FAQs for veterinary practitioners

The biggest risk to business continuity for private veterinary practices, aside from a mandated total shutdown, is the situation where a staff member is a diagnosed or suspected to have COVID-19 or has had significant high-risk contact with a known case.  In this event it is almost certain that all in-contact staff members will be required to undertake a mandatory 14-day period of isolation.

This has the potential to cause a total 14-day shut-down of a practice.  Many practices have already instituted a “two teams” roster of vets and nurses who will work in complete isolation from one another for the duration of the high-risk period.  Businesses that operate from multiple sites may choose to do this by basing teams at a specific site and ensuring that is the only physical address that they work from.

Other practices have gone to an all on–all off situation where the practice is staffed by one team or the other, at any one time.  By doing this, it decreases the chance that an entire staff of vets and support workers will be stood down simultaneously and veterinary services can still be provided by remaining “unaffected” staff.

AVA has a telemedicine policy as well as a number of “Telemedicine and COVID-19” resources.  Please refer to these documents for more detail.  However, in short, telemedicine is a legitimate tool that veterinarians can use in this situation.  However, it needs to be used both within its diagnostic and regulatory limitations.  AVA members are encouraged to consult with their relevant state or territory veterinary board for specific guidance on this issue.     

Veterinarians are strongly encouraged to utilise these telemedicine “platforms” as primarily a means of performing tele-triage and giving tele-advice during the current situation, thus reducing unnecessary face to face contact with clients.  The use of telemedicine technology as a direct replacement for physical examination and diagnosis in animals, should be avoided.  There are no current indications that veterinarians will not be able to continue to physically examine and treat sick, injured and suffering animals throughout the shutdown.  The judicious use of telemedicine as a support tool for practitioners in providing continuity of animal care in a responsible manner is encouraged. 

Further information is available here.

Given the most recent developments in terms of movement, social isolation and business restrictions imposed by state and federal governments, AVA recommends that private veterinary practices should no longer be accepting any of these categories of students for the foreseeable future.  Most universities, RTOs and high schools have now suspended all workplace training, but even in recent days, the situation is still somewhat unclear. 

PPE and disinfection supplies have become difficult to source since the declaration of the COVID-19 pandemic.  Obviously human medical services have the highest priority access to PPE, however it is important that veterinary practices can still access adequate supplies. 

Veterinary wholesalers are working exceptionally hard to source stocks of PPE to satisfy industry demand, but they face significant global logistical and supply challenges and a constantly changing situation.  Veterinary practices are strongly encouraged to communicate regularly with veterinary wholesalers via telephone, social media or their websites.  They are in the best position to give up to date information around PPE availability.  AVA urges practices to consider how to preserve PPE supplies, resist the temptation to panic buy and use PPE supplies judiciously.

It has been widely reported that the use of face masks is only warranted for those persons at greatest risk of actually carrying or spreading COVID-19 (people displaying cold and flu symptoms) or for veterinarians and staff who are in close contact with high risk clients.  Other than in these situations, the use of a mask is of dubious value.  Far greater protection comes from frequent hand washing or alcohol-based sanitisation and social distancing.

To further conserve PPE supplies, surgical masks can be reused.  AVA has produced a guide to the use and reuse of surgical masks, which can be found here.

On the 27 March, the Federal Minister for Agriculture, the Hon David Littleproud MP, issued a statement that veterinary services including livestock, companion animal and wildlife are considered to be essential.

While continuing to provide these essential veterinary services to the community, our advice is that veterinarians should also consider what aspects of their work can be postponed to help minimise risk and spread of the disease as far as possible.  

We would expect that veterinarians will use their clinical judgement and determine procedures based on a risk-based assessment.

More specific or definitive advice can be obtained by consulting relevant veterinary boards in the state or territory in which vets practice.

That AVA supports the view that: If veterinarians that if act reasonably, acting on available information and can provide relevant justification for the decisions they make, which must be in the patient medical records, it is unlikely that any Board would find you had acted inappropriately.

Advice from Veterinary Boards regarding essential services provided by veterinarians:

• QLD
• Victoria
• NSW (plus have also referred veterinarians to the Victorian guidelines above)
• Tasmania 
• ACT

When judging whether a procedure is “essential”, we are advising vets to make a professional judgement based on the risks to the animal(s).  If failure to do the procedure will risk the animal’s health or welfare, or public health, or food security and safety, then it can be justified.  See FAQ above.

In the case of vaccinations, it may depend on the individual circumstances of the animal(s). Priority vaccination cases would be that of:

• immuno-naive animals – previously unvaccinated older animals or pups undergoing primary courses of vaccination
• booster shots for previously vaccinated animals that are in high risk locales or households
• vaccination for prevention of parvo – especially in geographic areas where parvo is prevalent
• vaccination for prevention of Hendra virus - from both an animal welfare and public health perspective.

