COVID-19 VACCINE AVAILABILITY (01-06-21)
Happy New Year!
The question of the year so far is how/when/where can a veterinarian and their staff members receive the COVID-19 vaccine.
The State of Texas has deviated from some of the federal Centers for Disease Control (CDC) requirements and is NOT currently providing the vaccine to essential workers outside of the human medical field, Phase 1A, and people over 65 or with certain chronic conditions, Phase 1B. As of the date of this message, the ONLY individuals who might receive the vaccine are summarized below. However, TVMA has had some reports of veterinarians who have been vaccinated as healthcare workers by local officials who are not holding to specific state definitions.
TVMA has previously and will continue to press decisionmakers to include veterinarians and staff in earlier phases, the definitions of which have not yet been announced (CLICK HERE to see our argument.). As TVMA continues its efforts to have the veterinary profession prioritized, we encourage members to stay abreast of what is happening at the local level and the possibility that other avenues for vaccination may arise within their communities. Where the vaccine might be found is dependent on individual localities. Eligible recipients, especially veterinarians over 65, are urged to check this map and search their local health authorities online for more information and to make appointments. TVMA will continue to keep you updated as more phases and definitions are announced.
State FAQs are available here.
The first tier of distribution includes five groups.
- Hospital staff working directly with patients who are positive or at high risk for COVID-19. This includes doctors, nurses, respiratory therapists and other support staff (custodial staff, etc.). This also includes clinical staff providing lab, pharmacy, diagnostic and/or rehab services.
- Long-term care staff who work directly with residents at nursing homes and assisted living centers. It includes doctors, nurses and personal-care assistants as well as custodial workers and food service staff.
- Emergency Medical Service (EMS) workers who provide 9-1-1 emergency services like pre-hospital care and transport.
- Home health workers, including hospice care, who directly care for vulnerable and high-risk patients.
- Residents of long-term care facilities. This group includes anyone living in a long-term care facility.
The second tier of distribution consists of six groups.
- Outpatient care staff who interact with sick patients. This includes doctors, nurses and other staff. It also includes clinical staff who provide diagnostic, lab, rehab and transportation services.
- Free-standing emergency clinic staff who provide direct care in free-standing emergency medical care facilities and urgent care clinics.
- Community pharmacy employees who provide clinical services. This includes pharmacy staff who may vaccinate or test those who may have COVID-19.
- Public health and emergency staff who administer COVID-19 tests and vaccines.
- Last responders who provide mortuary or death services to the deceased with COVID-19. This group includes mortuary and related services, such as embalmers, funeral home workers and medical examiners.
- School nurses who provide health care to students and faculty.
Those in Phase 1B are also eligible to get the COVID-19 vaccine, depending on availability and the vaccine provider. Vaccine supply remains limited, but more vaccine will be delivered to providers each week. Phase 1B recipients include:
- People 65 years of age and older
- People 16 years of age and older with at least one chronic medical condition that puts them at increased risk for severe illness from the virus that causes COVID-19, such as but not limited to:
- Chronic kidney disease
- COPD (chronic obstructive pulmonary disease)
- Heart conditions such as heart failure, coronary artery disease or cardiomyopathies
- Solid organ transplantation
- Obesity and severe obesity (body mass index of 30 kg/m2 or higher)
- Sickle cell disease
- Type 2 diabetes mellitus
Veterinary Team Members and the COVID-19 Vaccine (12-22-20)
The COVID-19 vaccine was recently authorized by the U.S. Food and Drug Administration (FDA), and it is unclear precisely how it will be distributed. The Centers for Disease Control (CDC) have issued a Vaccination Program Interim Playbook for Jurisdiction Operations, which serves as an interim guide for state, territorial and local public health programs and their partners in delivering the vaccine. It identifies three phases for distribution and advises that critical infrastructure workers should have access to the vaccine in Phase I, following distribution to healthcare workers. Phase 1 assumes a limited number of doses are available and is divided into subphases 1A and 1B. Phase 1A includes people serving in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials and who are unable to work from home. Phase 1B includes people who play key roles in keeping essential functions of society running and cannot socially distance in the workplace, and those who are at high risk for severe COVID-19 illness. The CDC playbook notes that the identification of critical infrastructure workers varies by jurisdiction.
At the national level, prior to the release of the CDC playbook, the American Veterinary Medical Association (AVMA) has been continuously advocating for veterinarians and veterinary team members to be considered a priority group for vaccination. The CDC playbook now provides that the identification of critical infrastructure workers occurs at the state and local levels. As a result, whomever is selected may vary by jurisdiction. TVMA has picked up this effort at the state level and has been engaging in conversations about vaccine delivery and advocating for veterinarians who would like to receive the vaccine in earlier phases.
The State of Texas is currently in Phase 1A of vaccine distribution, and the COVID-19 Expert Vaccine Allocation Panel has determined that this includes residents of long-term care facilities and front-line healthcare workers. There are an estimated 1.9 million Texans in those groups, so it will likely be at least a few weeks before a transition to Phase 1B occurs. The timing will depend on the number of vaccines provided to Texas and the uptake of vaccines among the priority populations. After that, Phase 1B will begin with a goal of limiting the loss of life from COVID-19 and helping to reduce the burden on the state’s hospitals. Here is a link to the definitions of individuals in Phase 1B.
There are many groups asking to be included in the initial phases of vaccination, so we are not sure how successful TVMA will be at seeking earlier inclusion, but we are certainly making a good argument. Here is the substance of a letter that TVMA recently sent to members of the Texas COVID-19 Expert Vaccine Allocation Panel.
The members of the Texas Veterinary Medical Association (TVMA) are extremely thankful for all of the human healthcare workers and caregivers who are on the frontlines battling SARS-CoV-2 (COVID-19) throughout our great state. They truly are heroes for putting themselves directly in the path of the virus to serve others and care for our most vulnerable populations. Science has now given us the wonderful gift of a vaccine that can potentially mitigate the worst effects of this pandemic, and we understand that decisionmakers are in the process of determining how to initially allocate potentially scarce supplies.
