Dr. William Hardy, Jr-Director-National Veterinary Lab-COVID-19-Opening Thoughts and Commentary

 

William D Hardy, Jr., VMD

Director National Veterinary Lab

COVID-19 -Comments and Observations

Introduction:

SARS-CoV-2 spillover from Wuhan, China (below), occurred only 8 months ago and has changed the world, possibly forever.  Wuhan is the capital city and the largest city in Hubei Provence, the most populous city in Central China, with over 11 million people, more than New York City.  It has world-class industrial and medical research institutions, and is by no means a frontier city. Our veterinary profession has weathered the pandemic storm, probably because we have been schooled in epidemics, pandemics and “herd immunity.”  We are an essential profession caring for pet and domestic animals and are members of research teams around the world.  We now find ourselves in the middle of the pandemic since there are increasing reports of pet cats and dogs, infected in their households, by their SARS-CoV-2 infected owners.   After almost a 3 month “lockdown” in parts of this country, several states, New Jersey and New York, with the highest incidences, have reduced the numbers of new infections and deaths dramatically.  However, more than 35 states, with initial lower incidences, are now having dramatic increases of infections as they try to reopen their economies.  What does this mean for veterinary practices?  It seems prudent to follow the science recommendations of the AVMA, CDC, WHO, and other professional associations, who recommend continued caution and preventive measures.

 

WHO Director-General declares COVID-19 a pandemic on March 11, 2020

Dr. Tedros Adhanom Ghebreyesus, the WHO director-general, made the assessment that COVID-19 has the properties of a pandemic. He emphasized that WHO called every day for countries to take urgent and aggressive action. “We have rung the alarm bell loud and clear.” After reviewing earlier reports, it is apparent that the first COVID-19 case occurred on November 17, 2019 in another city in Hubei Province, a month earlier than the first case in Wuhan, and was not linked to the Wuhan animal market.

 

Update of SARS-CoV-2 Transmission

An open letter, published on July 6, 2020, from 239 health scientific experts calls attention to a neglected form of transmission and urges the WHO to consider this mode of transmission. The letter’s title is: It is Time to Address Airborne Transmission of COVID-19.⁴ In the past, only two types of SARS-CoV-2 transmissions were emphasized: inhaling respiratory droplets from an infected person in your immediate vicinity or - less common - touching a contaminated surface and then your eyes, nose or mouth. Now, in this letter the experts argue that, like other respiratory viral diseases, SARS-CoV-2 can also be spread by micro-droplets (microscopic respiratory droplets) up to several meters, or room scale, and may explain the “super-spreader” reports. This is unlike the known heavier respiratory droplets that don’t travel more than 6 feet before settling which was the reason for the 6-foot social distancing recommendation.  Although the heavier droplets are the major vehicle for spread, the micro-droplets increase the distance of SARS-CoV-2 viral spread and should be taken into account when considering prevention methods. This is an important factor to consider for re-opening indoor dining and for veterinary hospitals.

 

The experts recommend the following measures to be taken to mitigate airborne transmission:

1. Provide sufficient, effective ventilation (supply clean outdoor air, minimize recirculating air) particularly in public buildings, workplace environments, schools, hospitals, and care homes.

2 Supplement general ventilation with airborne infection controls such as local exhaust, efficient air filtration, and germicidal ultraviolet lights.

3 Avoid overcrowding, particularly in public transport and public buildings.

 

Opening Thoughts:

By William D. Hardy, Jr., V.M.D.

As I began to formulate my thoughts for the Summer Newsletter on July 6^th, I remembered it is on this day scientists celebrate World Zoonoses Day, which honors the first vaccination against rabies administered by Louis Pasteur on July 6, 1885, 135 years ago.  This pandemic is a harsh reminder of the persistent threat posed by zoonotic pathogens. Sixty percent of human pathogens come from animals, while 75% of new, emerging and re-emerging diseases are zoonotic. World-wide, it is estimated that around 2.6 billion people suffer from zoonotic illnesses and around 2.7 million die from these diseases every year.² How coincidental, that our laboratory concentrated, over the past 20 years, on testing for Bartonella, a zoonotic bacterial pathogen and we are now in the midst of one of the worst viral pandemics, the COVID-19 disease caused by the coronavirus SARS-CoV-2. And yet, despite the CDC guidelines, USA infections >3,000,000 and >130,000 (4.3%) deaths, the effect on the US economy, the stress on medical systems, there are many Americans who feel the pandemic is hyped by scientists, medical experts and the press.