However, in a more mature animal (>5) with a solid vaccination history it may be appropriate to postpone the vaccination, depending on that animal’s circumstances. The veterinarian should be free to make a risk-based assessment based on their clinical judgement about the animal(s) in question.

If veterinarians do choose to proceed with vaccinations or any other procedures, they should implement social distancing and infection prevention protocols as far as possible - see AVA’s COVID-19 Info Hub, in particular Infection Prevention and Control.

On the 27 March, the Federal Minister for Agriculture, the Hon David Littleproud MP, issued a statement that veterinary services including livestock, companion animal and wildlife are considered to be essential.

We expect that, by extension, this would include all the support services, drugs, supplies, staff and allied services that veterinarians need to do their jobs.

The below outline provides a summary of available Government support (Federal and State) as at 1 April 2020. Governments are continually making further funding announcements therefore the links provided below should be checked regularly.

Each business will be unique, and it is strongly recommended that you consult with your accountant or financial adviser to explore support opportunities.  The below information is not exhaustive but aims to highlight support that is likely relevant to small and medium sized businesses in relation to government announcements.  Information on loan support or superannuation has not been provided - this information should be sought and advised by your accountant or financial adviser.

Federal support

• All small and medium sized enterprises with an aggregated annual turnover under $50 million that pay salary and wages automatically receive a minimum payment of $10,000 or payment equalling 100% of the amount withheld in tax on employee salary and wages up to a maximum of $50,000.  An additional payment will be made in the July-2020 period, meaning eligible entities will receive at least $20,000 up to a total of $1000,000.  Further information.
  
  
• The JobKeeper payment of $1500 per fortnight per eligible employee is available and is relevant for those businesses that have a turnover reduced by more than 30% relative to a comparable period a year ago – and the employer must register for this.  This payment is paid to the employer to pay the employee that has been stood down or had their hours reduced and will be backdated to 1 March 2020.  Sole traders are also eligible for this payment.  You will need to make an application to the Australian Taxation Office (ATO) and continue to provide information to the ATO on a monthly basis, including the number of eligible employees employed by the business. Further information.
  
  
• The instant asset write-off threshold has been increased from $30,000 to $150,000 for businesses with aggregated annual turnover of less than $500 million.  This applies from 12 March 2020 until 30 June 2020 for new or second-hand assets.  Further information.

Support for businesses including wage subsidies, supporting credit and income support from the federal government can be accessed at this link.

State government support

State and territory governments are also supporting businesses.  These opportunities should be explored by your accountant or financial adviser in conjunction with federal government support.

Western Australia 

• Businesses whose annual Australian Taxable Wages are between $1 million and $4 million will receive a one-off grant of $17,500. No applications are required, as funds will automatically be paid from July 2020
• The payroll tax threshold will be increased to $1 million from 1 July 2020, six months earlier than originally planned
• Small and medium sized businesses affected by COVID-19 can apply to defer payment of their 2019-20 payroll tax until 21 July 2020

Information can be accessed here.

Queensland

• Employers (or part of a group of employers) who pay $6.5 million or less in Australian taxable wages will receive a refund of your payroll tax for 2 months (November and December 2019) and a payroll tax holiday for 3 months (January to March 2020). You can also apply for a deferral of payroll tax for the 2020 calendar year
• Employers (or part of a group of employers) who pay more than $6.5 million in Australian taxable wages who have been negatively affected (directly or indirectly) by coronavirus, can apply for a deferral of payroll tax for the 2020 calendar year and a refund of your payroll tax for 2 months (January and February 2020)

Information can be accessed here.

Northern Territory

• Small businesses that have been significantly impacted by the physical distancing requirements in response to (COVID-19) pandemic - for example, staffing, turnover – can apply for an immediate survival payment of between $2,000 and $50,000 to help offset the immediate cost pressures on businesses.  A payment of between $1000 and $5000 is available to help businesses make necessary changes they need to help adapt to the new operating environment.

• Small businesses have access to a grant of $10,000 to purchase goods and services that make permanent physical improvements to a business (land and/or building) that help its operations and customer experience. It could include buying new equipment, new shop fit outs and physical changes to attract customers.  Inverter upgrades, batteries and other electrical work that support energy efficiency are eligible works, as well as solar hot water installation.  The works must include a labour component.

Information can be accessed here.

New South Wales

• Payroll tax will be waived for three months (April-June 2020) for businesses with payrolls up to $10 million
• Payroll tax will rise to $1 million in the financial year 2020-21

Information can be accessed here.