TVMA respectfully requests that Doctors of Veterinary Medicine (DVMs), Licensed Veterinary Technicians (LVTs), veterinary assistants and other veterinary team members be included within the priority recipient group for vaccination against COVID-19 during Phase 1B. Veterinarians and their teams are Essential Critical Infrastructure and do not have the option of working from home. They contribute directly to supporting the food and agriculture industries, providing essential services and critical support for the sufficiency, safety and marketability of our states’ food supply. In addition, veterinarians actively participate in protecting public and animal health through surveillance for the SARS-CoV-2 virus in non-human animals. The surveillance function of the veterinary profession extends well beyond SARS-CoV-2, including additional protection of the public health by diagnosing, controlling and investigating zoonotic, foreign and emerging communicable diseases. Finally, humans and animals are inextricably linked, and therefore it is imperative to understand the connection and impact that veterinarians of all practice types have not only on animal health but also on human health and well-being.
There is no question that veterinarians are essential to infrastructure viability in the food and agriculture industry. The Cybersecurity and Infrastructure Security Agency (CISA) Essential Critical Infrastructure Workers Guidance framework recognizes this fact (pg. 11, bullet 4). Animal protein is a key part of our nation’s food supply, and access to food that is sufficient in quantity, of high quality and safe to consume is obviously critical to maintaining good human health.
As essential businesses, veterinarians and their teams have provided services throughout the pandemic and, in doing so, have used creative approaches to implement important engineering and administrative risk management controls (e.g., social distancing, use of physical barriers, curbside service, telemedicine consults) and also have thoughtfully used (and conserved) personal protective equipment (PPE). The reality, however, is that veterinarians and veterinary staff are not always able to maintain physical distancing fromeach other or from the public when handling animals or performing medical procedures. The risk of regular and repeated exposure to other people is obvious and includes exposure to those members of the public who may be ill (symptomatic or not) with COVID-19 but whose animals continue to need care and who may accordingly end up exposing veterinarians and their teams. However, the risks assumed when performing medical procedures on animals may be less recognized. Just as in human medicine, some of those medical procedures result in exposure to bodily fluids, including through aerosolization. Although SARS-CoV-2 appears to rarely affect non-human animals, we are aware that dogs, cats, mink, tigers and lions have acquired the infection naturally and that ferrets, bats, hamsters and macaques have been infected experimentally. As such, exposure to these species presents some level of risk for our doctors and our teams, including those working in animal research laboratories and zoo and wildlife facilities. Accordingly, the CDC has recommended the use of enhanced PPE when handling animals coming from environments where COVID-19 is known or suspected, particularly when such animals will undergo medical procedures that expose veterinarians and our staff to bodily fluids. Recognition of such heightened risk seems to support a recommendation for prioritized access to vaccination for veterinarians and our teams.
In addition to veterinarians’ important roles in protecting the health and safety of our nation’s food supply and the health of our pets, veterinarians provide critical surveillance for the presence of SARS-CoV-2 in non-human animals. Most are familiar with the theory that SARS-CoV-2 emerged from an animal source and then spilled over into the human population. And, as previously mentioned, several species of animals infected with SARS-CoV-2 have been reported by multiple countries. While, fortunately, evidence from risk assessments, epidemiological investigations and experimental studies to date does not suggest live animals or animal products play a role in supporting ongoing SARS-CoV-2 infections in humans, further study, including active surveillance, is needed to understand if and how different animals might be affected by SARS-CoV-2. Also important to acknowledge is the fact that the veterinarian’s role in surveilling for disease extends beyond SARS-CoV-2 to identifying and reporting infections with other potentially zoonotic diseases and zoonotic pathogens. Monitoring infections in animals is critical to understanding the significance of such infections for animal health, biodiversity and human health.
Pets share our homes and have played an important role in supporting their owners' physical and mental well-being during this difficult pandemic. They provide an incentive for their owners to get at least a minimal level of exercise, and they have been an important source of emotional and social support as human-to-human contact has been reduced due to self-isolation and social distancing. Healthy veterinarians and their teams are absolutely critical to the availability and safety of our food as well as the health and well-being of pets. For all of these reasons, we urge you to include veterinary teams in Phase 1B of vaccine distribution.
John Bruker, DVM
2020 TVMA President
As always, TVMA will continue to advocate for the veterinary profession and will keep you updated. Stay well.
Update on CE Requirements for License Renewal (05-13-20)
The Texas Veterinary Medical Association (TVMA) is receiving an increasing number of inquiries from members who are concerned about their ability to obtain the required number of continuing education (CE) hours in advance of their license renewal date. The Texas Board of Veterinary Medical Examiners (TBVME) currently has a policy stating that continuing education requirements will be waived for any license renewals occurring during the emergency declaration period. However, due to the cancellation of multiple continuing education conferences, there is still a lot of concern amongst DVMs and Licensed Veterinary Technicians (LVTs) about what will happen as we draw closer to the time when the emergency declaration period ends. TVMA has been reaching out to TBVME regarding this issue, and it appears that the agency will likely be extending the ability to renew a license without proof of CE for a period of time after normal working conditions resume. It is also likely that TBVME will review their rules on the number of hours allowed through remote learning. Nothing yet is set in stone, but we wanted to send a short update to let you know that these issues are being discussed and that action will be taken in the future to ensure veterinarians are not out of compliance due to the COVID-19 pandemic. TVMA will be back in touch with you as soon as we have additional information to share.
Governor’s Orders Reopening Texas and What It Means for Veterinarians (04-20-2020)
On Monday, April 27, Texas Governor Greg Abbott issued a trio of Executive Orders and announced his plan for reopening Texas:
The orders continue to maintain that in-person contact with people who are not in the same household should be minimized except when necessary to provide or to obtain essential services or reopened services, with people over 65 strongly encouraged to stay home.
Veterinarians should know that no changes were made to “essential services” as defined by the U.S. Department of Homeland Security in its Guidance on the Essential Critical Infrastructure Workforce (CISA) document, which continues to make references to the inclusion of workers “employed in veterinary health” as well as the processing and distribution of animal food and feed and retail sale of animal/pet food and pet supplies.
Other businesses that are not essential services are allowed to open with certain conditions and limitations relating to protective measures and capacity. However, the orders specifically provide, “People shall avoid visiting bars, gyms, public swimming pools, interactive amusement venues such as bowling alleys and video arcades, massage establishments, tattoo studios, piercing studios or cosmetology salons.”
