REINVENTING THE
TRILOGY
COVID-19 – ONE HEALTH
– THE ANIMAL KINGDOM
Thomas E. Catanzaro,
DVM, MHA, LFACHE
Dipomate, American
College of Healthcare Executives
CEO, Veterinary
Consulting International
DrTomCat@aol.com; www.drtomcat.com
One Health is the integrative
effort of multiple disciplines working locally, nationally, and globally to
attain optimal health in people, animals, and the environment. Because of their expertise, veterinarians
play critical roles in the health of animals, humans and even the environment,
but these roles are often overlooked or unrecognized by other healthcare professions.
Nonetheless, thanks mainly to efforts by the AVMA and veterinary education universities,
veterinary medicine is the only profession that routinely operates at the
interface of these three components of One Health!
One Health is
the integrative effort of multiple disciplines working locally, nationally, and
globally to attain optimal health for people, animals, and the environment.
Because of their expertise, veterinarians play critical roles in the health of
animals, humans, and even the environment, but these roles are often overlooked
or unrecognized. Nonetheless, veterinary medicine is the only profession that
routinely operates at the interface of these three components of One Health.
The term “One Health” or “One Medicine”
has been around a long time — the concept goes back as far as 400 BC in
Hippocrates' On Airs, Waters, and Places. In the 11th -13th
century, the Chou Dynasty included medical doctors and veterinarians in an
emerging public health system. In more recent times, Dr. Calvin Schwabe -
an epidemiology veterinarian and Davis professor — coined the term "One
Medicine" in his book, Veterinary Medicine and Human Health, in
1964.
Dr. Schwabe was a pioneer in
bridging the veterinary and human health professions. He established and
chaired the Department of Epidemiology and Preventive Medicine at his organic
veterinary school, the first of its kind anywhere, which soon became the base
of veterinary epidemiology training for the entire world - a professional
education program that emphasizes the principles and strategies of mass disease
control and prevention in animals. That program has since trained more than 10,000
leaders in public health and animal disease control from all over the world.
Dr. Elinor Ostrom extended
Schwabe’s thesis of “one medicine” by structuring the different scales of
systems biology with ecological and societal dimensions. In a small Swiss
village, farmers tended to private plots for family use, but shared a communal
meadow system to graze their cows. One significant feature in the Swiss Village
was that no individual family could graze no more cows on the meadow that they
could care for over the winter. This was the common agreement among the villagers
(this has been a village expectation since 1517). She
highlighted the “shared resources” of “governing the commons” (in small local
communities, combining personal success with a common pool (finite) of
resources: Indonesia and Maine – fishing, Nepal – forestry, Swiss – grazing).
In 2009, Dr. Ostrom received the Nobel Prize in Economics for her scholarly work
in “commons”.
In about 1980, Dr. Leo Bustad and
the McCulloch brothers established the Delta Society to study and promote the
human-animal bond. In the initial
design, the Delta Society was to be the library and clearing house for any and
all Human – Animal Bond research and position papers. The Delta Society
changed their emphasis and mission when they changed their name to Pet Partners,
to better describe their efforts in support therapy animal research
programs. The American Association of
Human-Animal Bond Veterinarians (AAHABV) soon formed following the Delta
Society formation, but later changed their name to Human-Animal Bond Association
(HABA) to better describe the diversity and expanded membership for a
multi-disciplinary group of advocates.
Faced with complex patterns of
global change, the inextricable interconnection of humans, pet animals,
livestock, and wildlife and their social and ecological environment is evident
and requires integrated approaches to human and animal health, which led to the
beginning of comparative medicine at the University level (Europe before the USA). In
the ensuing years, the approach took root and gained prominence. Recognizing
its value, the Centers for Disease Control established its One Health Office in
2009, advancing the concept globally.
From Theoretical to Operational
“One Health” can be
defined as the added value in
terms of lives
of animals and humans saved, financial
savings and improved ecosystem
services from a
closer cooperation of
human and animal health as
compared to single
sector approaches. (WHO, 2012)
Zoonotic diseases (common
between man and other animals) or vector-borne (carried from infected
individuals to others, cross species) are very common, both in the United States
and around the world. Scientists
estimate that more than six out of every ten known infectious diseases in
people can be spread from animals, and 3 out of every four new or emerging
infectious disease in people come from animals.
