RCVS Emergency only guidance

RE: RCVS Emergency only guidance

Beats — Fri, 27 Mar 2020 13:52:42 GMT

COnsidr installing whatsapp business on your phone, using the landline of the clinic you are working in as registered number (OK only one person at a time can use this, but I think that suffices for most clinics). Then simply Whatsapp video call the owner - much easier to triage than voicecall only I think. The pug for instance could perhaps have been done that way without need for a visit?

RE: RCVS Emergency only guidance

Iain Richards — Fri, 27 Mar 2020 13:42:34 GMT

People's version of urgent is relative. Sat in isolation for a week and they'll start to notice that niffy breath! It's why I'd be using video consults to give further reassurance.

RE: RCVS Emergency only guidance

Julie Innes — Fri, 27 Mar 2020 11:54:24 GMT

Meanwhile, so far today have fielded no fewer than 3 calls about nail clips, 3 about worming tablets and 2 about anal glands. We have one "emergency" PTS- a dog with a huge mass on its leg which has been there for months but is now emergent. I've also had a call from someone about his dog's bad breath...

How will these people cope when the NHS is shot to pieces?

RE: RCVS Emergency only guidance

Clive Ansell — Fri, 27 Mar 2020 11:49:06 GMT

I would probably have done much the same.

The choking Pug I would advise to see asap, although it turned out not to be.

the 3 others could have been referred back to their day time practices, need assessing but not emergencies. Although all need seeing at some point and by someone.

the coughing couple arriving by taxi could have waited outside, instead of in the entrance.

RE: RCVS Emergency only guidance

vetbl.locum — Fri, 27 Mar 2020 11:20:43 GMT

Currently doing OOH shifts Medium sized city

Last night

Pug choking on bone No bone wagged tail ate food at clinic

Cat bite on leg Treated LA injection

Both reasonable Owners sat in car low risk

Couple arrived via well known charity in taxi Dog not eaten 2 days has underlying problems They sat and coughed in entrance Dog treated anti vomiting Clean entrance way

High risk forced upon us

Private client old cat possible bleeding one or both nostrils Had been seen earlier in week Decided no need too see Ownwr arrived in car park Seen no evidence of bleeding

Unnecessarily seen but low risk ?

Would like to hear peoples thoughts re above cases and whether anything should have been done differently

Rgds

RE: RCVS Emergency only guidance

Julie Innes — Fri, 27 Mar 2020 10:56:38 GMT

[quote userid="3169" url="~/001/nonclinical/f/life-in-practice-discussions/28975/rcvs-emergency-only-guidance/220964"]Agree risk if isolating little old lady takes the tube, but is she at ANY risk walking out of her own house, onto her own drive and getting into her own car to trundle to the vets, not leaving said car? Really? Stopping at the corner shop where the owner has no concept of disinfection and hygiene for a pint of milk and a Woman's Weekly much more of a risk. 1000X greater.[/quote]

Yes, in theory. But in my experience (having fought with my dad about it for the last couple of weeks!) once people are out they think "while I'm out..." and then go other places.

RE: RCVS Emergency only guidance

Julie Innes — Fri, 27 Mar 2020 10:55:07 GMT

[quote userid="8991" url="~/001/nonclinical/f/life-in-practice-discussions/28975/rcvs-emergency-only-guidance/220962"]Jesus. You are allowed to leave the house. [/quote]

Actually, you're not! Not without good reason. I only leave my house to come to the surgery, because I have to. I haven't been anywhere else in the last 3 weeks. Even my dogs are being walked/ exercised in the garden and woods right next to our house. My dad lives next door and I haven't seen him (apart from on facetime) for the last couple of weeks. My husband and 3 kids have not been out further than the garden. We are lucky enough to have some gym equipment in our garage.

It's ironic all these people that suddenly need to go out for a walk or a jog. I'm betting if the government had brought in a rule that said you HAVE to go out for a walk or run every day they would be the first to argue! Suddenly all the couch potatoes, that the government has trying to persuade for years to get off their arses, need to exercise several times a day. If it wasn't so serious it would be funny.

RE: RCVS Emergency only guidance

Gillian Mostyn — Fri, 27 Mar 2020 08:17:36 GMT

[quote userid="8991" url="~/001/nonclinical/f/life-in-practice-discussions/28975/rcvs-emergency-only-guidance/220962"]

Jesus. You are allowed to leave the house.

Do you leave for locum work still. How can you class that as "essential"?

[/quote]

I have no work for a while now, because all practices where I wasnt essential have been cancelled, so you can stop worrying about what I'm doing.

I'll only be leaving the house to buy and deliver food to my mum. Possibly the odd dog walk.

