AVMA Updates

AVMA Update – April 2021

Aloha Colleagues!

Before I share with you the many programs the American Veterinary Medical Association has available for all members, I did want to take this opportunity to send a huge virtual Mahalo to you for your support of my candidacy for the AVMA Board of Directors District X Representative. Although I was not chosen, I am grateful to have been on the ballot – Mahalo!

We, Carolyn Naun (alternate delegate) and I (Delegate and State Advocacy Committee Member), will continue to represent Hawaii proudly at the House of Delegate meetings. If there are any questions or concerns, please feel free to contact us.

Aloha,
Leianne K. Lee Loy

Highlights from the AVMA:

AVMA Virtual Convention July 29 – August 1, 2021: Registration is open!
Check out “Convention at First Glance” to discover the over 300 hours of
continuing education. avmaconvention.org

VLC (Veterinary Leadership Conference) January 7-9, 2022 avma.org/vlc
(NOTE: Please click here for highlights of the AVMA House of Delegates Winter Session including the Veterinary Information Forum that took place during the VLC.) This is a great conference to develop, improve and perfect your leadership skills.

COVID-19 resource center: www.avma.org/Coronavirus
More information about veterinarians’ ability provide vaccines
E-book: COVID-19: Meeting the Challenge

AVMA Axon online platform – digital education https://axon.avma.org
Certificate Programs, Webinars, My Veterinary Life Podcasts Series

AVMA Trust Retirement Plan avmalifeplans.com/ARP
For questions, or to schedule a personal consultation, email AVMATrustRetirementPlan@transamerica.com or call
312-596-5336.

AVMA, VetSuccess Partnership
• Veterinary Industry Tracker
• To learn more about the AVMA’s economics resources, visit
avma.org/VeterinaryEconomics

Diversity, Equity, and Inclusion: avma.org/diversity

Telehealth
• AVMA Guidelines for the Use of Telehealth in Veterinary Practice
• 2021 AAHA/AVMA Telehealth Guidelines for Small-Animal Practice

Veterinarians as COVID-19 Vaccinators

Submitted by the American Veterinary Medical Association

The AVMA has been working hard for the past few months, as veterinarians have been increasingly discussed as needing to be among those able to assist in efforts to vaccinate people against COVID, to have veterinarians specifically included in the declarations under the federal Public Readiness and Emergency Preparedness Act (PREP Act), which authorizes the HHS Secretary to issue emergency public health declarations and provides limited immunity from liability to those covered under the act.

As of March 12, 2021, veterinarians and veterinary students are included in the PREP Act:

· It allows veterinarians who are licensed to practice under the law of any state to administer COVID vaccines in any jurisdiction in association with a COVID vaccination effort by a state, local, tribal, or territorial authority or by an institution in which the COVID vaccine is administered.

· This also applies to veterinarians who have held an active license or certification under the law of any state within the last five years which is inactive, expired or lapsed, as well as veterinary students with appropriate training in administering vaccines. The intent is to include recently retired veterinarians who may want to help.

· Today’s amendment preempts any state law that would otherwise prohibit veterinarians or veterinary students who are a “qualified person” under the PREP Act from prescribing, dispensing, or administering COVID vaccines or other covered COVID countermeasures.

· Veterinarians and veterinary students will be afforded liability protections in accordance with the PREP Act and the terms of the amendment. However, specific conditions must be met in order for the authorization to administer the vaccines and the liability protections to apply. These liability protections apply from March 11, 2021, through October 1, 2024.

· In order for the authorization and liability protections to apply, veterinarians and veterinary students must be participating in association with a COVID vaccination effort by a state, local, tribal, or territorial authority, or by an institution in which the COVID vaccine is administered. Additional specific requirements also must be met, such as having basic certification in CPR, completing the CDC COVID vaccination modules, an observation period, etc. There is a separate section of the declaration that applies to those in the uniformed services and for federal employees, contractors and volunteers when authorized to administer COVID vaccine.