A previous Executive Order that restricted nonessential procedures by healthcare providers was repealed and replaced with a directive to comply with any emergency rules promulgated by licensing agencies dictating minimum standards for safe practice during the COVID- 19 disaster. The Texas Board of Veterinary Medical Examiners (TBVME) has not specifically promulgated any rules restricting the services of veterinarians, and the Governor’s order supersedes conflicting orders issued by local officials if the local order restricts essential services or reopened services allowed by the new orders. As a result, any existing local prohibitions on the services provided by veterinarians are no longer valid.
The Executive Order also has superseded local discussions about whether to require face coverings. While the order encourages individuals to wear appropriate face coverings, it does not allow local jurisdictions to impose civil or criminal penalty for failure to wear a face covering. Private businesses are free to require patrons to wear masks.
Finally, the order requires all businesses (including veterinary clinics) to follow the minimum standard health protocols recommended by the DSHS and to implement social distancing, work from home if possible and practice good hygiene, environmental cleanliness and sanitation. This includes also following, to the extent not inconsistent with the DSHS minimum standards, the Guidelines from the President and the CDC as well as other CDC recommendations.
Here is a link to the checklist for all employers that was issued by DSHS as a part of the Executive Orders. Veterinarians who are already following some of the CDC recommendationsprobably already have the protocols required by this state-mandated checklist in place.
Governor's Report to Open Texas (04-29-2020)
Media outlets have reported difficulty in obtaining a copy of The Governor’s Report to Open Texas just released, due to high internet traffic. TVMA has obtained a copy which you can view here.
CLICK HERE TO DOWNLOAD REPORT
Animal Testing for SARS-CoV-2 (COVID-19) (04-24-2020)
On April 22, the Centers for Disease Control and Prevention (CDC) and the Department of Agriculture (USDA) National Veterinary Services Laboratories (NVSL) announced the first confirmed cases of SARS-CoV-2 in two pet cats. You can review additional information from the government on these cases by clicking here or information about all animal cases from the American Veterinary Medical Association (AVMA) by clicking here. With the release of this information, you might have clients who are interested in having their pets tested, so we wanted to provide you with additional resources on how to evaluate these cases and potentially obtain testing.
Testing at TVMDL
To obtain testing through the Texas Veterinary Medical Diagnostic Laboratory (TVMDL) veterinarians must have the approval of the Texas Animal Health Commission (TAHC) State Veterinarian and a Texas Department of State Health Services (DSHS) State Public Health Veterinarian who will coordinate the submission of the test. Only animals exhibiting clinical signs of illness compatible with SARS-CoV-2 infection, including respiratory symptoms, will be considered for testing. Veterinarians must have first performed a thorough and systematic diagnostic evaluation with appropriate testing to rule out common causes based on the patient’s clinical signs.
Currently, the following animals and situations will be considered for testing:
• Animals that have been in a household with a confirmed human COVID-19 case.
• Threatened or endangered non-human primates or other species in zoos or other facilities.
• Recently imported animals exhibiting an atypical pattern of disease suggesting a novel pathogen.
• Animals that are part of a validated research project.
To request approval to test, you can call 800-550-8242 or click here to review full guidance from the Texas Animal Health Commission.
Private Testing Option
Recently, IDEXX made a SARS-CoV-2 (COVID-19) RealPCR test available. Consultation with a local health authority prior to considering testing for COVID-19 in a pet is recommended and testing should be limited to those animals with known or strongly suspected COVID-19 exposure. IDEXX has a useful flowchart for testing available on its website to determine when testing may be appropriate. Positive samples require confirmation testing at USDA’s National Veterinary Services Laboratories (NVSL).
Safeguarding Your Staff & Advising Your Clients
For routine patient intake, veterinarians are encouraged to ask clients if the pet may have potentially been exposed to a person with COVID-19. The AVMA also has created a resource on interim recommendations for intake of companion animals from households where humans with COVID-19 are present.
The CDC has a guidance document that all veterinarians should review which contains a section that details actions to take of a pet owner has suspected or confirmed COVID-19. In part the CDC guidance provides the following;
If a pet owner currently has respiratory symptoms or is a suspected or confirmed case of COVID-19, they should not visit the veterinary facility. Consider whether a telemedicine consult is appropriate. If possible, a healthy friend or family member from outside their household should bring the animal to the veterinary clinic. The clinic should use all appropriate precautions to minimize contact with the person bringing the animal to the clinic. If there is an emergency with the animal, the animal should not be denied care.
- If a pet owner is suspected or confirmed to have COVID-19 and must bring their pet to the clinic, the following actions may be taken:
- Communicate via phone call or video chat to maintain social distancing.
- Retrieve the animal from the owner’s vehicle (also called curbside) to prevent the owner from having to enter the clinic or hospital.
- Maintain social distancing and PPE recommendations when interacting with clients.
- Request smaller animals be brought in a plastic carrier to facilitate disinfection after use. Also advise the owner to leave all non-essential items at home to avoid unnecessary opportunities for additional exposure.
- Every effort should be made to prevent ill persons from entering the clinic, without negatively impacting animal welfare
- If an ill pet owner must enter the clinic, consider the following preventive actions:
- Ask that the person wear a cloth face covering to cover his or her nose and mouth. Be prepared to provide a face covering to the ill person if they do not have their own.
- Direct the pet owner and patient to a single exam room or isolation room.
- Limit the number of veterinary staff that enter the room, handle the animal, or interact with the pet owner and wear appropriate PPE pdf icon as described below.
- Clean and disinfect the room, surfaces, supplies, floor, or equipment located within 6 feet of ill pet owners after they leave.
Here is a link to the CDC guidance for people with animals that you can use to advise your clients. In part, this guidance provides the following;
Until we learn more about how this virus affects animals, treat pets as you would other human family members to protect them from a possible infection.
- Do not let pets interact with people or other animals outside the household.
- Keep cats indoors when possible to prevent them from interacting with other animals or people.
- Walk dogs on a leash, maintaining at least 6 feet (2 meters) from other people and animals.
- Avoid dog parks or public places where a large number of people and dogs gather.
