Guidance for veterinary surgeons undertaking equine work during the COVID-19 pandemic effective from 14^th April 2020 for the duration of the lockdown period (to be reviewed in line with government advice)

Veterinary surgeons should follow current government advice (https://www.gov.uk/coronavirus) that states that everyone:

• Should stay at home
• Only goes outside for food, health reasons or work if you cannot work at home
• Stays a minimum of 2 metres from other people
• Washes their hands when you get home
• Should not meet others, even friends and family – you can spread the virus even if you don’t have symptoms 

Veterinary practices provide essential services to safeguard animal health and welfare, and it is vital that this work continues during the current lockdown. The provision of a 24-hour emergency service is essential to achieve these aims and should continue. However, for all veterinary work, individual vets and veterinary teams need to carefully try to balance the following needs: 

• to maintain animal health and welfare
• to work in ways that prevent the spread of the COVID-19 virus
• to protect ourselves, our colleagues and our clients
• to protect the NHS 
• to keep veterinary and allied businesses working and viable 

In order to comply with the most recent government requirements, the number of clients seen face-to-face should be kept to an absolute minimum. For non-urgent work, BEVA does not believe it is possible to provide prescriptive advice for all different scenarios, but rather expect veterinary surgeons to assess the risk to animal and human health prior to performing any visits or procedures. The results of each risk assessment should be recorded in writing.  

The flowchart published by the RCVS should be followed to help determine whether or not it is appropriate to consider undertaking any non-urgent work. 

In particular, veterinary surgeons should determine whether the work unequivocally needs to be done within the next one to two months (i.e. it is time-sensitive work) or whether it can be delayed. For example, it is difficult to see a justification for performing PPE or poor performance investigations at the current time.  If work cannot be delayed, then you need to determine whether it can be done safely (including maintaining 2 metres physical distancing from anyone else). If the work cannot be delayed, then it is appropriate to risk assess the specific circumstances and proceed if deemed safe and appropriate. However, if the work cannot be delayed but cannot be conducted safely, then you will need to use your professional judgement to devise a plan as how the situation can be resolved. The following government advice may be helpful: (https://www.gov.uk/guidance/social-distancing-in-the-workplace-during-coronavirus-covid-19-sector-guidance#outdoor-businesses). 

In order to assist veterinary surgeons, BEVA have developed:  

• An advisory document highlighting the factors that should be considered prior to performing an ambulatory visit (click here)  
• A risk assessment template to work through with the client prior to any visit (click here) 
• A client information sheet to be emailed to the client prior to any visit taking place (click here)  

BEVA considers that some elective work is fundamental to the functioning of the equine industry.  This work is acceptable only where it can be performed in line with government recommendations for outdoor businesses (https://www.gov.uk/guidance/social-distancing-in-the-workplace-during-coronavirus-covid-19-sector-guidance#outdoor-businesses).  

However, BEVA do not consider that this is “business as usual” and the profession must comply with the latest Government advice on Coronavirus at all times (https://www.gov.uk/coronavirus).  

Following the government restrictions imposed on movements on 23^rd March advice was issued by the RCVS/BVA and BEVA that remained in place for 3 weeks. On 9^th April the RCVS issued a flowchart highlighting the decision-making process (available here) for attending cases and the BVA provided new guidance that is to come into force on 14^th April (available here) for the duration of any “lockdown” period (subject to review). There are certain inconsistencies between the two sets of advice, and there is divergence from the outcomes of discussions that BEVA and equestrian industries have been having with government.

• The RCVS have indicated that any procedures that can be postponed for 2 months “without detriment to animal health and welfare or public health” should not be performed. The RCVS have also stated that it has no interest in taking anyone to task for considered professional judgment, providing you act reasonably in the circumstances, can justify your actions and take reasonable notes”
• The BVA have maintained a position that veterinary surgeons should only undertake in-person services which are essential for animal health and welfare or public health, including to relieve pain and suffering”. However, they have indicated that “veterinary practices may vary in their approach due to individual circumstances. Individual veterinary surgeons must also exercise their own clinical judgement in assessing cases and with regard to the veterinary declaration.
• The results of direct discussions with government, related specifically to Thoroughbred breeding work, have indicated that government does not intend for there to be a cessation of non-essential veterinary work in this area. By contrast, government have indicated to The Thoroughbred Breeding Association and to other industries that work should continue where it can be performed safely in accordance with government guidance on physical distancing.