You do what you do David, and I'll do what I do. Stay well. x

RE: RCVS Emergency only guidance

Iain Richards — Fri, 27 Mar 2020 07:53:31 GMT

The cases in Aus might be evidence that UV isn't that good!

RE: RCVS Emergency only guidance

Michael Woodhouse — Thu, 26 Mar 2020 21:59:18 GMT

Some people who've gotten themselves veterinary degrees with a chunk of epidemiology training seem to struggle to understand the concept of risk.

Direct person to person contact biggest risk. Fragile virus, easily killed with soap and water. Aerosol spread over very short distances. Fragile in UV light.

Agree risk if isolating little old lady takes the tube, but is she at ANY risk walking out of her own house, onto her own drive and getting into her own car to trundle to the vets, not leaving said car? Really? Stopping at the corner shop where the owner has no concept of disinfection and hygiene for a pint of milk and a Woman's Weekly much more of a risk. 1000X greater.

RE: RCVS Emergency only guidance

David Mills — Thu, 26 Mar 2020 21:44:01 GMT

[quote userid="2457" url="~/001/nonclinical/f/life-in-practice-discussions/28975/rcvs-emergency-only-guidance/220935"]he risk happens as soon as that client leaves their front door. Not just in your practice[/quote]

Jesus. You are allowed to leave the house.

Do you leave for locum work still. How can you class that as "essential"?

RE: RCVS Emergency only guidance

Julian Earl — Thu, 26 Mar 2020 21:34:20 GMT

ut we're not being asked to make that decision Julian. We're being asked to delay routine and non-urgent appointments for 3 weeks, and then reassess. The overwhelming majority of pets will come to no harm whatsoever.

Thanks Gillian, yes I agree that we are not, not asked to do this, not so explicitly but we are still advised not to go out to places and avoid all human contact where possible. I don't know bout you but in consultations an owner is invariably closer than 2 metres, and we then have to handle the fomite/ sorry I mean the pet! We are undoubtedly putting ourselves at risk by attending to animals. I would expect that many non-veterinary public think that we shouldn't to minimise the risk of further transmission Other dangers to vets are more avoidable/preventable than an aerosol-virus that is potentially serious.

No ? It is a pertinent question to ask if we should see an very ill or injured animal of owned by a sufferer of this dratted virus! The longer the outbreak continues, the more common this dilemma will rear its head. No easy answer but there are some simple ones: Either Yes we see everything or no we don't see any such animals at all. The choice is yours!

RE: RCVS Emergency only guidance

Julie Innes — Thu, 26 Mar 2020 14:07:46 GMT

My take on this comes from a position where I am owner of a small independent practice. I employ around 10 staff and charge moderately, with most of our income coming from services and just a modest mark up on drugs. I have very little in the way of savings, a pension fund which is probably worth zero now, and a husband who has just left the forces, with no income (new start up on his own) and a pension which covers around a third of his old salary. I've gone from this being a hobby of mine to bring the main breadwinner. 3 teenage kids, all wanting to go to university, wanting school trips to Iceland etc, and 12 years left to pay on my mortgage.

Money is the least of my concerns right now. Yes, I'll lose a lot. Might even lose the business. But I have been worried about this sort of pandemic for over 10 years, and I see the bigger picture. Everyone is going to struggle for money in the next few months. We'll find a way, and I'm pretty sure we won't starve. The clients will still be there (providing we try to stop as many as possible dying of this virus) when this is over. Mortgage companies will no doubt allow us to take payment holidays. There will be financial help. Businesses can come back, but lives cant! I love my team, they are amazing, and my biggest stressor at this time has been making sure they are safe. That is my responsibility, as it is all employers responsibility. We have shut the doors, installed a camera intercom, reduced staffing (will look at furlough next month, half of them self isolating at the monent!). No routine consults or ops. I won't sell wormers or flea treatments, as I cannot justify these as "essential" medications and will therefore involve people coming out unnecessarily. I've held firm against all sorts of wheedling from clients, because I definitely feel a social responsibility here. The businesses that are seen to be profiteering during this will be much maligned when it is all over and the true magnitude is apparent. A few bucks now isn't worth your reputation later. Staff who know you put them before profits will be appreciative (my lovely vet is painting the surgery today between emergencies, at her request!).

I'm definitely not worth 7 figures, far from it!! But I definitely agree with Gillian. Bigger picture is what matters. The whole thing will probably never go back to normal, but I will know I did what I thought was right for people, not business.

RE: RCVS Emergency only guidance

Gillian Mostyn — Thu, 26 Mar 2020 12:41:10 GMT

[quote userid="6550" url="~/001/nonclinical/f/life-in-practice-discussions/28975/rcvs-emergency-only-guidance/220934"]I agree we should be limiting the risk to staff and clients[/quote]

The risk happens as soon as that client leaves their front door. Not just in your practice.