If your client is sick:
If you are sick with COVID-19 (either suspected or confirmed by a test), restrict contact with your pets and other animals, just like you would around other people. Until we know more about this virus, people sick with COVID-19 should avoid contact with pets and other animals.
- When possible, have another member of your household care for your pets while you are sick.
- Avoid contact with your pet, including petting, snuggling, being kissed or licked, and sharing food or bedding.
- If you must care for your pet or be around animals while you are sick, wear a cloth face covering and wash your hands before and after you interact with them.
If you are sick with COVID-19 and your pet becomes sick, do not take your pet to the veterinary clinic yourself. Call your veterinarian and let them know you have been sick with COVID-19. Some veterinarians may offer telemedicine consultations or other plans for seeing sick pets. Your veterinarian can evaluate your pet and determine the next steps for your pet’s treatment and care.
Ventilator Survey (04-07-2020)
In response to the COVID-19 pandemic, Governor Greg Abbott formed a Supply Chain Strike Force whose primary mission is to guide the collaboration between the public and private sectors to ensure health care facilities have the supplies and resources they need. The Strike Force recently contacted TVMA regarding the potential availability of ventilators at veterinary facilities. It was emphasized that there is not an immediate need for ventilators, and the inquiry was primarily precautionary in nature. The State of Texas is simply ensuring that should the need arise in the coming weeks, it knows of possible sources for additional ventilators. TVMA understands that most veterinary clinics do not own ventilators, but if you have access to one or more and would be willing to loan the equipment to hospitals should the need arise, we encourage you to respond to this survey.
Take Survey Here
Companion Animal Coronavirus Testing in Texas (04-07-2020)
The Texas Animal Health Commission has released important interim veterinary guidance on the testing of companion animals for coronavirus in Texas. Please CLICK HERE to view the guidance document.
Checking In: A Message From Your Foundation (04-06-2020)
I am writing you today in the midst of an event unlike anything any of us have experienced. Just one month ago, we were at the TVMA annual conference with no idea of how profoundly our world would change in just a few weeks. Now many of us face dilemmas in our practices: supply shortages, maintaining the safety and health of staff and clients, the effect of ‘stay at home’ orders on business, and more. In the midst of this uncertainty, I wanted to reach out to you.
How are you? Are you doing okay? Can we help you?
TVMF is here to support you.
- Many of our clients are experiencing financial uncertainty as businesses have had to close and lay off staff. We expect that some of our clients will face tough decisions if their pet needs expensive treatment. TVMF Medical Expenses Disaster Grants are available to TVMA members whose clients are experiencing financial hardship due to COVID-19. Please contact Leah Ann Tibbitts at firstname.lastname@example.org for more information on these grants.
- Like many of you, I have been concerned about meeting my annual CE requirements. While the state board is waiving requirements for CE at present, I recognize that it will not be easy for many to acquire CE once this pandemic has passed. TVMF has a dedicated fund set aside for the purpose of furthering CE opportunities for Texas veterinarians. The TVMF Board of Trustees is discussing how we might use these funds to help veterinarians who are affected by COVID-19 obtain their required CE. I will keep you posted as we develop a plan.
I have never been more proud of our profession than I am now. As you know, veterinarians are at the front line of public health every day. Whether it is through protecting the public from zoonotic disease, making advances in research that benefit human and animal health, protecting our food supply or promoting the mental health and wellbeing of pet owners by maintaining the health of their companion animals, veterinarians are essential to our communities. Now as many cities and counties across Texas have enacted ‘stay at home’ orders and are preparing to deal with the COVID-19 pandemic, not only are veterinarians continuing to provide these essential public services but many are even going further by supporting human health providers. I am humbled by the generosity and care I have seen from our profession, and I am honored to serve our profession with colleagues like you.
With heartfelt gratitude,
Chad Harris, DVM
Essential Business: Complying with Emergency Government Orders (04-03-2020)
Earlier this week, Texas Governor, Greg Abbott issued a new executive order amending his previous orders regarding person-to-person contact, stating that “every person in Texas shall, except where necessary to provide or obtain essential services, minimize social gatherings and minimize in-person contact....” While several Texas cities and counties previously issued orders limiting in-person contact to those providing or obtaining essential services, which in almost all cases specifically included veterinary medicine, Governor Abbott has now done so on a statewide basis. Unlike the local proclamations, the Governor’s order does not specifically list what are considered essential services but instead provides that “essential services” shall consist of everything listed by the U.S. Department of Homeland Security Cybersecurity and Infrastructure Security Agency (CISA) in its Guidance on the Essential Critical Infrastructure Workforce, plus religious services.
What, if anything, does this change regarding the provision of veterinary services in Texas? Taken as a whole, the Texas Veterinary Medical Association (TVMA) believes there is nothing in this order that prohibits the practice of veterinary medicine or leads us to the conclusion that veterinary clinics are not essential businesses. The Food and Agriculture section of the federal CISA document cited in the Governor’s order includes all mentions of animals, including pets. Various bullet points under this heading make references to the inclusion of workers “employed in veterinary health” as well as the processing and distribution of animal food and feed, retail sale of animal/pet food and pet supply. Also included are animal shelter workers, workers in animal diagnostic and food testing laboratories and transportation of animal medical supplies, vaccines, drugs, etc.
Veterinary services have consistently been deemed essential services in the various local orders issued across the state in recent days. The Governor’s order does supersede any conflicting order issued by local officials but only to the extent that such a local order restricts essential services allowed by this executive order or allows gatherings prohibited by the executive order.
TVMA’s Advice on Remaining Open
As practitioners wrestle with how they may do business during this difficult time, it is important to remember that previous Executive Orders issued by the Governor are still in effect, including the order that required healthcare facilities to postpone surgeries and procedures not immediately medically necessary. This order expressed concern about the depletions of personal protective equipment (PPE) supplies needed to cope with the COVID-19 disaster. It further stated that the prohibition does not apply to procedures performed within the proper standards of care that don’t deplete hospital capacity or the PPE supply. The most applicable portion of the order to veterinary medicine was the necessity not to deplete the PPE supply needed to cope with the COVID-19 disaster. There also have been similar local, county and municipal directives to eliminate elective procedures at medical and dental facilities.