BEVA recognise that equine veterinary surgeons have a key role in maintaining the health and welfare of equids in the UK and are integral to the functioning of the UK equine industry that is worth £8 billion to the economy annually. Veterinary surgeons are educated in virology, epidemiology and biosecurity, and are well placed to be able to work in a manner that minimises and possibility of spread of COVID-19.

The work that is performed by equine veterinary surgeons has fundamental differences from the work performed by either farm animal vets or small animal vets believes that the development of appropriate guidelines that encompass all sectors of the profession and all scenarios that equine veterinary surgeons face is not feasible. The current guidance has therefore been developed by BEVA following extensive discussion with our regulators, members and other organisations to provide specific guidance for equine veterinary surgeons.

Further to our previously published guidance, we are now entering the second week of the initial three-week period of partial “lockdown” in the UK.

Our previously published guidance remains unchanged.

Our guidance is based on the UK government’s rules and advice, which is centred around the following:

Stay at home

• Only go outside for food, health reasons or work (but only if you cannot work from home)·
• If you go out, stay 2 metres (6ft) away from other people at all times
• Wash your hands as soon as you get home
• Do not meet others, even friends or family

We are at the start of the COVID-19 pandemic in the UK, and seeing what has happened in other countries and seeing the pressure that our NHS is already under, we consider it to be vital to restrict our work to what is absolutely necessary for animal health and welfare for the next two weeks. If, as we all hope, the measures taken by the government and are effective at “flattening the curve” we will hopefully be able to relax some of these measures after that time.

Our guidance also mirrors guidance from RCVS and BVA. It is vital that we all work together and, wherever possible, follow these guidelines, not only to reduce the spread of the SARS-CoV-2 virus, but also to avoid confusion for the general public and bringing the profession into disrepute. Government guidance lacks clarity in certain areas, and this has resulted in some differences of opinion about certain types of equine veterinary work that can be continued. Different practices will be working under different circumstances and professional judgement is needed to determine each practice’s policy.

However, the overarching principles are that all travel / movement should only be undertaken if it is considered essential for animal health and welfare, and wherever feasible physical distancing of at least 2 metres must be maintained.

We appreciate that furloughing and self-isolation measures are causing significant difficulties to many equine veterinary practices. We urge neighbouring practices to support each other and the local community in whatever ways they can.

The two areas that have caused the greatest amount of confusion and controversy are routine influenza vaccinations and routine breeding work.

Routine Influenza Vaccinations

• The issues around influenza vaccinations are complicated by the certification requirements of various equestrian sports’ authorities.
• In the current “lockdown” period, with no competitions taking place, the risk of equine influenza epidemic is considered to be low. In addition, the heightened vaccination levels carried out in 2019 should have resulted in an elevation of the herd immunity. RCVS have advised that there should be a ‘real and imminent risk of disease’ for a vaccination to be warranted. 
• We are currently in consultation with the various regulatory authorities to determine if some partial relaxation of the vaccination requirements for competition can be temporarily permitted during the period of lockdown.
• Therefore, for the next two weeks (to be reviewed at that time), we consider that routine influenza boosters are not urgent.
• However, if (and only if) a veterinary surgeon is required to attend a yard for an essential / emergency consultation, it could be possible to undertake routine vaccinations of other animals on the yard, provided that it does not involve interaction with anyone else and provided that physical distancing of at least 2 metres is maintained at all times. In practical terms, this means that a horse would need to be vaccinated without being held by anyone else, or if held it would need to be injected into the rump.
• If, whilst attending an urgent case on a yard, you are asked to vaccinate a horse that is normally under the care of a different practice, you should first consult with the other practice and establish if this is acceptable, and agree how the service should be charged.
• There may also be scenarios where, in your professional judgement, booster vaccines are urgent – e.g. to reduce a real and imminent risk of disease.
• Where part of a vaccine course has already been given and the animal may be exposed to the disease, veterinary judgement is paramount and the (health rather than economic) risk of leaving an incomplete course must be weighed against the ability to see the animal whilst maximising social distancing.
• We do not consider any other routine procedures (e.g. routine health checks or routine dentistry) to be appropriate to undertake whilst on a yard for an essential / emergency consultation.
• “Remote veterinary certification” – i.e. where an influenza vaccine is prescribed and dispensed to an owner / trainer for vaccination of their horses themselves, and the veterinary surgeon subsequently certifies this in the passport, is not currently possible. However, for horses not competing under any rules, after checks about appropriate handling of the vaccine, competency of performing the injection, and disposal of syringes and needles have been made, prescribing and dispensing a vaccine for the owner to administer could be considered; the owner should record the date administered and details of the vaccine in the passport, but this cannot be certified by the veterinary surgeon.