Because of this, CDCP works 24/7 to protect people from zoonotic
diseases in the United States and around the world.
COVID-19 - FAST FORWARD
In the news, we were 4 months
into the pandemic before someone even mentioned “herd health”, and it was not
from the veterinary side of the debate. We are too close, and most veterinarians
studied epidemiology and “herd health” while in veterinary school (e.g., the
infamous disappearing distemper pandemic). If there was really an integrated
professional team looking at the Covid-19 pandemic, this would have been an
early descriptor.
The Argentine researchers are
looking at an equine serum vaccine for the Covid-19 pandemic. As a veterinarian, I needed prophylactic protection
against rabies, and in the early days, it was in an equine serum, with
alternating quadrants of the belly daily, for just under two weeks. The pain of the equine serum reaction, as
well as the daily injects for almost two weeks, would never be accepted by the
public. Again, a research effort without
a knowledgeable veterinarian on the team
Why cats get Covid-19, but dogs
do not? It took two Canadian researchers until July to share this observation
(discussed below). Seems interesting how the “multi-disciplinary” teams are
configured.
A leading science institute
forecasts that U.S. Coronavirus deaths will exceed 200,000 by Election Day. The
general feeling is that the pandemic is winning and Americans are losing.
America with 4% of the world’s population accounts for more than 22% of global
lives reported lost to the disease.
Dr. Fauci, a leading infectious disease expert,
stated earlier in August, that the American daily COVID-19 infection rate must
fall to 10,000 by September – the current 50,000 to 70,000 rate is three times
the rate in Europe. Scientists are racing to develop therapeutics and vaccines,
but in the mean time the death toll will continue to climb and the economy will
continue to fall as the politicians play “whack-a-mole” with community efforts
to control the spread while trying to save the small businesses (about 55% of
the National employment and economy).
The Federal government has funded at least 12
vaccine developers (8 are in China), with NO MANDATE to share developing technological
findings. Then we look at recent cardiac findings, and wonder why the
findings/validations are from single National labs in different countries:
- Rare syndrome
linked to Covid-19 found in nearly 600 U.S. children. CDCP reported over
four months during the peak of the pandemic, a Multisystem Inflammatory
Syndrome (MIS-C) caused systems with toxic shock and Kawasaki disease. Including
fever, rashes, swollen glands and in severe cases, heart inflammation.
This has been reported in children and adolescent patients about 2 to 4
weeks after the onset of Covid-19.
- Italian researchers
found heart deficiencies in Covid-19 patients, and blamed it on a concurrent
bacteria infection.
·
Two German studies, published Tuesday in the peer-reviewed journal JAMA
Cardiology, found heart abnormalities in COVID-19 patients months
after they had already recovered from the disease caused by SARS-CoV-2. New
evidence suggests the coronavirus has lasting impacts on the heart, raising
alarm for cardiologists who have been concerned about potential long-term heart
injury from COVID-19.
·
CDCP now states (Aug 2020) there has been 245,000 youth
infections, and these cases should be followed post-infection for cardiac and
brain complications.
When the first animal infection was detected,
it was in a New York Zoological tiger (Feb 2020). Then they found similar infections in canines
(Mar 2020). Then we have the Covid-19 versus Sars-CoV-2 situation as reported by
AAHA in Aug 2020:
·
A couple of Canadian researchers may have figured out why cats get
COVID and dogs don’t: a mutation in the gene that provides a vector for the
novel coronavirus. While a few noted dogs have tested positive for SARS-CoV-2,
the virus that causes COVID-19, no dogs have been diagnosed with COVID-19 to
date.
·
Researchers at Dalhousie University in Halifax, Nova Scotia,
published a study in which the
authors write: “A single genetic change in the host receptor for the virus
inherited in cats, but not dogs, correlates with feline susceptibility.” In
other words, during SARS-CoV-2 infection, the virus targets the
angiotensin-converting enzyme 2 protein (ACE2). Dogs have a
mutation in their ACE2 that gives them a natural resistance to the novel
coronavirus. Cats don’t.