It is true that other possibly non-essential businesses are carrying on trading, by bending the rules. But I do think as medical professionals we should be supporting our NHS in whatever small way we can.

People keep talking about the timescale. The point of the 3 week total lockdown is to reduce the peak sufficiently to let some normal activity resume for a while. It really is worth reading about the predicted epidemiology of this disease. China is certainly not over this problem, but their fairly short lockdown means life has now resumed. We don't know how long for, but they are certainly now better prepared and stocked for the next peak.

RE: RCVS Emergency only guidance

Bob Russell — Thu, 26 Mar 2020 12:34:58 GMT

But at least you can buy a bicycle pump and a new spade!

I agree we should be limiting the risk to staff and clients but should we be leaving puppies unprotected at the stage of life they are most vulnerable? This partial lockdown is for 3 weeks but this could be extended.

I will not profiteer from this (Heck there is no guarantee the business will still be here in 3 months) but I would prefer to do a few socially distanced puppy vaccinations than fight to keep one alive with parvo.

I would spay a cat at risk of pregnancy though thankfully all our owners are able to restrict the kittens for the time being.

I understand peoples concerns but risk can be reduced with careful precautions.

We are furloughing those we can and the drawbridge is up.

Fingers crossed that practices will survive. It is not selfish to try to preserve jobs.

RE: RCVS Emergency only guidance

Gillian Mostyn — Thu, 26 Mar 2020 12:28:00 GMT

[quote userid="3094" url="~/001/nonclinical/f/life-in-practice-discussions/28975/rcvs-emergency-only-guidance/220929"]So which is more important to us as vets? Animal suffering or human life? [/quote]

But we're not being asked to make that decision Julian. We're being asked to delay routine and non-urgent appointments for 3 weeks, and then reassess. The overwhelming majority of pets will come to no harm whatsoever.

Veterinary care for those animals that do need it will continue, with as many safeguards for staff and clients as possible, but with some inevitable degree of risk to both. That's why I went to work this week despite the fact that, as has been pointed out, I don't immediately need the money. I would much preferred to have stayed home with my family but the other vets at the practice were either vulnerable or living with vulnerable children. I'm not asking for gratitude ... It pales in comparison even to those sat at checkouts, but I will not be accused of double standards.

RE: RCVS Emergency only guidance

Iain Richards — Thu, 26 Mar 2020 12:12:20 GMT

Human first. No debate really.

Though a balloon debate with eg Trump and a lab puppy would only see one winner....

RE: RCVS Emergency only guidance

Julian Earl — Thu, 26 Mar 2020 11:30:57 GMT

Some animals may suffer, very few will die. People are and will continue to die.

This brings up a challenging moral question! The medics swear to protect life. e swear to prevent/stop suffering in animals. So which is more important to us as vets? Animal suffering or human life? This is a real moral dilemma I would suggest. For non-vets the answer will surely be human life but we are not the general non-vet population. We have promised to protect animals no matter what. So do we renege our promise or not to save people perhaps? Just throwing this question into the arena in order to to see to where it leads? If not round in circles!

RE: RCVS Emergency only guidance

Iain Richards — Thu, 26 Mar 2020 11:16:06 GMT

And I imagine that this difficult conversation has already happened in hospitals across the country, if overwhelmed, who lives, who dies.

It would be great if the little bugger that is mutated corona would mutate itself back again. In the future I suspect gene drive technology may be used to do this.

RE: RCVS Emergency only guidance

Nicola Cole — Thu, 26 Mar 2020 11:15:56 GMT

[quote userid="3169" url="~/001/nonclinical/f/life-in-practice-discussions/28975/rcvs-emergency-only-guidance/220919"]Consider the people who've has their 'elective' operations cancelled so remain in pain longer, many cancer patients who cannot be cured but helped surgically apparently fall into this class.[/quote]

But does that not give an idea of the gravity of this situation from a medical viewpoint? They’re delaying cancer surgery-that’s not a decision to be taken lightly. Whether we were in lockdown or not those surgeries would (highly likely) still have been delayed.

Why? Because the anticipated numbers for coronavirus far outweigh the capacity. Either Covid patients don’t get treated and get left at home to fight it or die, or they get admitted to hospital, potentially ICU and the capacity of the hospitals to do anything else goes. Or they could put very strict limits on which suspected Covid patients get admitted to keep numbers down and the rest die at home?

Yes, this is a novel virus and we don’t know how it’s going to act. We do have data from other countries though that are further ahead in the ‘disease progression’ showing us doubling times for rate of infection etc so we can extrapolate numbers from there to give us an idea as to number of hospital beds and ICU beds required 2 weeks from when lockdown started.