There are likely a wide variety of opinions amongst veterinarians regarding what is/is not an elective/non-essential procedure that can be postponed and what is non-elective/essential and must be done immediately. TVMA advises veterinarians that it is the responsibility of the medical director/veterinarian in charge at each veterinary facility to make this determination that may be unique to each veterinary case, facility and region. When making this determination, practitioners must consider how they can keep staff and the public safe by complying with the Governor’s order to minimize in-person contact and prevent the spread of COVID-19.
For practices that choose to remain open, we highly recommend and encourage that writtenprotocols be established and implemented to protect the staff and public at each veterinary facility based on the infrastructure and procedural risk of each veterinary entity. Social distancing should be strictly maintained, and the guidelines as established by the CDC should be utilized to establish specific policies and procedures. We must protect ourselves, our staffs and the public.
We continue to strongly encourage those veterinary facilities that have PPE that they can do without to donate such equipment to local human hospitals. The human health care teams need access to all available PPE to reduce exposure to COVID-19. The need is greater than ever, so please do what you can to help.
Finally, veterinarians must continue to maintain the front lines and guard against the introduction and spread of zoonotic, epidemiologic and foreign animal diseases. Practitioners must utilize all their infectious disease training to protect their staff, clients and the general public.
Employer/Employee Issues During the Pandemic: Q&A (03-30-2020)
The COVID-19 pandemic has raised a lot of questions for employers and employees. Visit our website to find generalized answers to some commonly asked questions. Currently, laws are changing day by day, and we will continue to update these FAQs as things change.
- What are employees entitled to under the new sick leave requirements passed by Congress?
- My business is not closing. What precautions should I be taking?
- Can I ask my employees to take their temperature prior to working each day?
- What if an employee who is already working from home claims to be ill or tests positive for COVID-19?
- Can I send employees home who exhibit potential symptoms of contagious illnesses at work?
- What are best practices if you find an employee either tests positive for COVID-19 or exhibits symptoms?
- How should I address employees who have may have been exposed to COVID-19?
- What If my employee had COVID and wants to return to work?
- Should employers require written proof of COVID-19 illness for employees or their family members before taking time off?
- What if I am open but my employees do not want to come to work?
- Can employees sue employers if they contract COVID-19 at work?
- Am I required to pay employees who are not working?
- What are some options if I need to layoff or furlough employees?
- How can workers obtain unemployment benefits due to COVID-19?
CLICK HERE TO VIEW Q&A
TVMA’s Business Alliances Provide Resources for Your Practice During the COVID-19 Pandemic (03-30-2020)
Members of the Texas Veterinary Medical Association (TVMA) have access to specially negotiated savings on veterinary products and services that have been vetted for quality and customer service through a program called TVMA Business Alliances. Here’s what our business alliances are doing for members during the COVID-19 pandemic:
iEnergy North America is helping TVMA members by following up with energy providers and asking for extensions on due dates for electric bills. iEnergy customers can email email@example.com or firstname.lastname@example.org.
Infintech is recommending two payment solutions to help minimize contact and keep things moving in the veterinary community. The PAX S920 WIFI processes PIN debit, chip cards and contactless payments like Apple Pay. Authorize.net is a full-feature payment gateway that can be used as an online virtual terminal for processing payments and can be accessed via any browser. A free mobile app processing solution with card reader is included. Contact Kevin Walter at 888-908-6952 or email@example.com.
Lendkey is helping TVMA members refinance student loans at some of the lowest rates they have seen in nearly 10 years. As of March 26, 2020, fixed rates are as low as 3.39% APR and variable rates as low as 1.90% APR through LendKey. In response to COVID-19, the federal government put a pause on student loan interest and announced that all federal student loan borrowers now have the option to suspend their monthly payments for at least the next 60 days. These policies only apply to federal loans and therefore won’t have an impact on private student loans or loans that have previously been financed. Special options are available to offer relief from the stress caused by COVID-19. Whether you’re unsure if student loan refinancing is right for you or you’re not quite sure where to start, LendKey can help. If you’re still interested in learning more about your options with student loans, check out their full library of resources including a blog, infographics, calculators and more.
LifeLock is helping members get ahead of several challenges that are likely to impact employers’ and employees’ focus, stress and ability to conduct business. The extended tax-filing deadline of July 15 will lead to more members becoming the victim of tax fraud. When they hear from the IRS that they have “already filed” and received a refund they never actually received, will they know what to do? LifeLock can fix it! Their expert team will untangle the mess, with no co-pays or deductibles. Also, with so many employees working remotely—often not on secure networks—and every family member clicking links and websites, not only does that make members’ networks vulnerable but it makes all their devices likely candidates to get hacked, locked and the victim of ransomware. If you have not taken advantage of LifeLock in the past, there is no better time to get the protection you need at a discount through TVMA. Contact Bob Whitt at 512-695-0501 or firstname.lastname@example.org.
Office Depot is working closely with their vendors to keep cleaning and personal care products stocked. Find these and all of your remote working needs at business.officedepot.com/work-from-home. TVMA members receive a 10% discount in addition to saving with specially negotiated prices on certain products. To access member pricing, contact Jose Padron at email@example.com or 512-560-1250. You can download a printable discount card HERE.
PSI Vet is helping connect member veterinarians with janitorial products, telemedicine tools, pet food and medicine and well-being resources. To learn more about the PSI Vet purchasing program, email firstname.lastname@example.org or call 888-275-6523.
Trinity Merchant Group (TMG) is helping many veterinarians get free mobile card readers to allow secure exam room check-out and curbside payments. Find out more by contacting Clay Farrell at 817-528-8805 or email@example.com.
To learn more about all of TVMA’s Business Alliances and what they offer for your practice, visit www.tvma.org/Practice/Business-Alliance.
Department of Labor Issues New Required Posters (03-26-2020)
Recently, the U.S. Congress hastily passed and the President signed into law the Families First Coronavirus Response Act, which, in part, requires small and medium-sized businesses to provide emergency paid sick leave and expands the existing Family Medical Leave Act (FMLA)to address COVID-19. To read TVMA’s analysis of the new laws, CLICK HERE.
The Secretary of Labor just released the required posters relating to employees' rights to benefits under the emergency law. All veterinary clinics should post this poster with the rest of their mandated employee notices.
