Why must we suspend spay-neuter surgery during the pandemic
An open letter from Dr. Julie Levy.
To my colleagues in animal welfare:
I’ve spent my career studying, training, and advocating for spay/neuter in all of its incarnations – pediatrics, HQHVSN, TNR, MASH – even when it was unpopular. I never thought I would be advocating otherwise.
Spay-neuter has been intricately woven into the fabric of animal lifesaving for more than 3 decades. And then suddenly, COVID-19 challenged every aspect of daily life and shelter operations, rewriting the book on what essential services are. We’re told to be #SaferAtHome to avoid overloading the healthcare system and that every exception to social distancing decreases its efficacy. What does that mean for spay/neuter programs?
These are unprecedented times that come with challenging and ever changing dynamics. Animal welfare professionals have earned a place at the national table as experts in helping with disasters and providing guidance to others in overcoming what appear to be unsurmountable problems.
The public health emergency that is upon all of us with COVID-19 calls all of us to action. We must immediately focus our attention on doing absolutely everything possible to support our human health care system and affiliated resources. This means social distancing and staying safe. Even if we distance ourselves from the public, performing surgery brings staff to work and into close proximity with each other.
Essential procedures are for conditions that are life-threatening, rapidly deteriorating, may cause permanent dysfunction, or relieve suffering. What’s not included in the list of essential functions? Spay and neuter services for the public, shelter pets, and TNR/SNR. Please, let’s just stop.
The urgency of this unprecedented pandemic calls for radical action to protect human lives, and as a consequence of that, to protect animal lives. Of utmost importance is to support our healthcare system, which is close to the breaking point, via #SaferAtHome.
It is no longer just about our animal welfare missions, but about those brave souls who are literally putting their lives and personal welfare on the line for us. The sacrifices we make in this moment will determine what larger sacrifices will be trust upon us in the coming weeks and months. It is time to suspend routine spay-neuter.
This will help keep as many people as possible healthy and out of our community hospitals so that life-saving beds are available when needed.
This will safeguard our staff so that when this crisis subsides, and it will, we have an intact work force of experts that can go back to work with renewed vigor and tackle the animal needs that we are all highly committed to.
This will conserve PPE so we will have it for the inevitable emergency cases or for when the local hospital calls upon veterinarians to share their stock because their frontline nurses and doctors are working without it.
On the topic of PPE, please realize that it is a minor consideration. Although we vets are fully capable of MacGyvering all the alternatives when regular supplies run low, this is about being #SaferAtHome to slow the pandemic spread of COVID.
The decisions we make today will determine the outcome of the pandemic, including how many people die and how many of our animal welfare organizations and staff survive to carry on when the pandemic subsides. Every compromise of social distancing and staying home undermines success. The nurses and doctors on the front lines are begging people to stay home. We must listen and act.
Spay/neuter is a tool of lifesaving, but we are too creative and resourceful to believe we cannot overcome in other ways, kitten season notwithstanding. Pausing spay/neuter is a gut punch, and it will have consequences – kittens will be born, revenue will fall, staff may be furloughed – but these pale in comparison to the alternative.
The work we have done in animal welfare, animal control, and shelter medicine in the past 30 years positions us to step away from the spay/neuter focus we are accustomed to during this crisis and thrust our efforts onto doing everything we can to stop this pandemic, to save human lives, and get our world back as soon as possible.
Your leadership means everything to this effort. Please join in.
– Dr. Julie Levy, Fran Marino Endowed Professor of Shelter Medicine Education, Maddie’s Shelter Medicine Program, University of Florida
As veterinarians, we’ve tried to summarize the evidence-based reasons underpinning our call to suspend routine spay/neuter surgery – to preserve supplies, staff safety, and health care capacity.
Our advice is a well-reasoned and dispassionate accounting of risk vs benefit. However that calculus is devoid of the heartrending testimony of those on the frontlines of the pandemic. Our choices now will have downstream consequences for them. We offer their voices here:
Nurses Speak Out
A registered nurse describes what she has experienced inside a Long Island hospital and the toll that caring for coronavirus patients is taking on health care workers.
“‘I haven’t slept because my mind won’t shut off. I cried in the bathroom on my break, as I peeled off the PPE from my sweaty self, mask indentations on my face. I cried the entire ride home,’ the nurse wrote in a social media post. The nurse, whom CNN is not naming, says patients are streaming in with ‘non stop coughing, sweaty, fevers’and with ‘fear in their eyes.’
