaking example, we have created a world where the very people we are acting to protect—residents of Long Term Care homes—have been relegated to prisoners of their own small rooms. In these confines, many are denied socialization activities, group dining, and even outdoor access. Most have been unable to see their family members, some unable to hold or even meet their newborn grandchildren. When faced with a death (many of which are completely unrelated to the coronavirus), marriages of several decades have been ripped apart without so much as a funeral permitted for the grieving survivor.
While the starkest example, the detrimental effects of recent restrictions are not limited to our seniors. “Vulnerability” also encompasses the children deprived of proper socialization and education, many without access to proper nutrition and others still in unsafe or violent homes. It encompasses those with pre-existing mental illness, who are at a significant risk of further deterioration. It encompasses the homeless, the socially isolated, and the poor. It encompasses those trying to keep afloat businesses they sacrificed decades of their life for, those trapped in abusive living situations, and so many more.
Certainly, the status quo is not appropriate for a global pandemic. But the rapid, severe changes to our everyday lives are not without consequences, and I do fear the implications of lockdown measures will be greater and longer-lasting than the current media attention would have us believe.
Even before COVID, our society has been in desperate need of a serious conversation about life and death; quality vs. quantity. The simplicity of treating death as the worst possible outcome for any situation belies the harsh realities of an existence that lacks substance. In veterinary medicine, the gift of euthanasia has allowed countless animals to experience a painless end to the various forms of suffering this world inflicts. The “human world” seems much more averse to acknowledging affliction and how it can impact our resolve to live. A failure to address the long-term impact of COVID restrictions on everything from social needs and career prospects to food security and the environment is a failure to act in the best interests of society.
2. Communication and accountability
In all medical fields, and veterinary medicine in particular, communication is of the utmost importance. The sharpest practitioner in the world is ineffective if he or she is unable to properly share crucial information with their patient or client. In this case of COVID-19, communication is less an issue at the individual level and more problematic at the public level. From the first rumblings of a troublesome virus on the other side of the world, citizens have received mixed messages on what they should or should not be concerned about and how they should or should not act.
A part of the explanation for this rapidly changing information is simply the inherent progressive nature of science. As an academic, I recognize that public health officials are for the most part doing their jobs when they change course on recommendations or mandates given the most recent available evidence. And while I also recognize that the response to this virus should be varied based on the particular circumstances of each region, the lack of unity among officials in the advice, stances, and bylaws shared with citizens, further breeds confusion and contempt among a public that is already understandably scared and frustrated.
It also important for health professionals to be accountable for their actions and mistakes. This is true regardless of species, yet accountability is sorely lacking in the context of this pandemic. The emergence of this virus, whatever its source, is of course not the fault of North American public health officials. However, there have been botched responses from the WHO (World Health Organization) and federal governments; a chain of errors committed by those whose very jobs are to prevent these circumstances from occurring, or at the very least have us adequately prepared in advance of such inevitable challenges. This accountability has been absent in the aftermath of the negligence displayed, and could arguably be cited as kindle for the fire of conspiracy theories that now abound (theories to which I do not subscribe).
Without messaging that is consistent, truthful, and considerate, people quickly grow wary and distrustful of the voices meant to speak in our best interests. This is true in veterinary medicine where we are advocates for our patients, and is truer now than ever among citizens experiencing growing discontent with arbitrary rules, conflicting advice, and neglected concerns.
3. Understanding economic limitations and applying realistic expectations
Do not misunderstand me—there is not a ‘price’ that can be put on people’s lives. For decades, though, veterinarians in all fields have had to balance the funds available for treatment with the ideal medical approach. This is a challenging task that has established itself as a regular part of doing business in our field, particularly in rural medicine.
Just as vets do their best to spend a client’s money wisely, so too should the government do its best to spend taxpayers’ money wisely. Continuing this comparison, I emphasize once again that it is not about whether the patient’s life is worthy, but whether the ‘gold standard’ of treatment is possible. In the case of COVID-19, this is even less of an issue because taxpayers are not so much concerned with their dollars treating coronavirus patients, but the breathtaking sums doled out in such a short amount of time to keep people at home, even as the economy itself comes to a grinding halt.