The poster can be found here: www.dol.gov/sites/dolgov/files/WHD/posters/...
You can read FAQs about the posters by clicking here: www.dol.gov/agencies/whd/pandemic/...
TVMA will continue to monitor this new law and how it impacts veterinary practices. Soon you will receive our breakdown of the new rules passed by the Department of Labor to implement the law including what options are available to businesses that can’t afford to provide paid leave.
The TVMA Personal Protective Equipment Challenge (03-25-2020)
TVMA is launching a Personal Protective Equipment (PPE) Challenge. This initiative is inspired by Texas State Senator Lois Kolkhorst’s request for veterinarians to donate spare PPE to hospitals. PPE items could include masks, gloves, face shields, gowns, booties and hair covers, etc.
Dubbed the TVMA PPE COVID-19-19-19 Challenge, the goal is for Texas veterinarians and clinics to donate three different PPE items in sets of 19.
To complete the challenge, here’s what you need to do:
- Post to Facebook a picture or video of you with the PPE items that you will donate. Ideally, three items in sets of 19. However, only donate what you can—do not exceed a number of items that affect the needs and protection of your clinic.
- Caption the post, “As part of the TVMA PPE COVID-19-19-19 Challenge, I donated [NUMBER] PPE items to [HOSPITAL NAME]. I challenge my veterinary colleagues to do the same. #TVMAChallenge #PPE” Please use the hashtags #PPE and #TVMAChallenge.
- In the post, tag at least five veterinary colleagues or veterinary clinics so they receive a notification. To tag others, use the @ symbol and type in their name.
- Our hope is those who are tagged complete their challenge and tag five more colleagues.
- TVMA will share some of these posts on our Facebook page.
Thank you for participating in the TVMA PPE COVID-19-19-19 Challenge and helping your fellow healthcare professionals during this crisis. If you have any questions, please do not hesitate to contact us at firstname.lastname@example.org.
COVID-19 Essential Employee Authorization Letter (03-25-2020)
With so many jurisdictions in Texas currently subject to a ‘shelter at home’ order, there is concern that employees of veterinary clinics that have been designated as essential businesses might encounter issues traveling to and from work. For that reason, TVMA developed a COVID-19 Essential Employee Authorization Letter for your use. Please complete the letter as indicated and be sure to delete the note at the top when printing the form on your clinic letterhead. If for any reason the Word document is not attached to this email, please check the TVMA COVID-19 Updates and Resources page at https://www.tvma.org/Resources/COVID-19-Resources where the letter will be posted shortly.
Please contact TVMA by phone at 512-452-4224 or email at email@example.com should you have any questions.
TVMA Update: The FDA and the VCPR (03-25-2020)
The Federal Government recently issued some statements on the use of veterinary telemedicine that loosen veterinarian-client-patient requirements, but it is important for Texas veterinarians to know that those changes have no real impact on veterinary practice in Texas as relates to the prohibition on establishing a veterinary-client-patient relationship (VCPR) solely by telephone or electronic means (telemedicine).
- The Food and Drug Administration (FDA) announced that it intends to temporarily not enforce the animal examination and premises visit portion of the existing VCPR requirements. This would allow veterinarians to prescribe drugs in an extra-label manner or authorize the use of Veterinary Feed Directive (VFD) drugs without direct examination or making visits to patients. The FDA noted that veterinarians still need to consider state VCPR requirements that may exist in their practice area.
- The Drug Enforcement Administration (DEA) has provided that a practitioner may issue a prescription, using any of the currently available methods, for all schedule II-V controlled substances to patients without an in-person exam, provided all of the following conditions are met:
- The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of his/her professional practice;
- The telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system; and
- The practitioner is acting in accordance with applicable federal and state laws.
When considering these federal requirements, it is important to point out that, in this matter, state law controls. The state board recently stated on their website:
The statute and rule on telemedicine allow for veterinarians to provide care via telemedicine to existing patients. However, a veterinarian client patient relationship may not be established solely through telemedicine. There is no written guidance on how often a veterinarian must see an animal to maintain the valid client-patient relationship. During these times, we encourage our licensees to use their best judgment and use telemedicine where they can to meet the needs of their clients and patients.
Based on this, it may be safe to say that the state board will be liberally construing the VCPR statute. For example, the board is unlikely to act on issues such as issuing a heartworm refill to a client who hasn’t been seen in 18 months or more. Since, as the board says, “There is no written guidance on how often a veterinarian must see an animal to maintain the valid client-patient relationship,” the real issue is compliance with the standard of care. The current rule on standard of care in part states, “Licensees shall exercise the same degree of humane care, skill, and diligence in treating patients as are ordinarily used in the same or similar circumstances….” Currently, the entire state is operating under extreme circumstances that certainly impact the standard of care.
The takeaway for Texas veterinarians is that, despite the changes to the federal requirements announced by the FDA, the VCPR still cannot be established solely through telemedicine in this state.
Changes to Local COVID-19 Orders? Contact TVMA (03-24-2020)
With local governments making changes to their COVID-19-related orders daily, it is important that such proclamations continue to allow veterinary facilities to operate—even if in a somewhat limited fashion. TVMA is keeping a close eye on the actions being taken around the state, but it is often TVMA members who hear of changes or potential changes before we become aware at our office in Austin.
If you learn of new or changing orders in your city or county that could impact veterinary medicine, particularly if those changes would negatively impact the profession, please contact TVMA. We are prepared to assist by working with local governments to ensure that they are aware of the important role veterinary professionals play and the need for veterinary facilities to remain open as essential businesses.
Please contact either Chris Copeland (firstname.lastname@example.org) or Elizabeth Choate (email@example.com) via email or call us at 512-452-4224 if you know of impending changes in your area.
Click here for TVMA’s guidance on remaining open and complying with state and local emergency orders.
CALL TO ACTION: Texas Veterinarians Asked to Donate PPE (03-23-2020)
With the shortage of personal protective equipment (PPE) in hospitals growing worse by the day, Texas State Senator Lois Kolkhorst, chair of the Senate Health and Human Services Committee, has asked TVMA to “Act Now.” Senator Kolkhorst personally contacted TVMA’s leadership to ask that we urge veterinarians to donate any PPE that can be spared. This includes masks, gloves, face shields, gowns, booties, hair covers, etc. These supplies should be donated to local hospitals as soon as possible. Due to a lack of ventilators at hospitals, veterinarians are also asked to consider loaning such equipment if possible.