“‘I cry for the ones who passed away. I cry because we intubated 5 patients within 10 min and im terrified. I cry for my co workers, because we know it will get worse and I already feel like that is impossible and we are already at our breaking point, I cry for the parents, children, siblings, spouses who cannot be with their loved ones who may be dying but cant have visitors because there is no visiting allowed,’the nurse added.”(from CNN)
“‘We are averaging five to seven intubations and three to four deaths a day. We have had to set up a temporary morgue (white box) outside the ED next to ambulance ramp for those who expire from COVID-19, this temporary morgue is full,’ the nurse said.” (from CNN, downtown New Orleans hospital)
Shelter Veterinarians Speak Out
“If we as veterinarians think we’re in difficult positions making difficult, gut-wrenching decisions, just imagine what the MDs are doing who have to choose which human patients to put on ventilators?
And what if the 20-somethings who ignored the warnings take the ventilators that your mom and dad need instead? I know someone here who watched her dad die from COVID on a ventilator. And now her mom is on one. Disease can’t transmit if people stay home. When we do surgery, even with two techs, there is a risk of transmission within that group of three people.”
“Exposing people for veterinary elective surgeries causes more downstream exposures. We can stop the pandemic and get back to business as usual much sooner if people stay home.”
“The biggest concern is the risk of spreading the virus to all people involved in the s/n. It sucks for all of us, stopping s/n for many reasons, but it really is for the human greater good.”
“I’m in MN and our vet board has already mandated we stop, so I don’t get to make that choice and since I am a private contractor that means that 90% of my work has just been taken away…no PTO, nada. So from a personal level it sucks. But if by stopping the activities we can means that less people will die from this terrible virus, it’s totally worth it.”
Executive Directors Speak Out
“[Taking a deep breath:] I’m not sure who has and who hasn’t been following the conversation about considering adopting out animals unaltered during this crisis.
Obviously this is something that we’ve always seen as mandatory, so it’s a difficult topic. In case it’s helpful, I’d like to share our decision and the main factors that led to it:
- Our new state order and other national-level directives say elective veterinary surgery should be avoided right now.
- While spay/neuter surgery is highly desirable, in the end it is elective from the animal’s point of view. The surgery uses resources such as PPE and oxygen that are urgently needed in human healthcare now.
- We need to get animals out as quickly as we can right now, and spay/neuter adds a minimum of a day for us.
- In our part of the country, there isn’t broad overpopulation of animals.
- Whether or not we alter animals for a two-or-three-month span in 2020 is not going to affect the overall curve of animal population or animal welfare.
For these reasons, we at XXX let go of nonemergency spay/neuter on March 17, and will pick it up again after the crisis.”
“Our clinic in XXX is closing tomorrow. Today is the last day of surgery. I am the Executive Director and I agonized over this decision. I agree 100% that our surgeries are essential, especially this time of year. Initially, my goal was to stay open unless given an order by the government to close. We enacted social distancing measures last Monday the 16th. I felt good at that time that we were doing everything we needed to do.
“As time has gone on and I have read more and more information from the CDC, VVMA, AVMA, etc, I have come to the conclusion that there is no way that I can ensure my staff’s safety. I realized that I would not be able to live with myself if one of my employees or their family members contracted this virus. I don’t want to even think about if one lost their life.
“When you add into account that anyone who gets admitted into the hospital (for any reason) will not be allowed to have their loves ones visit, that makes it even worse. Then, on our HQHVSN Directors discussion group, someone made the comment that by keeping our clinics open we are encouraging people to break the quarantine and social distancing recommendations by coming to our clinic. That was the final tipping point for me.
“I know that this is going to cause an increase in puppies and kittens in the shelters, but I have to take care of my staff and community first.”
Our animal welfare community has come together in unprecedented unity to prioritize human and animal lifesaving by providing the following guidance for navigating this difficult time:
Webinar: Spay/Neuter in the COVID Era
Spay/neuter has been intricately woven into the fabric of animal lifesaving for more than 3 decades. And then suddenly, COVID-19 challenged every aspect of daily life and shelter operations, rewriting the book on what essential services are.
We’re told to be #SaferAtHome to avoid overloading the healthcare system and that every exception to social distancing decreases its efficacy. What does that mean for spay/neuter programs?
In this recorded webinar, you’ll hear the latest national guidance on the role of spay/neuter during the pandemic and how programs are navigating these unprecedented times.
Dr. Julie Levy, Fran Marino Endowed Professor of Shelter Medicine Education, Maddie’s Shelter Medicine Program at UF
Aimee St. Arnaud, Director of National Veterinary Programs, Best Friends Animal Society
Sharon Harvey, President and CEO, Cleveland Animal Protective League
Dr. Staci Cannon, Medical Director, Nashville Animal Care and Control