 

Science and Anti-Science History:

Science definition: Science is the investigation of natural phenomena through observation, theoretical explanation, and experimentation, or the knowledge produced by such investigation.  Science makes use of the scientific method, which includes the careful observation of natural phenomena, the formulation of a hypothesis, the conducting of one or more experiments to test the hypothesis, and the drawing of a conclusion that confirms or modifies the hypothesis.

 

Anti-Science is a philosophy or way of understanding the world that rejects science and the scientific method.³ People holding antiscientific views do not accept science as an objective method that can generate universal knowledge.  Many Americans feel they are entitled to their own views on diseases and their liberty and rights are at stake, if they must comply with rules established, with the guidance of scientists, by government entities. The internet is greatly responsible for the surge in anti-science thinking in the world, where anyone can post information on any subject whether it is correct or not.

 

Politics and Anti-Science The previous administration established a White House Pandemic Response Team, after the SARS and MERS outbreaks, which was disbanded in 2018 by the present administration, with no plausible justification, just a year before the present pandemic struck. They also disbanded the Expert Committee on Invasive Species, whose budget was a mere $1.5 million dollars a year, again with no explanation. And finally, they recently defunded America’s contribution to the WHO in the midst of the pandemic. At this writing, 3 million Americans have been infected with SARS-CoV-2, the virus that causes the disease COVID-19, and more than 130,000 Americans have died of the disease and the pandemic remains out of control. Great Britain: The British Prime Minister expressed his opinion that the COVID-19 pandemic was nothing to fear and flaunted much of the medical advice at the start of the pandemic. He became infected and had a relatively severe disease before recovering and now seems to be abiding by scientific advice.

Brazil:  The president of Brazil, an anti-science devotee, allowed the pandemic to increase alarmingly in his country, through misinformation and neglect, by not adhering to medical advice. He also recently became infected with SARS-CoV-2 and is being treated with the clinically tested, but proven ineffective drug, hydroxychloroquine.

United States:  Our administration, from the beginning of the pandemic, sought to downplay the dangers, calling it a bad flu, a hoax, and giving advice that was contrary to their own Pandemic Advisory Committee regarding lock downs, wearing face masks, and social distancing.  Misinformation and disregard for scientific findings has contributed greatly to the >3,000,000 infected Americans (about 1% of the American population) and >130,00 deaths. Other Countries:  Many other countries, including China, Japan, countries in Europe, Australia, and New Zealand have followed scientific and medical advice and have their pandemics under control at this time.

Anti-vax Groups: Many people presently don’t use vaccines and a recent poll showed that 30% of Americans would not take a SARS-CoV-2 vaccine if, and when one, is developed.

 

Science Matters:

 

Animals and SARS-CoV-2 and COVID-19

Reverse Zoonotic Updates:

There are increasing reports of SARS-CoV-2 infections of cats and dogs from their infected owners.^5-19  There is no evidence, to date, of reverse zoonoses by SARS-CoV-2 from infected cats or dogs to people.  However, as with many other aspects of this pandemic, we still do not know conclusively if this is possible.

 

 

SARS-CoV-2 Naturally-Infected Animals

	Animal	Date	Location	Ref.
1	Cats	1-2020	Wuhan	6
2	Dog	2-28-20	Hong Kong	7,8,9
3	Dog	3-18-20	Hong Kong	10,11
4	Cat	3-27-20	Belgium	12
5	Cat	3-31-20	Hong Kong	13
6	Tigers	4-5-20	New York	15
7	Lions	4-15-20	New York	15
8	Mink	4-2020	Netherlands	16,17
9	Cat	4-21-20	New York	15
10	Cat	4-21-20	New York	15
11	Mink/Cats/Dog	4-23-20	Netherlands	16,19
12	Mink/Cats	4-25-20	Netherlands	18
13	Cat	5-29-20	France	14
14	Mink/Dog	6-17-20	Netherlands	18
15	Dog	7-1-20	Georgia USA	5

