COVID-19 and Your Pet

Updated March 20, 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 their established 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 facemask if possible; don’t share food, kiss, or hug them; and wash your hands before and after any contact with them.

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?

Dog in Hong Kong: On Thursday, February 27, Hong Kong’s Agriculture, Fisheries, and Conservation Department (AFCD) reported that samples obtained on February 26 from the nasal and oral cavities of a pet dog (a 17-year-old Pomeranian whose owner had been diagnosed with COVID-19) had tested “weak positive” for SARS-CoV-2, using a real time reverse transcriptase polymerase chain reaction (RT PCR) test. A fecal sample was negative. The RT PCR test is sensitive, specific, and does not cross-react with other coronaviruses of dogs or cats. A “weak positive” result suggests a small quantity of SARS-CoV-2 RNA was present in the samples, but does not distinguish between RNA detected from intact virus and fragments of RNA. PCR testing was repeated on February 28, March 2, 3, 5, and 10 with continued “weak positive” results. In addition, gene sequencing of the SARS-CoV-2 virus from the dog and its close human contacts was completed on March 12 and the viral sequences were very similar. A virus isolation test conducted on March 12 was negative. Experts from the School of Public Health of the University of Hong Kong and the College of Veterinary Medicine and Life Sciences of the City University of Hong Kong believe the consistency and persistence of the results suggest the virus may have spread from the infected people to the dog in this particular case. Testing was conducted by the laboratories of the AFCD and the School of Public Health of the University of Hong Kong. The latter is an accredited reference laboratory for the WHO for the testing of SARS-COV-2. This pet dog was one of two pet dogs under quarantine. The second pet dog had negative results of tests for the virus. Neither dog showed any signs of being ill with COVID-19. Unfortunately, the dog that tested positive passed away on March 16. The dog was 17 years old and had ongoing health issues that were likely responsible for the death of this dog, rather than COVID-19. We are told the second pet dog has been released from quarantine. On March 19, the AFCD reported that a third dog, a German Shepherd Dog living with an owner testing positive for COVID-19, had also tested positive. Another mixed-breed dog from the same residence tested negative. Neither dog has shown signs of disease. Both dogs are in quarantine and are continuing to be monitored and tested.

Testing of companion animals: To date, there have not been any reports of pets or other animals becoming ill, and there is no evidence that domestic animals, including pets, can spread SARS-CoV-2. 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 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.

COVID-19 RESOURCES

Updated 3/26/2020

Quick Links to COVID-19 Resources:

AVMA COVID-19 webpage
AVMA Webinar: “COVID-19: What Veterinarians Need to Know”
Infection Control in Veterinary Practices
Utilizing Telemedicine
Conserving Mask and Gown Resources
Hawaii State Updates on COVID-19

US Government Resources:

Coronavirus Response Business Toolkit
Disaster Assistance Loans from the SBA
Disaster Help Desk for Small Businesses

Join the Discussion

https://www.facebook.com/groups/808COVIDvets/

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.
IRS Website
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:

  1. 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.
  2. 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.
  3. 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.
  4. Tax credits – There are tax credits for employers intended to mitigate the impacts of the expanded leave provisions; and
  5. COVID-19 testing – It provides for free testing for the coronavirus during the emergency.

Read more about the bill here.

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.

Cannabis Info from AVMA

AVMA submitted comments to the FDA regarding critical veterinary issues related to cannabis products, and the importance of addressing them. The AVMA submitted the comments following a public hearing held by the agency in late spring to gather stakeholder input while considering regulatory frameworks for hemp derivatives—including CBD—used for therapeutic purposes and as food additives.

“Veterinarians have a strong interest in, and enthusiastically support, exploring the therapeutic potential of cannabis-derived and cannabis-related products,” according to the AVMA comments. “But we want to be sure we can have continued confidence in the efficacy, quality, and safety of products used to treat our patients.”

The AVMA’s concerns stem largely from the widespread marketing of cannabis-derived products, including hemp products, with health claims that haven’t received the required FDA evaluation and approval. “The FDA should establish a clear and efficient process for approval of cannabis-derived and -related therapeutic products, and then conduct consistent enforcement against manufacturers and distributors who are noncompliant,” the AVMA said in their comments. Read full AVMA article here.

In addition to advocating for practitioners, the AVMA provides several resources regarding cannabis:

Hawaii Pet Expo 2019

In celebration of both National Pet Week and Be Kind to Animals Week during May 5-11, 2019, the Hawaii Veterinary Medical Association proudly presents Hawaii Pet Expo 2019, to be held on Saturday and Sunday, May 11 & 12 from 10 am to 4 pm at the Neal Blaisdell Center.