TVMA Offers COVID-19 Recommendations (03-23-2020)
With information regarding COVID-19 and its impact on veterinary medicine being updated by the minute, including orders from the governor and local authorities, it has become extremely difficult for practitioners to not only keep up but to know what they should do during these unprecedented times. Can I continue to practice medicine? What services can I offer? How do I protect my staff and clients?
In an effort to help our members answer these difficult questions, TVMA has developed some recommendations regarding COVID-19 and the practice of veterinary medicine.
TVMA will continue to monitor events carefully and will provide updates as needed. Please be sure to visit the TVMA COVID-19 Updates and Resources page, which is being constantly updated with the latest news and information: https://www.tvma.org/Resources/COVID-19-Resources
New Emergency Paid Sick Leave Requirements on Employers (03-23-2020)
Recently, the U.S. Congress passed and the President signed into law the Families First Coronavirus Response Act. This law takes effect on April 2, 2020, so anything up until that time is up the employer. This article will discuss the two different leave provisions of this Act that apply to employers. How precisely these two provisions work together is not yet fully determined. However, the Secretary of Labor will soon be issuing regulations that will provide an additional layer of detail and hopefully provide answers to the currently unanswered questions about how and under what circumstances small businesses with under 50 employees can request exemption from the law. First, Division E of this Act provides emergency paid sick leave subject to certain conditions, while Division C expands the existing Family Medical Leave Act (FMLA) to address COVID-19.
Employers required to provide the benefits described can claim a tax credit against the employer's portion of Social Security taxes for 100 percent of the emergency paid sick leave wages paid to employees, subject to the caps discussed below. If a person is self-employed, they are allowed to take the tax credit if they regularly carry on a trade or business and would be entitled to receive paid leave during the taxable year if they were an employee of an employer other than themselves.
Employers will be required to post a notice relating to these new employees' rights to benefits under the emergency law that will be made available by the Secretary of Labor. An employer’s failure to comply constitutes a failure to pay minimum wages in violation of the existing Fair Labor Standards Act (FLSA.
It is illegal for an employer to discharge, discipline or discriminate against an employee who takes leave in accordance with the law.
Emergency Paid Sick Leave
The new law provides that full-time employees themselves who are unable to work or telework due to specific purposes related to coronavirus (purposes 1 to 3 listed below) are entitled to up to 80 hours of paid leave. Part-time employees are entitled to the average number of hours the employee works during a two-week period. This is capped at $511 per day and $5,110 in total. If the leave is used to care for another person with COVID-19 (purposes 4 to 6 below), leave is paid at two-thirds the employee's regular rate of pay, capped at $200 per day and $2,000 in total.
This paid sick time is available regardless of how long the employee has been employed and is available for immediate use. An employer may not require an employee to use existing paid leave provided by the employer before using this new benefit. The new unused leave does not carry over to a new year as this entitlement is intended to address the current situation.
Specified purposes for paid leave:
- The employee is under a federal, state or local quarantine or isolation order related to COVID-19.
- The employee has been advised by a health care provider to self-quarantine because of COVID-19 concerns.
- The employee Is experiencing COVID-19 symptoms and seeking a medical diagnosis.
- The employee is caring for an individual subject to a quarantine or isolation order or advised to self-quarantine because of COVID-19 concerns.
- The employee is caring for a son or daughter (as defined in the FMLA) where, due to COVID-19 precautions, the child's school or place of care has been closed or their child care provider is unavailable.
- The employee is experiencing any other substantially similar condition specified by the Secretary of Health and Human Services in consultation with the Secretary of the Treasury and the Secretary of Labor. (This one will be further specified by administrative rule.)
Emergency Family and Medical Leave Expansion Act
Previously, the FMLA only applied to employers with 50 or more employees, but the new COVID-19 provisions apply to any employer with 500 or fewer employees. The Secretary of Labor is authorized to issue regulations that exempt businesses with fewer than 50 employees from the new paid sick leave provisions if providing them would jeopardize the viability of the business. These regulations have not yet been issued.
A qualified employee may take up to 12 weeks of leave under FMLA if an employee is unable to work (including telework) due to a need to care for a child under the age of 18 whose school or place of care has been closed or their childcare provider is unavailable due to a public health emergency. The law applies to eligible employees who have been employed for at least 30 calendar days. The first 10 days for which an employee takes leave may consist of unpaid leave, and the employee may elect to substitute any accrued vacation, personal medical or sick leave. The amount to be paid is not less than two-thirds of the employee’s regular pay rate and the number of hours the employee would otherwise be normally scheduled to work. However, this leave shall not exceed $200 per day and $10,000 in the aggregate.
In the case of an employee whose schedule varies from week to week as to make the number of hours that would have been worked uncertain, the employer shall use the average over the prior six-month period. If the employee did not work over such period, the average hours that were a reasonable expectation of the employee at the time of hiring will be used.
Certain employees who take leave under FMLA are entitled to some degree of restoration of position upon return to work. If an employer has 25 or more employees, the employee is entitled to reinstatement to the same or an equivalent position. However, if an employer has fewer than 25 employees, the returning person is entitled to reinstatement to the position held when the leave commenced. This is unless that position no longer exists due to economic conditions or other changes in operating conditions that affect employment and are caused by a public health emergency during the leave. The employer is supposed to make reasonable efforts to restore the employee to a position equivalent to the position held when the leave commenced with equivalent pay and benefits. If reasonable efforts fail, the employer shall contact the employee if an equivalent position becomes available within a one-year timeframe.
Currently, veterinary practices are doing the best they can to manage this crisis and protect employees while caring for clients. Some businesses that are able are paying employees who are off either regular wages or smaller stipends. There is absolutely nothing wrong with this because FLSA does not prohibit employers from paying employees for unproductive time. To take advantage of new leave benefits, employers should not request written proof of COVID-19 illness for the employee or family before the time off is taken. This is because the government is not recommending testing for everyone, and testing is not yet widely available to all people.