RE: RCVS Emergency only guidance

Neil Wheadon — Thu, 26 Mar 2020 10:57:36 GMT

[quote userid="4367" url="~/001/nonclinical/f/life-in-practice-discussions/28975/rcvs-emergency-only-guidance/220924"]I suspect Granny won't be given a respirator if the need outstrips supply, so it almost amounts to the same thing[/quote]

True, but in any euthanasia debate where do you draw the line, that's the key question

Neil

RE: RCVS Emergency only guidance

Iain Richards — Thu, 26 Mar 2020 10:52:10 GMT

[quote userid="3094" url="~/001/nonclinical/f/life-in-practice-discussions/28975/rcvs-emergency-only-guidance/220921"]I do think that e should not publicly compare this to foot and mouth as beig comparable[/quote]

Unusually, I'll have to disagree with you Julian! In 2001, most of the spread was fomite or animal very little by aerosol. There was a quote that 95% came in through the gate, not over the hedge. The similarities are further, a virus where shedding occurred before clinical signs and there were (almost) asymptomless carriers).
A very specific comparison is that of human behaviour, both at the beginning (rules don't apply to me as I am essential); in the middle (bored of biosecurity now); and towards the end (normal life has to go on).
We did do more testing, but in fairness it was only us and not the world needing tests.

[quote userid="8958" url="~/001/nonclinical/f/life-in-practice-discussions/28975/rcvs-emergency-only-guidance/220922"]In COVID19 we can't just put Grandma to sleep because we don't have enough ventilators or trained staff[/quote]

I suspect Granny won't be given a respirator if the need outstrips supply, so it almost amounts to the same thing

RE: RCVS Emergency only guidance

Neil Wheadon — Thu, 26 Mar 2020 10:43:12 GMT

[quote userid="3169" url="~/001/nonclinical/f/life-in-practice-discussions/28975/rcvs-emergency-only-guidance/220919"]After a short glut of people the NHS would be in a much healthier state once a lot of the old and sick (the high users) were removed from the equation.[/quote]

From the centre of the boxing ring...

The best veterinary analogy is parvovirus in my opinion. So we have an outbreak and we don't have enough drip pumps, what do we do? Well we have the advantage of saying 'Well Bonzo has had a great puppyhood, Mrs Wiggins and you don't have the finances, so the kindest thing....'

In COVID19 we can't just put Grandma to sleep because we don't have enough ventilators or trained staff. We also need to think of NHS doctors/nurses in the frontline with a hospital heaving with COVID19, I'd be nervous wouldn't you?

So I think the present 'middle way' is the best way. All we need now is a testing kit and that's coming, so we can deal with this far more scientifically

Neil

RE: RCVS Emergency only guidance

Julian Earl — Thu, 26 Mar 2020 10:32:16 GMT

I do think that e should not publicly compare this to foot and mouth as beig comparable in terms of the epidemic/epizootic nature. When I was at uni, a few years ago[!], we weretold that foot and mouth virus is the most infectious disease known to mankind. If an infected pig in Holland coughs, then with an easterly wind, the pigs in East Yorkshire and/or Anglia would be infected, etc., etc. This coronavirus that infectious it seems. It is clearly infectious via fomites, be this door-handles, , shared cups, envelopes from the postman, maybe pet's coats? But a two metre gap is not quite enough to stop F & M virus from spreading at all! Please don't refer to this as a good animal-comparison, just in case the government gets a more severe control measure! like that for foot and mouth!

Even Ebola does not spread as easily as foot and mouth so let's keep the latter out of the conversation please. It is misleading if nothing else.

TIA. = Thank you.

RE: RCVS Emergency only guidance

Arlo Guthrie — Thu, 26 Mar 2020 10:01:23 GMT

Well, I've slightly got my eye on a few other balls .... what with daughter in hospital, and also trying to get the Expert forums ready to go in order to support GPs working in isolation.

And what a great debate - in the green corner, we have Gillian et al making the case for saving lives and lockdown being the answer, whereas in the red corner we have David Mills et al arguing the futility of lockdown (I know I am oversimplifying).

I do think it is good that this is a robust discussion, and good that people like David challenge the prevailing viewpoint robustly. That's very important. But really, David, please stop telling people to grow up, or to stop being patronising or condescending. That's a step too far. And really, it is more of a reflection of your interpretation of their behaviour based on limited info, than their behaviour, if that makes sense.

What I mean is that if you were having this discussion face to face, I very much doubt you would think someone was being patronising. Similarly to the way that when we met all that time ago, you were a very different person to the one I expected to meet (in a positive way!)

Let's keep it robust, but a little less snarky.

Oh, and I think since the new website I have noticed a little less use of the emoticons to soften what people say. I am not sure if that is because they are a little less visible.