Hawaii Pet Expo encourages responsible pet ownership and strengthening the unique bond between people and their pets through educational displays, live animal demonstrations, and the latest in pet products and services.

This year’s theme is “More than a Pet, More than a Friend … Family.” As always, pets are welcome. Dogs must be leashed and pets must be in good health and under their owner’s control at all times.

This event is free to the public, but donations of nonperishable food items will be accepted at the door to benefit the Hawaii Foodbank. Parking at the Neal Blaisdell Center is $6.

We are still looking for volunteers! All veterinary staff and family members are welcome to join in the fun. Sign up here.

Feline Fix by Five Campaign

Why the change in recommended age of sterilization of cats?

Philip A. Bushby, DVM, MS, DACVS

In June of 2017, the AVMA formally endorsed the consensus document put forth by the Veterinary Task Force on Feline Sterilization for Age of Spay and Neuter Surgery, which recommends cats not intended for breeding be gonadectomized by five months of age. This joined endorsements from other veterinary medical and cat breeding associations including the
American Association of Feline Practitioners, Association of Shelter Veterinarians, American Animal Hospital Association, Winn Foundation, Catalyst Council, Cat Fancier’s Association and The International Cat Association. Feline Fix by Five (FFF) is a campaign promoted by the
Marian’s Dream Foundation to share this recommendation that has garnered such broad support. FFF was born out of awareness that cats can be reproductively active by 4 to 5 months of age, yet most veterinarians recommend spay/neuter of cats at 6 months of age or older. The
result of this mismatch between age at which cats can become pregnant and the recommended age of sterilization is demonstrated any time one walks into a local animal shelter.

Animal shelters are generally overrun with kittens, the vast majority of which are the result of unplanned and unexpected pregnancies of young cats. A survey conducted in the State of Massachusetts revealed surprising results. While many people believe that pet-overpopulation is the result of pets that are left intact for their entire life, the opposite is true. Cats that were eventually spayed accounted for 87% of all litters born. [1]

Cat owners who are unsure of when to have their cat sterilized or simply wait until 6 months of age or later are faced with the dilemma of what to do with an unexpected litter of kittens. Too often those kittens are relinquished to local shelters and too often those kittens are euthanized. The problem was not that the owners refused to spay or neuter their pet; it was that they didn’t have it done in time.

Esther Mechler of the Marian’s Dream Foundation, who initiated the FFF campaign, has stated that “the number of births prevented – simply by changing the recommended age for spay/neuter of cats from 6 months to between 4 and 5 months – could reduce the numbers of shelter intakes enough to balance the number of potential adopters with available cats and
kittens. We could end the overpopulation of cats by this one simple change.” [2]

As a profession, we need to recognize that there is, at present, no scientifically sound basis for waiting until 6 months of age or older to sterilize cats and no contraindications for spay/neuter at 4 to 5 months of age. Anesthetic concerns about juvenile surgery voiced in the 60s and 70s
are no longer valid. There are many anesthetic drugs and protocols in use today that are safe in cats as young as 6 weeks of age. Old fears that castration of juvenile male cats would predispose to urinary obstruction were disproven in the 90’s. [3]

There are numerous known health benefits for spay/neuter in cats, in addition to the population management benefits, and there is “no evidence to suggest that pediatric gonadectomy by 5 months of age is linked to any
increased risk of disease.” [4] A survey conducted in 2000 of veterinarians who were, at that time, spaying and neutering cats under 5 months of age, confirmed that the surgeries were easier, faster, and had fewer complications than spay/neuter of cats at 6 months of age or older. [5]

So, what should the practicing veterinarian do to make this change? Simply add one more appointment to your standard kitten wellness protocols. Make no changes in current vaccination and parasite control recommendations except add an appointment for spay/neuter two to three weeks after the last kitten vaccination. Owner compliance will be increased,
surgeries will be easier, and, in time, local shelters will not be overrun with kittens.

For more information on Feline Fix by Five go to http://www.felinefixbyfive

For more information on the AVMA’s position on spay neuter go to
http://www.avma.org/spayneuter

1. Manning MM & Rowan AN, Companion animal demographics and sterilization status: Results from a survey in four Massachusetts towns. Anthrozoos 5 (3).
2. Esther Mechler, Personal Communication, October 25, 2017.
3. Stubbs WP Scrugges SL, et al BMS. Prepubertal gonadectomy in the domestic feline: Effects on skeletal, physical and behavioral development. Vet Surg. 1993;22.
4. Dale S. When to Spay/Neuter Cats? Vet Consensus Says Fix by Five Months. Vet Pract News. 2016.
5. Land TDVM, Wall SDVM. Survey of the Coalition of Spay/Neuter Veterinarians. J Am Vet Med Assoc. 2000;216(5).