· While the liability outlined in the PREP Act is broad, it does not apply to willful misconduct, and the federal government does not provide a legal defense in the event that you are sued. Your state may have separate liability protections, along with separate requirements to qualify, and may or may not provide a legal defense. Veterinary malpractice will not likely respond to claims arising from a veterinarian intentionally vaccinating people against COVID.

More information on vaccination volunteer requirements

PREP Fact Sheet that Includes Veterinarians as Qualified Health Professionals

Federal Requirements for the Veterinarian-Client-Patient Relationship

The following guidance information has been provided by the AVMA

THE BASICS

The federal government regulates veterinary medicine and animal drugs very differently than it does human health care and drugs intended for human use. This is, in part, because veterinarians are key to maintaining a healthy, safe, and wholesome food supply and because they also play an important role in overseeing the judicious use of antimicrobials in animals. One important difference between human and veterinary medicine is that the U.S. Food and Drug Administration (FDA) has authority under the federal Food, Drug and Cosmetic Act (FDCA) over the use of animal drugs and human drugs by veterinarians, and the authority to define how a veterinarian-client-patient relationship (VCPR) is established for certain uses of animal and human drugs. [1]

For these uses, FDA has authority to require the keeping of veterinary medical records and to access them at any reasonable time to verify and copy them. [2] Use of animal and human drugs by veterinarians that violates the federal VCPR parameters set forth in the FDCA and its implementing regulations results in the drug being statutorily deemed unsafe for the use and, if in animal feed, the feed is statutorily deemed adulterated. [3] The USDA, which regulates veterinary biological products, also has promulgated rules defining a VCPR using the same language as the FDA. [4]

APPLICATION OF THE FEDERAL VCPR

The federal VCPR applies to any use of an FDA-approved human drug in animals, including over-the-counter (OTC) human drugs. [5] It applies to any use of an FDA-approved animal drug in any manner that differs from its approved labeling (Extra Label Drug Use [6]), such as a different frequency of administration, different dose, different medical indication for its use, different route of administration, or use in a different species. [7] It also applies to the use of compounded drugs by veterinarians [8] and a veterinarian’s authorization of a veterinary feed directive (VFD). [9] All of these are very common occurrences in the day-to-day practice of veterinary medicine.

Establishing the federal VCPR requires a physical examination of the animal or timely and medically appropriate visits to the premises where animals are kept. The FDA does not allow the VCPR to be established through electronic means. [10] FDA does allow the VCPR to be maintained electronically through telemedicine. [11] Veterinarians must comply with the federal VCPR in each of the circumstances in which it applies, irrespective of whether state law defines it differently.

The federal VCPR also applies in two important, but more limited, circumstances under USDA authorities. Veterinarians who manufacture biological products for use in their patients must do so within the context of the federal VCPR. [12] Veterinarians also must have established a federal VCPR when using prescription platform product biologics, which are a new category of biotechnology vaccines. [13]

CONFLICTING STATE AND FEDERAL VCPR DEFINITIONS AND TELEMEDICINE

• Conflicting state and federal VCPR definitions (e.g., states allowing the VCPR to be established electronically) would cause significant confusion. The FDA and USDA have used the same regulatory definition to avoid such confusion.
• Veterinarians must comply with the federal VCPR requirements where they apply, regardless whether state laws are more lax. Activities where the federal VCPR applies are extremely common in day-to-day veterinary practice.
• State law and regulations relating to the establishment of a VCPR that conflict with federal law would also cause telemedicine encounters to be frustrating for many veterinary clients. A veterinarian who has not already established a VCPR that complies with federal requirements (i.e., by conducting an in-person examination/visit) could not even recommend the use of an FDA-approved human OTC product for an animal without violating federal law.
• There are many valuable uses of telemedicine within the parameters of a federal VCPR.

