Quick Links to COVID-19 Resources:
AVMA COVID-19 webpage
AVMA Webinar: “COVID-19: What Veterinarians Need to Know”
Infection Control in Veterinary Practices
Conserving Mask and Gown Resources
Hawaii State Updates on COVID-19
US Government Resources:
Join the Discussion
COVID-19 Vet Resource Survey
Please help Hawaii better understand our veterinary resources (PPE, ventilator equipment, staff) by filling out our survey.
Essential vs. Non-Essential Services
HVMA and AVMA are working to educate our state and local governments on the essential services that veterinarians provide. We strongly discourage veterinarians from offering non-essential services during this period as this undermines our efforts. Continuing to offer or promote non-essential services during this period of government-mandated social distancing increases the risk of virus transmission to our staff, our clients, and our communities at large. Additionally, continuing to perform non-essential procedures and surgeries uses up limited resources that are in short supply and may be necessary for essential procedures and surgeries in the near future. Please consider the serious consequences of continuing practice as usual in the face of the rapid and undetected spread of COVID-19. Below are several guidelines to help you determine which services are essential.
Update on Telemedicine
FDA announced today that they are taking steps to temporarily suspend enforcement of certain federal VCPR requirements as it relates to allowing veterinary telemedicine during this period of social distancing. This change only affects regulations regarding extralabel drug use in animals and veterinary feed directives. Read press announcement here.
Please consider using telemedicine as a way to continue to help your clients/patients and generate revenue, but minimize the spreading of COVID-19 during this critical time. The State of Hawaii Board of Veterinary Medicine follows the policies and guidelines of the AVMA. AVMA has laid out specific guidance on Telemedicine.
Many questions are arising on establishing a VCPR, and the limits on legal telemedicine practice. Here are some highlights from AVMA:
- “A Veterinarian-Client-Patient Relationship cannot be established solely by telephonic or other electronic means.”
- “Veterinary telemedicine should only be conducted within an existing VCPR. An exception may be made for advice given in an emergency situation until a patient can be seen by a veterinarian.”
- “Without an established VCPR – The veterinarian may provide general advice but must specifically stay clear of diagnosing, prognosing, or treating patients. Advice should not be specific to an individual animal, diagnosis or treatment. Non-client electronic communications should be in the non-clinical realms of general advice, mHealth, web content, and other generalized messaging.”
Both TeleAdvice and TeleTriage are legal without establishment of a VCPR:
TeleAdvice is “the provision of any health information, opinion, guidance or recommendation concerning prudent future actions that are not specific to a particular patient’s health, illness or injury, and that is not intended to diagnose, prognose, treat, correct, change, alleviate, or prevent animal disease, illness, pain, deformity, defect, injury, or other physical, dental, or mental conditions.”
TeleTriage is “the safe, appropriate, and timely assessment and management (immediate referral to a veterinarian or not) of animal patients via electronic consultation with their owners. The assessor determines urgency and the need for immediate referral to a veterinarian, based on the owner’s (or responsible party’s) report of history and clinical signs, sometimes supplemented by visual (e.g., photographs, video) information. A diagnosis is not rendered.”
We are currently awaiting guidance from the state on whether veterinary clinics in Hawaii will be allowed to establish a VCPR electronically during the emergency response to the COVID-19 outbreak.
Statewide Stay-At-Home Order 3/25 – 4/30
Effective March 25 through April 30, 2020, everyone in the State of Hawai‘i is required to stay at home or in their place of residence. This supplement to Governor David Ige’s emergency proclamation was announced on March 23, 2020. Read more here.
Under the proclamation, individuals may leave their home or place of residence only for essential activities, to engage in essential businesses and operations, and only if their work cannot be conducted through remote technology from home.
Veterinarians are currently considered essential businesses. Please continue to refrain from offering non-essential services during this period so we can maintain this status. Offering or promoting non-essential services uses up limited resources that are in short supply and may be necessary for essential procedures and surgeries in the near future. Additionally, encouraging clients to come into public spaces during this period of government-mandated social distancing increases the risk of virus transmission to our staff, clients, and communities at large.
Self-Quarantine for Travelers Arriving After 3/26
Effective, Thursday, March 26, 2020, all persons entering the State of Hawai‘i must self-quarantine for 14 days or for the duration of their stay in Hawai‘i, whichever is shorter. Residents returning to Hawaii must also self-quarantine in a designated location in their residence. If you are assisting with pet travel into the state of Hawaii, please notify pet owners of the self-quarantine requirement.
The Rabies Quarantine Station in Halawa Valley is currently closed to visitors. Pets may be released from quarantine as soon as the mandatory quarantine period is completed.
Details on self-quarantine procedures (pdf)
State and Federal Tax Relief
Internal Revenue Service (IRS) and State of Hawaii Department of Taxation have postponed the due dates for payment and filing of 2019 Federal and State income tax returns to July 2020. Additional action is not needed by Income taxpayers to participate in this tax relief program.
State of Hawaii Department of Taxation Website
State of Hawaii Department of Taxation Announcement 2020-01 (pdf)
Am I Doing the Right Thing?
During this time of undetected spread of COVID-19, please protect your staff, your clients, and your community. If you or one of your staff becomes ill or is known to be exposed to COVID-19, in addition to concerns about your and their wellbeing, there is the possibility that you will be asked by public health officials to temporarily close your practice for personnel isolation and facility cleaning.
With this risk in mind, veterinarians should work to reschedule all nonessential appointments so as to limit public exposure. This includes wellness visits for vaccinations, spay/neuter procedures, routine dental procedures, and anything that can be safely delayed for a few weeks to months.