 

 

Natural Animal SARS-CoV-2 Observations: 

In January of 2020, a group in China did a serological survey (see Table) of the natural infections of SARS-CoV-2 in pet and stray cats from Wuhan.⁶ Serum samples were obtained from cats in Wuhan, including 102 samples taken after the COVID-19 outbreak, and 39 negative control samples taken before the outbreak.  15 of 102 (14.7%) cat sera collected after the outbreak were seropositive for SARS-CoV-2 virus by ELISA and by western blot.  Among the positive samples, 11 had SARS-CoV-2 neutralizing antibody titers ranging from 1:20 to 1:1080. Three of the pet cats, with high neutralizing antibody titers, were owned by people with COVID-19 disease. This study demonstrated that the human SARS-CoV-2 virus infected pet and stray cats in Wuhan during the initial outbreak.

 

A February 2020 study from Hong Kong found 2 pet dogs, from separate households with people diagnosed with SARS-CoV-2 infection, to be infected. Neither dog showed clinical signs. In the Netherlands 3 cats and a dog, the dog had respiratory signs, were infected from an infected  owner.  Also, in the Netherlands, mink at >20 breeding farms showed signs of respiratory illness and were found to be infected with SARS-CoV-2.  They likely were infected from farm workers.  Subsequent studies found evidence of mink zoonotic spread to humans and that infected stray cats were responsible for spread of the virus between farms. This implicates interspecies transmission, from cat to mink, and reverse zoonotic transmission, mink to human.^17,18,19

 

There are increasing reports (see Table) of animals, including pet cats and dogs, infected by exposure to infected owners in households in Europe, Hong Kong, and the United States.   A cat living in Belgium with a COVID-19 patient tested positive for the virus and showed clinical signs of cough, shallow breathing, diarrhea and vomiting, signs similar to those seen in people with the virus.¹² A dog in Georgia was recently infected.⁵  In France, a pet cat was also found to be infected while living with a COVID-19 owner.  In New York, a veterinarian tested a cat due to mild respiratory signs.  The cat was SARS-CoV-2 positive, but no person was positive for the virus in the household.  The cat must have been infected outside the household from a person or even from an infected cat in the area.  Finally, at the Bronx Zoo in New York City, 4 tigers and 3 lions, who had been exposed to a COVID-19 positive zookeeper, developed respiratory signs and tested SARS-CoV-2 positive, all recovered.

 

Commentary:

Studies found that pet cats, ferrets, mink, tigers, lions, hamsters, monkeys, and apes are susceptible to SARS-CoV-2 infection, whereas dogs are less so. Veterinarians must play significant One Health roles in protecting animals and humans from this SARS-CoV-2 spillover threat and more that are likely to emerge. It is only logical to speculate that reverse-zoonosis may occur from infected pet cats to their owners during periods of extended lockdown, despite no evidence that it has occurred. Can SARS-CoV-2 mutate in cats to effectively increase its infectious zoonotic potential?  Even though the CDC, AVMA, and other organizations state that there is no evidence (yet) that cats can re-infect people, we need more studies to be sure. 

 

COVID-19 Comments from Thomas E. Catanzaro, DVM, MHA, LFACHE

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 11^th -13^th 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!

COVID-19-Helping Each Other by Caring and Sharing

Donald H DeForge, VMD
SilverSandsVeterinary.com
GlobalVeterinaryEthicsCongress.blogspot.com


Global Veterinary Ethics Congress
COVID-19

COVID-19 has changed the world and all of us live in fear of the unknown.  Fear is as dangerous as the virus!

This essay is not a prescription that will take away that fear but it is an essay of optimism and hope!

One of my favorite educators of the '80's and 90's was Dr. Leo Buscaglia.  He saw life differently and tried to teach others that they can "change the world"!

Here is one of his famous quotations:

"The purpose of life is to help others, and if you can't help them, won't you at least not hurt them? I know that is a platitude, that is sentimental and can easily be attacked. But loving and caring is simple and we make it complex. Our own neuroses make it complex." Leo Buscaglia

Think about that quote and then reflect on the hoarding going on in supermarkets, drug stores, and dollar stores throughout this country.