21 USC 360b; 21 CFR Part 530
21 CFR 530.5
21 USC 360b(a)(1), (2), (4) & (5); 21 USC 342(a)
9 CFR 107.1(a)(1)
21 USC 360b(a)(5); 21 CFR 530.2; 21 CFR 530.3(a)
https://www.fda.gov/animal-veterinary/resources-you/ins-and-outs-extra-label-drug-use-animals-resource-veterinarians
21 USC 360b(a)(4); 21 CFR 530.2; 21 CFR 530.3(a)
https://www.fda.gov/animal-veterinary/resources-you/ins-and-outs-extra-label-drug-use-animals-resource-veterinarians#compounding; FDA Draft Guidance for Industry #256
21 CFR 558.6(b)
FDA letter to the American Veterinary Medical Association, April 6, 2017 – “Therefore, for the purposes of the federal definition, a VCPR cannot be established solely through telemedicine (e.g., photos, videos, or other electronic means that do not involve examination of the animal(s) or timely visits to the premises).”; During the pandemic FDA announced they will temporarily suspend enforcement of the federal VCPR physical exam and premises visit requirements. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/cvm-gfi-269-enforcement-policy-regarding-federal-vcpr-requirements-facilitate-veterinary. In this announcement FDA reiterated that under normal circumstances – “Given that the Federal VCPR definition requires animal examination and/or medically appropriate and timely visits to the premises where the animal(s) are kept, the Federal VCPR definition cannot be met solely through telemedicine.”
Id. “The regulations do not specifically address the use of telemedicine to maintain an established VCPR. However, based upon the language of the VCPR definition provided above, nothing would prohibit the use of telemedicine (e.g., use of photos, videos, or other electronic means that may be considered virtual) to allow the veterinarian to keep informed and able to make medical judgments regarding the health of the animal(s) and the need for medical treatment between periodic examinations of the animal(s) and/or timely visits to the premises where the animal(s) are being kept.”
9 CFR 107.1(a)
USDA Veterinary Services Memorandum 800.214

AVMA House of Delegates Updates

Submitted by HVMA HOD Representatives Leianne Lee Loy and Carolyn Naun

The first Virtual Annual House Of Delegate (HOD) Session was held on July 30 and 31, 2020. Regular Annual Meeting Agenda included: Veterinary Information Forum with open mic discussion, candidate introductions, officer speeches, Informational meeting (AVMF, PAC, PLIT, CVTEA, COE), Reference Committee, and the district caucuses.

Highlights of the meeting:
Discussion, cases and stories of HOD COVID-19
Diversity and Inclusion in Veterinary Medicine
Two Resolutions Approved: Revised Policy on Antiparasitic Resistance and Transportation of Research Animals for the Purpose of Research, Testing, and Education

Election results:
AVMA President Elect 2020-2021: Jose Arce
AVMA Vice President 2020-2022: Sandra Faeh

Continuing Education Opportunity with AVMA

This summer, the AVMA’s first Virtual Convention will take place August 20-22. Take a step back from the day-to-day and rekindle your energy and passion for veterinary medicine—without leaving your home!
Tracks include:

Cannabis Symposium
Companion animal medicine
Food animal / equine
Practice management
Professional development
Public and corporate practice
Veterinary technology

Find out more and register here

Diversity and inclusion

As you know, diversity and inclusion has become a salient issue over the past several months. AVMA leadership has listened, and the HOD passed recommendations to the Board of Directors outlining some actionable steps. The Multicultural Veterinary Medical Organization released a thought provoking video that we recommend you watch if you have not seen it already: https://www.youtube.com/watch?v=j7Pl4YX_QNc.

Given recent events in Washington involving a Member of Congress who is a veterinarian, we wanted to clear up one misunderstanding we have heard regarding the use of member dues. AVMA does take an active role in advocating for the profession and championing the legislative causes that affect us. This effort is nonpartisan in nature. However, in accordance with federal law, your AVMA dues cannot be used toward political campaign contributions.

The AVMA’s Political Action Committee is a separate entity supported by individual contributions from members. AVMA PAC does support veterinarian Members of Congress, as they understand the challenges faced by our profession and the issues you care about, without regard to party affiliation. You can reach AVMA PAC to provide feedback or to make a contribution at avmapac.org.