Veterinary staff members who have symptoms of acute respiratory illness should stay at home and should not return to work until they are free of fever (fever is defined as a temperature of 100.4F or higher, using an oral thermometer), signs of a fever, and any other symptoms for at least 24 hours without the use of fever-reducing or other symptom-altering medicine (e.g., cough suppressants).
In addition, veterinary clinics should be aware that the limit on statewide gatherings of 10 people applies to activity in their clinics.
Telemedicine and emergency teletriage within the context of an existing VCPR can be extremely helpful in limiting your staff’s exposure, and enable you to support and monitor the health of your patients and conform to local requirements, while preventing the potential spread of COVID-19. Conducting pre-visit triage can help protect you and your staff as you prioritize and determine which patients need to be seen at the clinic.
Please do the right thing to limit the spread of this disease in our community.
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 you must care for your pet, then wear a facemask; don’t share food, kiss, or hug them; and wash your hands before and after any contact with them.
Managing Veterinary Practice in a Pandemic:
Multiple universities and practices have implemented the following practices to protect the health of their employees, clients, and surrounding communities:
- Limit patient care to acutely ill animals and/or emergencies. Animals that are sick or injured should receive veterinary attention.
- Reschedule existing new and recheck appointments that are considered non-essential (unlikely to experience significant harm if treatment is not administered in a timely manner).
- Reschedule elective procedures.
- Utilize telemedicine to assess patient condition and needs.
- If an animal needs to be seen in person, a healthy family member or friend should bring their sick animal to a veterinary hospital or clinic.
- Have clients drop off their animal and remain in their cars during appointments.
- When meeting clients, veterinary team members should wear appropriate PPE.
- In light of limited supply, be strategic in the use of personal protective equipment (PPE), including masks, gowns, and gloves.
- If a mobile or house call veterinarian must examine an animal in a home where someone is ill with COVID-19 and no other options are available, consult with local public health officials for guidance. Appropriate PPE and access to handwashing and disinfection materials should be considered in all cases.
Keeping Your Veterinary Team Healthy:
- Veterinary healthcare team members who have symptoms of acute respiratory illness should stay at home and should not return to work until they are free of fever (100.4F or higher, using an oral thermometer) and any other symptoms for at least 24 hours without the use of fever-reducing or other symptom-altering medicine (e.g., cough suppressants).
- Communicate about COVID-19 with your team. Flexible sick leave policies are important and team members should be made aware of these policies. Team members who appear to have symptoms of acute respiratory illness upon arrival at work or who become sick during the day should be separated from other team members and sent home immediately.
- If a team member is confirmed to have COVID-19, the veterinary practice owner should inform other team members of their possible exposure to COVID-19, but maintain confidentiality as required by law. Team members who are exposed to another employee with confirmed COVID-19 should contact their physician or local health department to determine how best to proceed.
- Surfaces in the veterinary clinic/hospital that are touched frequently, such as workstations, keyboards, doorknobs, countertops, and stethoscopes, should be cleaned often and wiped down by employees with disposable wipes between cleanings.
- Provide no-touch disposal receptacles.
- Place hand sanitizers in multiple locations, including in exam rooms, offices, and conference rooms to encourage hand hygiene.
- Team members should avoid close contact (within approximately 6 feet) with other people who are ill.
- Avoid touching your eyes, nose, and mouth.
- Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
- Wash your hands often with soap and water for at least 20 seconds, especially after coughing, sneezing, going to the bathroom, and before eating.
- If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol.
Families First Coronavirus Response Act:
On March 18, 2020, the President signed into law the Families First Coronavirus Response Act (H.R. 6201).
The final bill included some significant policy changes from the original proposals that were intended to address both the impacts on small businesses and individuals. We expect lawmakers to continue to address economic measures for small businesses and individuals through future legislative packages.
Lawmakers and the Administration remain engaged in ongoing negotiations to produce additional measures, and AVMA continues to ensure the concerns of the profession are heard as this dynamic situation unfolds.
The final bill includes:
- FMLA COVID-19 benefit – This benefit provides up to 12 weeks of family and medical leave benefits related to the coronavirus to be paid at 2/3 of regular pay rates after the first 10 days, which are unpaid. The leave is only available for child care in the event of school closure or if the employee’s child care provider is unavailable due to the public health emergency.
- COVID-19 sick leave – This benefit applies up to 80 hours of additional paid sick leave for employees related to the coronavirus. There are daily and aggregate caps on the sick leave benefit of either $511 per day and $5,110 in the aggregate if the employee is sick or quarantined, and $200 per day and $2,000 in aggregate if the employee is caring for someone else.
- Potential exemption – There is language granting authority to the Department of Labor to create regulations that can exempt small businesses with fewer than 50 employees from the leave requirements when the imposition of the requirements would jeopardize the viability of the business as a going concern.
- Tax credits – There are tax credits for employers intended to mitigate the impacts of the expanded leave provisions; and
- COVID-19 testing – It provides for free testing for the coronavirus during the emergency.
3/24/2020 – The Department of Labor just released Frequently Asked Questions documents on the Families First Coronavirus Response Act:
1) DOL FAQ
2) DOL Fact Sheet for Employers
3) DOL Fact Sheet for Employees
- Significantly, the FAQ DOL indicates the effective date for the Families First Coronavirus Response Act is April 1, 2020, and applies to leave taken between April 1, 2020, and December 31, 2020.
- For the exemption for business with fewer than 50 employees when providing the leave under the act would jeopardize the viability of the business, DOL advises that for now employers should document why they believe this to be the case. DOL then indicates that more detail will be forthcoming in regulations.