People are acting aggressively to purchase every roll of toilet paper; disinfectant; and canned food they can HOARD in a room in their home and probably never have to use.  

Cold medicines for the sick are depleted; masks for hospitals are not able to be purchased; and basic food items are in major shortage.

Dr. Buscaglia says-"if you cannot help others--please--won't you at least not hurt them".  

As a profession, we have turned away from compassion and have centered on economics; new technology; and very expensive specialist intervention in the New Millennium.

We have to change!  We must become the leaders in compassion to stop this terrible moment of fear from spreading.  

The fear is as bad as the virus!  The fear will not allow the sick and the elderly to have food and basic cleaning supplies in their homes.
The fear will not allow people to be helped with non-COVID 19 respiratory illness because OTC medicines are GONE!

Supermarkets have set up early shopping hours to allow seniors a time to be alone to shop and limit contact with others.  Now we see adults-not seniors-- invading these senior hours to grab and hoard because the markets are not as busy at that time.  Very sad.

So what can we do today?  E-Mail a colleague with your suggestions on~~~ coping with COVID-19 in your practice~~~ that they may want to initiate; Skype a friend who may be alone; call a neighbor to see how they are doing; and most importantly use compassion in shopping.

We will get through this crisis!

Our hospitals will suffer economic hits of significance.  We will have mortgages and loans deferred. We will have credit card payment penalties deferred.  That is serious but it is ECONOMIC.

We will recover as a profession and be stronger than ever.  To do this, we must begin our "journey of compassion" today.  Dr. Buscaglia, if he were still with us, would say........yes--that is the answer!  

Be safe and be well,
Don DeForge, VMD
Acting Chair of the Global Veterinary Ethics Congress
23March2020

Compassion in Medicine~GVEC-~Jan 2020 Number Four

Global Veterinary Ethics Congress
Compassion in Medicine

Donald H DeForge, VMD
Fellow of the Academy of Veterinary Dentistry
Director: Silver Sands Veterinary
Director: Advanced Veterinary Dentistry
1-800-838-3368
DonDeForge100@gmail.com
www.SilverSandsVeterinary.com
AnimalDentistrySolutions.blogspot.com
Jan 2020 #4

The Global Veterinary Ethics Congress [GVEC]

The Human-Animal Bond
The Preservation of the Five Freedoms

Addressing connections between Ethics and the Human-Animal Bond:

Collaborative-Synergistic-Enlightening

Compassion in Medicine   
One Medicine

The Global Veterinary Ethics Congress will be studying Compassion in Veterinary Medicine in the months ahead.  Look at the video below concerning our human brothers and sisters in medicine. Jennifer Dobner in the essay to follow describes where we have been and where we should begin again in a quest for compassion in medicine.  It will only take a few moments to view the video and read the essay.  It is a gift well worth experiencing.

Donald H DeForge, VMD
Acting Chair-The Global Veterinary Ethics Congress

"At the beginning of medicine, when our knowledge was frankly limited or absent, what is it that we were able to provide?" asks Dr. James Doty, a neurosurgeon, who has practiced medicine for more than 30 years. "It was not cure. It was not intervention. The only thing we could provide was care and comfort."

Compassion isn't entirely gone from health care -- those working in the profession are still driven by a desire to ease suffering -- but in practice, it's a tenet that seems to have been lost or pushed aside over time, says Doty, the director and founder of the Center for Compassion and Altruism Research and Education (CCARE) at Stanford University.

"We've become enamored with the technology and the power of science," he says. "Certainly, they've had a huge impact on health and health outcomes. But we also have seen the result of negating that and what we have learned is that there is immense power to demonstrating compassion and caring to individuals who are ill."

Working to put compassion back at the center of health care systems will be the focus of Compassion Week, a joint initiative of CCARE, the Charter for Compassion, and the Tenyin Gyatso Institute, which seeks to instill compassion into the arenas of business and public service.