Tasmania 

• Businesses with payrolls of up to $5 million will be able to apply, based on the impact of virus, to have their payroll tax waived for April to June 2020
• Business vehicle registration savings and deferrals are available
• One-off grants of up to $750 are available through the Business Continuity Grant to assist small business fight the economic impact of COVID-19 and prepare the foundation to set Tasmania up for a rapid recovery when the situation eases

Information can be accessed here.

South Australia

• Businesses with annual Australian wages of up to $4 million will receive a six-month payroll tax waiver. Eligible business groups will not be required to pay any payroll tax in the months of April to September 2020
• Business groups with annual Australian wages above $4 million that can demonstrate they have been significantly impacted by COVID‑19 will, upon application, be able to defer payroll tax payments for the six months from April to September 2020. For these eligible business groups, payroll tax payments that were due to be paid from April to September will now be due from October 2020
• businesses (and individuals) paying land tax quarterly in 2019-20 will be able to defer payment of their remaining 2019-20 land tax payments for six months

Information can be accessed here.

Australian Capital Territory 

• All ACT businesses with Australia-wide wages of up to $10 million can defer their 2020-21 payroll tax, interest free until 1 July 2022 by completing an application form. Eligible businesses will need to lodge their payroll tax returns as normal but will not be required to make the associated payment at the usual time. If the deferred amount is paid before 1 July 2022, no interest will be charged. Interest will be applied to any outstanding deferred amounts from 1 July 2022.  For those who lodge their payroll tax assessment monthly, deferral can commence for their July 2020 payroll tax liability, which is usually payable by 7 August.  For those who lodge their payroll tax assessment annually, they can defer payment of their full 2020-21 payroll tax liability, which is usually payable in July 2021
• The government will waive fees for 12 months from 1 April 2020 for businesses that require an infection control licence
• Small business owners with electricity usage below 100 megawatts per year will see rebates of $750 automatically applied to their next electricity bill in around June or July 2020

Information can be accessed here.

Victoria 

• Full payroll tax refunds for the 2019-20 financial year to small and medium-sized businesses with payroll of less than $3 million
• Businesses with payroll of less than 3 million can defer any payroll tax for the first three months of the 2020/21 financial year until 1 January 2021

Information can be accessed here.

Veterinary practices will be faced with a range of HR challenges as a result of business disruption from the COVID-19 pandemic.  Managing staff sick leave, holidays, RDOs, long service leave and potentially redundancy issues will all be potential issues faced by employers.  The best place to start with this is the AVA HR Advisory Service.

Veterinarians, like people from all other walks of life will be under significant stress during the COVID-19 pandemic due to the drastic disruption to their work and social lives, financial stability, the uncertainty of the situation and the risk to the health of themselves and their families.

It is important to stay connected with friends, family and work colleagues, even if this is virtually.  Pick up the phone, FaceTime someone or drop them an email.  The AVA has several Mental Health resources for the profession including a Help Line for veterinarians who need professional help.  The following link will direct you to these resources: 

https://www.ava.com.au/member-services/vethealth/emergency-help/

Other organisations that veterinarians may contact for help dealing with the mental stress of the current situation include:

• Beyond Blue 
• Black Dog Institute
• Headspace Australia
• MindSpot Clinic

During this challenging period, compassion shown towards owners of loved pets that require euthanasia is important.  Many practices are now operating on the basis that owners do not enter the practice with their pet – rather the pet is collected from outside the building by a staff member.

Veterinarians will inevitably be faced with the predicament of owners wishing to stay with their pet whilst it is euthanised.  It is advisable that the owner does not accompany the pet if the following circumstances apply:

• The owner has been overseas within the past 14 days
• The owner is unwell or has symptoms consistent with COVID 19 or
• The owner is required to self isolate

Outside of the above, the professional judgment of the veterinarian should be applied in these situations.  Precautions that may be undertaken to allow an owner to accompany their pet during euthanasia include:

• Prepare the consultation room for the euthanasia before the procedure
• Collect the animal from outside the building as per standard COVID-19 procedure
• With the assistance of a staff member, sedate the animal and insert an intravenous catheter with a 2m extension line before allowing owner entry to the room.
• Before entry to room, provide hand sanitizer and gloves to the owner

This should allow the owner to hold and comfort the animal whilst minimising person to person contact time and maintaining physical distancing from staff as euthanasia is performed.  Ensure that adequate decontamination occurs after the procedure has been performed.

Veterinary practices have been efficient and diligent in adapting to the COVID-19 pandemic.  Practices have implemented a range of measures in the workplace enabling them to adhere to both social distancing and infection control requirements, helping to protect veterinary staff and clients.

The AVA has developed a range of resources at AVA’s COVID-19 Info Hub, in particular Infection Prevention and Control.