Here is a link to the statement from AVMA regarding the reported interaction between Rep. Ted Yoho and Rep. Alexandria Ocasio-Cortez: https://www.facebook.com/avmavets/posts/10163691028363990

Rep. Ted Yoho is retiring from Congress at the end of this year.

COVID-19 and Your Pet

Updated April 5, 2020

How to Best Protect Your Pet

Stay home and follow social distancing orders from authorities. Studies show COVID-19 is often spread by those who are not yet showing symptoms of disease. Consider yourself infected and take the proper precautions to protect your community.
DO NOT take your pet to a veterinary clinic for wellness visits, vaccinations, or elective procedures (such as spay/neuter) that may be safely delayed for a few months.
If you are concerned with your pet’s health issue, CALL YOUR VET. Many vets are practicing telemedicine with established and new clients and patients, and will be able to make a tentative diagnosis and prescribe medication over the phone or after an online consult.
If you are diagnosed with COVID-19 but do not need to be hospitalized, you can still safely care for your pet. Practice good hygiene practices by washing your hands before and after interacting with your pet, not kissing or sharing food with your pet, and avoiding close contact (hugging, sleeping together). If possible, wear a facemask to reduce your spread of virus particles.

Make a Plan for Your Pet

You should identify a family member or friend who can care for your pets if you need to be hospitalized.
Have an appropriate carrier/crate for each pet, and enough food, medication, and supplies for at least two weeks.
Ensure all medications are documented with dosages and administering directions. Including the prescription from your veterinarian is ideal.
Pets should have identification: Collar with ID tag and microchip.

COVID-19 and Pets

Infectious disease experts and multiple international and domestic human and animal health organizations agree there is no evidence at this point to indicate that pets become ill with COVID-19 or that they spread it to other animals, including people.
If you are not ill with COVID-19, you can interact with your pet as you normally would, including walking, feeding, and playing. You should continue to practice good hygiene during those interactions (e.g., wash hands before and after interacting with your pet; ensure your pet is kept well-groomed; regularly clean your pet’s food and water bowls, bedding material, and toys).
Out of an abundance of caution, it is recommended that those ill with COVID-19 limit contact with animals until more information is known about the virus. Have another member of your household take care of walking, feeding, and playing with your pet. If you have a service animal or must care for your pet, wear a cloth facemask; don’t share food, kiss, or hug them; and wash your hands before and after any contact with them.

CDC Recommends Cloth Facemasks

CDC recommends wearing cloth face coverings in public settings to slow the spread of the virus and help people who may have the virus and not know it from transmitting it to others. Cloth face coverings fashioned from household items or made at home from common materials at low cost can be used as an additional, voluntary public health measure.

Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance.

The cloth face coverings recommended are NOT surgical masks or N-95 respirators. Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders, as recommended by current CDC guidance.

CDC: How to Protect Yourself
CDC: Info on Cloth Masks

General information about COVID-19:

The betacoronavirus that causes COVID-19 is SARS-CoV-2 (formerly 2019-nCoV).
Person-to-person and community spread has been reported in numerous countries, including the United States.
Transmission primarily occurs when there is contact with an infected person’s bodily secretions, such as saliva or mucus droplets in a cough or sneeze. Transmission via touching a contaminated surface or object (i.e., a fomite) and then touching the mouth, nose, or possibly eyes is also possible, but appears to be a secondary route. Smooth (non-porous) surfaces (e.g., countertops, door knobs) transmit viruses better than porous materials (e.g., paper money, pet fur) because porous, especially fibrous, materials absorb and trap the pathogen (virus), making it harder to contract through simple touch.
There are currently no antiviral drugs recommended or licensed by FDA to treat COVID-19, and there is no immunization available.
Cases of COVID-19 and community spread are being reported in most states.
The best way to avoid becoming ill is to avoid exposure to the virus. Taking typical preventive actions is key.