·
That seems to apply to all cats, large and small: the researchers determined
that, along with cats, a number of different feline species—cheetahs, leopards,
tigers, and lions—are likely to be susceptible to the virus. So are ferrets.
WHO REVISED DEFINITION
(Pre-Covid-19)
One health is a
collaborative, multisectoral, and
Trans-disciplinary
approach – working at local,
Regional, national,
and global levels – to achieve
optimal health and
well-being outcomes recognizing
Interconnections between people, animals,
plants
and our environment.
COVID-19 reminds us of the dangers posed by
global systemic risks to the protection and safeguarding of human life – the first
duty of any government – in our ever more global civilization. It also exposes a basic contradiction between
enormously complex planetary ecosystem and our still dominant form of political
organization: a fragmented system of sovereign states (previously categorized
as politicians playing “Whack-a-Mole” in their attempt to balance public safety
with economic needs). The theorist Buckminster Fuller captured this mismatch
almost 40 years ago”
We have today, in
fact, 150 supreme admirals and only one ship – Spaceship Earth. We have the 150
admirals in their 150 staterooms each trying to run their respective stateroom
as if it were a separate ship. We have the starboard side admiral’s’ league
trying to sink the port side admirals’ league. If either is successful in
careening the ship to drown the ‘enemy’ side, the whole ship will be lost.
This is what is happening as new cases and
hospitalizations slip in Arizona, California, Florida, and Texas: remaining
high in Georgia, Illinois and Nevada: and rise alarmingly in Alabama,
Mississippi, Missouri and Oklahoma. To
keep the outbreak in check, we need to be doing enough things right for a long
enough time (best guess for a Covid-19 vaccine is 2021, with unknown immunity duration
at this time). Doing “right” includes:
Ø
Once and for all, fix testing. Tests that take a
week or more for results are virtually worthless. Right now only seven governors (3 Republicans
and 4 Democrats are pressuring manufacturers to ramp up production of rapid-detection
tests.
Ø
Ensure adequate supplies – the federal
government, through the Department of Health and Human Services, must undertake
an end-to-end supply chain analysis to identify bottlenecks and shortages in
the manufacturer rapid-detection tests, as well as vaccine development.
Concurrently, the Departments must ensure all necessary gear for fighting the
disease (mostly medical and laboratory supplies). There is a National Defense Production Act to
facilitate getting the job done!
Ø
Build a COVID-19 infection barometer to guide the states. A crucial reason testing remains vital is
that it reveals viral spread and whether more needs to be done to curb transmission. No one needs the Alabama – Atlanta politician
conflict on mandating face masks, closing bars, inside dining, and other group assembly
activities. Extending and/or enforcing
the stay-at-home orders can be based on incidence rates rather than “Whack-a-Mole”
knee jerk decisions. E.G., a reasonable rate is where no more than 5% of tests
given in a metroplex or state are positive for at least 14 days (recent
WHO/CDCP recommendations). Hospitalizations
and deaths are key indicators for immediate mitigation – the federal government
must be crystal clear on criteria for key factors for ratcheting up mitigation.
Ø
Tell the truth. This
goes back to the “transparency” of decision making. This includes full
accounting on how States are grappling with Covid-19 data points including per-capita
infection rates, death rates, hospitalizations, outbreak rates by type of businesses,
testing turn around times, outbreaks among healthcare workers, and subsequent sequalae
after infection.
Americans have traditionally become weary of
any restrictions. Understandably, it applies
to this pandemic, but the coronavirus isn’t tired of finding victims. The
simple truth, as Dr. Fauci outlined for Congress in earl August, is that much
of the Nation never thoroughly shut down and too quickly reopened.
The issue of children under 15 yrs of age,
and the back to school pressures, are of MAJOR concern. Also, the American
attitude toward freedom has lent to increased cross-infection rates at beaches,
parks, and social gatherings, especially on 3-day and 4-day weekends. As we head
into the fall professional athletic events, even if social distancing is
established in stadiums, tail-gate parties, bar fan groups, and even home-based
sharing of visiting fans, will cause increased infection rates as well as
higher death rates.
Now is NOT the time to give up until cures or
vaccines arrive. It is time to do better!
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