Over the months of COVID-19 thus far, our expectations have somehow shifted from containing the virus and preventing an overwhelmed health care system to a total eradication of the disease. Those of us with backgrounds in immunology and epidemiology know the near-impossibility of this ideal, particularly in the context of a globalized and travel-based economy. Moreover, the advent of an effective vaccine is neither guaranteed nor likely to be prompt, and in the meantime citizens are experiencing a growing array of suffering and challenges that will only impede an economic recovery when it becomes possible.
4. Holistic approach to challenges
Veterinary medicine is a uniquely comprehensive practice. DVMs act collectively as pharmacists, surgeons, anesthetists, cardiologists, dentists, counsellors, and so much more. While specialization does obviously exist in the field, the general approach to veterinary medicine is (or at least should be) holistic: examining the animal as a whole and putting together history, exam, and diagnostic findings to come up with an optimal treatment plan in the context of the client and patient.
I would liken the response to the COVID-19 crisis as a myopically-handled vet appointment. If a cat came in having just been hit by a car, and diagnostic testing showed a broken femur along with blood work indicating a major underlying kidney issue, the obvious priority of staff would be to address the broken leg. However, if all attention was directed to perfectly healing the leg at the expense of the renal issues, you might soon have a dead cat with four great legs.
Similarly, society has responded to the coronavirus as if other health and societal issues do not exist or are of little importance. Mental illness was already a significant issue overburdening our health care system before this pandemic, and the combination of lockdown factors with pre-existing deficiencies has set us up for a disaster that will persist long after the crisis phase of this virus is considered over. Issues of poverty, culture, education, and economics have similarly been dismissed in recent months, not to mention the swath of physical health issues that have been sacrificed in the name of directing resources to COVID containment. For a virus that could very likely become an endemic presence in our lives, this is an unacceptable distribution of priority by public health officials and the community at large.
For a time when the focus of everyone seems to be on personal sacrifices for the greater good, there is an astonishing lack of compassion exhibited by society as a whole and public health leaders in particular. So much energy has been directed into blaming and shaming: chastising those who don’t wear masks; targeting certain age groups for their alleged ‘invincibility’ feelings and further spread of the virus; dismissing those wanting to reopen the economy as “Karens” who “just want to get their hair cut.”
What shockingly few people are failing to acknowledge is the significant impact this virus and its associated lockdown are having on citizens. People have sacrificed their educational and/or job opportunities, once-in-a-lifetime milestones, health care access, and ceremonies of celebration and grief. They have suffered immense economic hardship, in many cases irreparably. Many are experiencing significant mental distress due to isolation, uncertainty, and frustration. This pandemic is more than a mere inconvenience, it’s a total restructuring of our daily lives.
In veterinary medicine, staff serve daily as counsellors to difficult decision-making, accounting for a client’s economic and personal circumstances, along with the animal’s physical state and availability of treatment. Whatever decision is made, vets understand the difficulty owners face in juggling their many priorities in life. Even in cases where we may not personally agree with the decision, it is our responsibility to at least attempt to sympathize with a client’s position.
We can have compassion for those affected by or at risk of this disease, and take reasonable steps to protect them, without placing indefinite expectations on society to sacrifice the things that make us human. Certainly, there are virus deniers and anti-maskers who seem only interested in the effects of this crisis on themselves. Yet they are a stark minority, and most people looking for some relief from lockdown hardship are simply trying to process the loss of life as they know it, and gain some sort of stability in rebuilding a predictable and enjoyable life.
Life does, always has, and always will come with inevitable risk. We engage in practices to lower those risks to a reasonable level, but we do not eliminate or diminish to unrecognizable any activities that bring inherent risk. We wear seat belts and post speed limits to prevent automobile accidents, but we do not ban cars or ask people to drive 10 kilometers per hour. In veterinary medicine, we recommend safe vaccines for our dogs but we do not tell owners to avoid off-leash areas or all other animals. With this virus, as we begin to get things under control, we need to have difficult but crucial discussions around implementing reasonable safety precautions, and avoiding excessive measures that transcend the borders of reasonability.
Ultimately, it is up to members of our society to take care of one another, and public health officials to lead in this approach. Now that the initial shock and suddenness of the coronavirus has worn off, we must move forward with reasonable implements in place to minimize harm to all citizens. We need to account for all demographics and factors, not just those at the forefront of the virus. We need to acknowledge the multitude of challenges we face, as tempting as it may be to only focus on the most visible issue at hand. More than anything we must be aware that our actions today have consequences for tomorrow, lest we contribute inadvertently to a bigger crisis in the near future.