TVMA will continue to monitor and alert you to regulatory changes as they develop. If you have questions, please contact TVMA Director of Government Relations/General Counsel Elizabeth Choate, JD, at firstname.lastname@example.org or 512-452-4224.
Client COVID-19 Information Sheet (03-20-2020)
Are clients asking about the impact of COVID-19 on them and their pets? TVMA has produced a one-page flyer with factual information (primarily from the CDC) that can be printed or shared electronically (social media, website, etc.).
CLICK IMAGE ABOVE TO DOWNLOAD PDF
Please contact TVMA at 512-452-4224 or email@example.com if we can be of any assistance.
Veterinary Vitals Offers Financial & Operational Guidance (03-20-2020)
TVMA is here for you during this unsettling time, specifically by providing you with relevant, timely information. Today this comes in the form of a podcast episode. In this special edition of Veterinary Vitals, you’ll hear from acclaimed veterinary practice consultant Karen Felsted, DVM, CPA, MS, CVPM, about the following topics:
- Taking Care of Your Veterinary Team Physically, Emotionally and Financially
- What and How to Communicate with Clients
- Operational Changes to Reduce Exposure
- Expense Control and Preparing for a Possible Recession
LISTEN TO EPISODE
We hope you gain some applicable knowledge from this episode as you continue to navigate unforeseen financial and operational challenges. If you have any questions or concerns, please do not hesitate to contact our office at 512-452-4224 or firstname.lastname@example.org.
Veterinary Practices as “Essential Businesses” (03-20-2020)
Today, Governor Greg Abbott issued a statewide executive order closing schools and mandating that people avoid social gatherings in groups of 10 or more people, avoid eating in bars or restaurants and not visit nursing or retirement homes. However, this order does not prevent businesses from providing essential services and closes only two types of businesses (gyms and massage parlors). Furthermore, there is nothing in this order that limits the practice of veterinary medicine.
The Texas Veterinary Medical Association (TVMA) has been making the case to the Governor’s office and other elected officials that veterinary practices are essential businesses that provide essential services. Here is a link to TVMA’s letter to authorities on this issue: CLICK HERE.
For veterinary clinics that choose to remain open, TVMA suggests that veterinarians utilize all of their training on the transmission of disease to protect staff and minimize the transmission of the virus. There are many creative methods that practices can and currently are utilizing to minimize human contact. If you experience any forced closure-related issues from local officials, please let us know because we may be able to provide assistance.
If you have any questions, please contact TVMA Director of Government Relations/General Counsel Elizabeth Choate, JD, at email@example.com or 512-452-4224.
COVID-19 TVMA SURVEY (03-18-2020)
The COVID-19 pandemic has presented the veterinary profession with its own set of challenges, and each veterinary practice faces its own unique issues. TVMA is here for you and would like to learn more about what your clinic is encountering, so we can better serve you during this trying, unprecedented time. Please take a few minutes to complete this brief survey. Your answers will provide us with the insight necessary to offer services and information tailored to your needs and concerns.
Stay safe, and take care of yourselves. As always, please do not hesitate to contact the TVMA office at 512-452-4224 or firstname.lastname@example.org.
CLICK HERE TO TAKE SURVEY
BVME Waives CE Requirements During Emergency (03-18-2020)
Please see this important message from the Texas Board of Veterinary Medical Examiners regarding the waiver of continuing education requirements during this emergency, as well as comments on the use of telemedicine.
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Free Coronavirus (COVID-19) Webinar (03-17-2020)
Due to the announcement of the global COVID-19 pandemic by the World Health Organization, Virox Animal Health™ has organized an educational webinar featuring top infection prevention and epidemiology experts. The webinar is scheduled to take place on Thursday, March 19th at 2:00pm Eastern Time, developed and presented by Jason W. Stull, VMD, MPVM, PhD Diplomate ACVPM and J. Scott Weese, DVM DVSc DipACVIM.
“The COVID-19 pandemic has already proven challenging for all of us – both personally and professionally.” said Dr. Jason Stull, presenter and Associate Professor in veterinary medicine at The Ohio State University and Atlantic Veterinary College. “Misinformation as well as lack of information and guidance further challenge our ability to appropriately respond and prepare for this disease. This talk aims to break down what we do and do not know about human and animal aspects of COVID-19, accompanied by tailored options we can immediately put into place, so that each of us can make balanced risk-benefit decisions with this crisis.”
The 1-hour webinar, titled Coronavirus (COVID-19) in veterinary and animal group settings: Protecting people and animals will be free, funded by Virox. Attendance will be limited to 5000 participants, however, the session will be recorded and shared, along with a resource information kit, following the webinar to all registrants.
Coronavirus (COVID-19) in veterinary and animal group settings:
Protecting people and animals
Thursday, March 19, 2020 - 2:00pm Eastern Time
Registration link: https://event.webinarjam.com/channel/RescueDisinfectants
CLICK IMAGE ABOVE TO DOWNLOAD PDF
TVMA COVID-19 Update (03-16-2020)
Recent events involving COVID-19 have made many aspects of daily life more difficult for everyone. The veterinary profession is certainly facing its own challenges, and we want you to know that we are here for you and doing all that we can to help our members through these trying times. At this point, there are more questions than answers, but we will continue to work toward obtaining the information you need and sharing it as it becomes available.
Our friends at the American Veterinary Medical Association have done a great job of gathering information regarding some of the issues most important to the profession, including critical background information on COVID-19, actions being taken by the federal government, and helpful advice for veterinary clinics regarding patient care, business operations, etc. You can find that information here: https://www.avma.org/resources-tools/animal-health-and-welfare/covid-19
TVMA is concentrating its efforts on issues at the state level. On Friday, March 13, Texas Gov. Greg Abbott declared a “state of disaster” in Texas due to COVID-19, which should provide some flexibility when dealing with fallout from the virus. TVMA is in contact with the Texas Board of Veterinary Medical Examiners to discuss issues such as the impact the virus is having on licensees seeking continuing education for license renewal, the possible role of telemedicine going forward and other matters impacting the profession in Texas. As soon as we have something definitive to share, we will provide that to you.
TVMA will offer continuing updates to our membership as important information becomes available. As always, if there is anything TVMA can do to assist you, please do not hesitate to call our office at 512-452-4224 or email us at email@example.com.
Please take care of yourselves and each other.