Dignity Health is a lead sponsor of the week's events that include the 2nd Science of Compassion Conference, the 3rd Empathy and Compassion in Society Conference, the Charter for Compassion Day, a "Living Compassionately" Retreat, a youth gathering, and the inaugural Compassion and Healthcare Conference.

Research has produced ample empirical evidence for proving what should seem obvious: Feeling soothed or cared for through the experience of meaningful social or human connections produces a physiological state in the body that is optimum for healing, Doty says.

The immune system gets a boost. Cortisol levels drop. Blood pressure goes down. Stress and anxiety begin to melt away and a person's mental state improves.

"I always tell people that while science and technology have probably saved millions of lives, the fact of the matter is that kindness and compassion have probably saved more," says Doty.

But it can be hard to hang onto compassion in an industry that has become increasingly complicated and expensive, relies on payment models that reward procedures over wellness care, and moves cautiously around legal and regulatory concerns, Doty and Dignity Health's Heather Walker say.

A pediatric nurse who now runs the Learning Institute Simulation Center at Dignity Health's St. Joseph's Hospital and Medical Center in Phoenix, Walker says she's watched nursing become heavy with requirements for documentation and creates mounds of paperwork.

"What I see lately is that health care is just so task-oriented," says Walker, who chose a career in nursing because she wanted to make a healing connection with others. "Many of those tasks are important, but we are just so focused on the tasks that we sometimes forget the patient because we are busy checking off all the boxes."

Part of Walker's job is to teach compassion skills to health care workers across the spectrum, from nurses and respiratory technicians to medical students and others. To do that, Walker uses a team of hired actors and volunteers to serve as "patients" in simulated situations -- known as the standard patient program -- to measure a health care provider's performance.

What she's watching for: How is the health care worker interacting with the patient? Are they looking the patient in the eye? Are they really listening? Is the patient understanding the information about medications?

"Everybody calls them soft skills, but I think they are hard, harder than just learning the technical stuff," says Walker, who plans to show a video from a simulation during a conference panel discussion.

The simulations include providing students with immediate feedback from their "patients."

Many get heaps of praise, but some are also surprised at how poorly they score on the compassion scale, even when the perceived infractions might seem small in the overall scheme of things.

"Like moving the bedside table closer. It's not a huge thing, but when a patient can't get to it and you leave the room, they're saying, 'wow, that's really rude''," she says. "We have to practice these things every day. I tell my students, what if this was your mother in your bed? Your child? What would you want for them?"

From Walker's perspective restoring compassion -- a touch, a listening ear or an acknowledgment of a patient's frustration or sorrow -- is an important way in which hospitals and other care facilities can differentiate themselves from each other.

Today, patients can readily find satisfaction surveys on the internet and made choices about where to seek treatment.

"As consumers, patients are really looking at whether they feel like they are being listened to," says Walker, who is slated as a presenter on a Wednesday conference panel. "So we really need to put the patient back into the center of health care and make sure we are taking care of the whole patient."

Doty believes the health care system is at an important crossroads that make this the right time for conversation and action around the idea of compassionate care.

"I think a lot of people understand the prices we have paid for ignoring this aspect of health care," he says. "There's an understanding that compassion is not only what defines our humanity but it defines us physicians and health care providers."

It's why, he says, the future of medicine resides in understanding the past and the beginnings of medicine.

Doty hopes conference -- goers will leave the event with a deeper understanding of the power compassion and caring can have on medicine and health care.

"It is fundamentally at its core," he says. "I want them to have a sense of excitement in regaining this part of medical practice and to give them some tools to use within their own environments that will not only support them in terms of resilience but also allow them to better re-engage with those they are caring for."

Posted in Power Of Compassion

Salt Lake City-based Jennifer Dobner is an independent award-winning journalist and writer and a regular contributor to Reuters, The New York Times, WebMD, and NBC’s Today Show. Her resume includes stints at newspapers large and small across the western United States, and for seven years she was the lead reporter in the Salt Lake City bureau of The Associated Press. She has written extensively about the Mormon church, criminal justice, politics and health care. Before working in journalism, Dobner worked in sporting event management and media relations for sponsors of professional golf events and for a professional soccer team. Raised in the San Francisco Bay Area, she studied journalism at Fresno State University.