We would like to share with you what practices are currently doing to decrease the risk of COVID-19 infection.  It should be noted that currently there are no restrictions as to what specific services or procedures veterinarians can deliver.  The AVA is not directing any practice to implement the following measures, it is simply a way of sharing information for your consideration.

• Advise clients that if their pet needs veterinary attention and
  • The owner has been overseas within the past 14 days
  • The owner is unwell or has symptoms consistent with COVID 19 or
  • The owner is required to self isolate

They SHOULD NOT ATTEND the clinic.  In this case teletriage and assessment should be performed and advice can be given to the owner on how best their pet can be treated.  Arrangements can still be made for the pet to be seen, for example with a house visit, but under strict conditions of infection control

• Direct any member of the public attempting to deliver lost animals to deliver to council or phone council for advice and do not present them to a veterinary clinic if possible
• Adhere with indoor restrictions of space of 4 sqm per person
• Encourage telemedicine consultations where appropriate, with an emphasis on teletriage and teleadvice, with over the phone payments
• Place seats in waiting room at least 1.5 metres apart
• Advise clients that contactless payment is preferred (limit cash handling)
• Mark a safety and exclusion line 1.5 metres from the reception desk to protect reception staff
• Defer grooming/nail clipping treatments as non essential
• Cancel puppy socialisation (puppy pre school) classes (this cannot be performed due to government mandated social gathering restrictions)
• Reschedule vaccinations that can be safely postponed
• Consider extending opening hours to accommodate space between each appointment to decrease overlap of foot traffic. Some clinics have increased weekend trading hours as part of this approach
• Veterinary staff to wear PPE at all times if infection risk is high
• Erect signage outside premises advising not to enter without phoning first
• Lock the main entrance door to the clinic building. This is a critical control point all practices can enforce.  Nursing staff can greet client safely, assess requirements and admit clients and pets (preferably pets only), as appropriate
• Deactivate online booking and insist on phone bookings so physical appointments can be prioritised – telephone or video consultations may be possible with some clients
• If you have adoption animals at clinic – schedule viewing time as with appointments in a dedicated area
• Limit of one pet owner into the building per pet that is presented for an appointment
• Advise clients that when arriving for appointment, call from the car to announce arrival – have no people in waiting in reception – once previous client leaves, next one can be called in from car
• Advise all clients to use hand sanitiser when entering and leaving the practice
• Advise clients to phone ahead for purchases of prescription repeats, prescription food and worming and flea control treatments to allow veterinary staff to have order ready (and deliver to car on arrival). If possible, arrange for over the phone payment as well to further reduce contact
• Acquire mobile EFTPOS machine that can be taken to cars or outside clinic for payment
• Advise that nurse can collect animal from car and take to consult room so owner does not need to enter premises – phone or video link can occur with owner in car to gather further history and discuss case whilst pet is being treated
• Splitting staff into two teams that do not overlap shifts – including splitting medical supplies used by each team. Maximises chances that there will always be at least one “clean” team available to staff the practice in the event of dangerous contacts
• Sanitizing entry door handles/buzzers/eftpos machines after each client
• Acquire verbal consent for treatments (rather than written) to avoid physical sharing of pens/paper. Record this consent in computer records however
• Consider asking clients to wait outside clinic – nurse to collect pet
• Consider providing a pick up service of pets to take to clinic if required. Especially for clients in isolation or very old/high risk clients that should not be moving around

1. We believe that the Federal Government has advised all human pharmacies, and suppliers of human medicines to pharmacies, to prioritise human medicines for human use.  This doesn’t mean that they must not supply human medicines to vets, just that they can only be supplied after the human needs are met.  This will not apply to any products which are APVMA registered of course.  Vets should use APVMA products where possible, but if there is not an appropriate veterinary drug available, an option is to get drugs compounded by a vet compounding pharmacy rather than using a human medicine
   
   
2. We have also heard of some veterinary panic buying occurring. There have been reports of vets stockpiling supplies which is putting a strain on the supply chain, resulting in protracted delivery times. As with all deliveries, the increased stress on transport with additional deliveries is also adding to delays in supplies reaching clinics
   
   
3. Some of our industry vets are being asked about certain products they supply with regard to which veterinary services are considered essential – ie. vaccines & vaccinations. Vaccination is still appropriate for at-risk animals and public health reasons (see FAQ regarding vaccinations)
   
   
4. The AVA’s Risk Management guideline (https://www.ava.com.au/coronavirus/covid-19-risk-management-for-workplaces/) issued on 23 March advises vets to “minimise use of consumables in short supply (and) please consider delaying non-essential elective procedures”
   
   
5. Stay in contact with your preferred veterinary wholesalers. They are working very hard to ensure ongoing supply of pharmaceuticals and consumables for veterinary practice and are happy to speak to their clients and keep them updated on the situation