Have Any Pets Been Infected with COVID-19?

On April 5th, the USDA National Veterinary Services Laboratories has confirmed the presence of SARS-CoV-2 in one tiger at a zoo in New York. Read full USDA article.

While two dogs (Hong Kong) and two cats (one in Belgium and one in Hong Kong) living with people diagnosed with COVID-19 have also been reported to have been infected with SARS-CoV-2, other dogs and cats also living with infected people remain uninfected. To date the CDC has not received any reports of pets or livestock becoming sick with COVID-19 in the United States. Infectious disease experts and multiple international and domestic human and animal health organizations continue to agree there is no evidence at this point to indicate that, under natural conditions, pets spread COVID-19 to people. To date, all animal cases have had no or mild symptoms that resolved with supportive care.

Because the situation is ever-evolving, public and animal health officials may decide to test certain animals out of an abundance of caution. The decision to test will be made collaboratively between local, state, and federal animal and public health officials. After the decision is made to test, state animal health officials will designate a state-appointed veterinarian, USDA-accredited veterinarian, or foreign animal disease diagnostician to collect the sample using appropriate personal protective equipment (PPE) and sample collection methods.

Again, current expert understanding is that COVID-19 is primarily transmitted person-to-person. This supports a recommendation against testing of pets for SARS-CoV-2, except by official order. If dogs or cats present with respiratory signs, veterinarians should test for more common respiratory pathogens.

Pets in homes with owners with COVID-19: Although there have not been reports of pets becoming sick with COVID-19, out of an abundance of caution, it is recommended that those ill with COVID-19 limit contact with animals until more information is known about the virus. If you are ill with COVID-19 have another member of your household take care of walking, feeding, and playing with your pet. If you have a service animal or you must care for your pet, then wear a cloth facemask; don’t share food, kiss, or hug them; and wash your hands before and after any contact with your pet or service animal. You should not share dishes, drinking glasses, cups, eating utensils, towels, or bedding with other people or pets in your home. Additional guidance on managing pets in homes where people are sick with COVID-19 is available from the CDC.

Keeping pets safe: For responsible pet owners, preparing in advance is key. Make sure you have an emergency kit prepared, with at least two weeks’ worth of your pet’s food and any needed medications. Usually we think about emergency kits like this in terms of what might be needed for an evacuation, but it’s also good to have one prepared in the case of quarantine or self-isolation when you cannot leave your home.

While we are recommending these as good practices, it is important to remember that, to date, there have not been any reports of pets or other animals becoming ill with SARS-CoV-2, and there is currently no evidence that pets can spread COVID-19 to other animals, including people.

Should any animal showing signs of respiratory illness be tested?

USDA and CDC do not recommend routine testing of animals for this virus. Because the situation is ever-evolving, public and animal health officials may decide to test certain animals out of an abundance of caution. The decision to test will be made collaboratively between local, state or federal public and animal health officials.

Should I avoid contact with pets or other animals if I am sick from coronavirus (COVID-19)?

You should restrict contact with pets and other animals while you are sick with COVID-19, just like you would with other people. Although there have not been reports of pets becoming sick with COVID-19 in the United States, it is still recommended that people sick with COVID-19 limit contact with animals until more information is known about the virus. When possible, have another member of your household care for your animals while you are sick. If you are sick with COVID-19, avoid contact with your pet, including petting, snuggling, being kissed or licked, and sharing food. If you must care for your pet or be around animals while you are sick, wash your hands before and after you interact with pets. More information is available on how to keep people and animals safe at https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/animals.html.

What should I do if I think my animal has the virus?

Call your veterinary clinic with any questions about your animal’s health. In order to ensure the veterinary clinic is prepared for the household animal, the owner should call ahead and arrange the hospital or clinic visit. Make sure to tell your veterinarian if your animal was exposed a person sick with COVID-19, and if your animal is showing any signs of illness. Veterinarians who believe an animal should be tested will contact state animal health officials, who will work with public and animal health authorities to decide whether samples should be collected and tested.