BHA's announcement (1 April2020) regarding the vaccination for equine influenza in British racehorses can be see here.

BEF's announcement (2 April 2020) regarding the vaccination for equine influenza in competition horses can be seen here.

Routine Reproductive/Stud Work

There is current confusion about whether routine pre-breeding stud / reproductive work, including artificial insemination, is considered to be essential work. We are seeking clarification from the government on whether Thoroughbred +/- other horse breeding activities should be considered essential.

For the next two weeks (to be reviewed at that time), unless we receive official government guidance on this issue, we recommend that routine pre-breeding stud work is not carried out (unless the veterinary surgeon is resident on the stud or attending the stud for other essential reasons). However, we understand the pressures that veterinary surgeons face in this area, and individual practices need to risk assess and make their own judgements on what they consider to be essential work. In all circumstances biosecurity measures must be in place at the premises/stud and 2m physical distancing maintained. Procedures and official guidelines should be reviewed regularly (or daily) should the individual premises/stud or national situation change.

Biosecurity advice for veterinary surgeons attending horses at owners premises

• Maintain physical / social distancing of at least 2 metres (the “average” horse length is 2.4 metres)
• Only have a client present if absolutely necessary (check that client has no symptoms of COVID 19 or is self-isolating before attending)
• If an owner / handler is necessary, ensure that he/she wears gloves
• Wear gloves yourself and change them regularly
• Avoid touching your face
• Before leaving the yard, disinfect any area that you may have touched or come into contact with and that could act as a fomite if you are infected with the COVID 19 virus but not yet displaying symptoms
• Wash your hands thoroughly
• Disinfect any equipment that you have used 

We are experiencing an unprecedented public health emergency, the likes of which none of us have experienced before, and the health and safety of our staff, clients and society must be at the forefront of our decisions.

There has been a lot of discussion recently within our sector of the profession regarding what level of service it is appropriate that we should be continuing to offer, and the issue of key worker status. Following consultation with members of BEVA Council and executive, the following are our recommendations as of today (24th March). The situation is changing rapidly, and we should be aware that further guidance from the government may alter this advice.

BEVA’s view is that we should be doing everything possible to protect human health and follow the recommendations and advice from the UK government, which is based on efforts to reduce the spread of the COVID 19 virus and to protect the NHS. At the same time we need to maintain the provision of 24-hour emergency care.
BEVA feels: 

• We should concentrate on maintaining a 24-hour emergency service for our equine patients. All non-essential and routine work should be stopped.
• We recommend that routine procedures, including pre-purchase examinations, routine dentistry, routine health checks, poor performance / mild lameness examinations, etc. should be stopped immediately.
• Telephone / video consultations should be used when feasible.
• For cases where physical examinations are absolutely necessary (i.e. for ill and injured patients), then a declaration from the owner / trainer that they are free from COVID 19 symptoms should be obtained beforehand and social distancing (i.e. at least 2 metres between people) should be practised – however we appreciate that this may not always be safe, and vets are urged to use their professional judgement and only break the “2 metres rule” when absolutely necessary for maintaining animal and human welfare.
• Routine 6-monthly influenza booster vaccinations be stopped.

Of course, stopping routine influenza vaccinations will have particular implications for competition horses. We are currently in discussion with the various regulatory bodies looking at ways that we can minimise the longer-term impact of temporarily reducing / halting influenza vaccinations. We further recommend that ALL other influenza booster vaccinations be halted for one month (to be reviewed after that time).
For the administration of other equine vaccines, such as tetanus, equine herpesvirus and rotavirus vaccines, we urge veterinary surgeons to make decisions whether or not to vaccinate on a case-by-case or farm-by-farm basis.

The issue of routine stud / reproductive work raises particular questions. On the basis of the government’s advice, and despite the ability to mitigate risks, we are currently struggling to see how this type of service is essential for animal welfare. However, we appreciate that this has far-reaching implications beyond the veterinary profession, and we have sought guidance from government and are in discussion with the breeding industry; we hope to provide further direction soon.

Such actions will obviously have significant financial implications to practices big and small. The government has introduced extraordinary economic measures aimed to help businesses and employees affected by these measures – details and links to government information are available on the BEVA website.

On the issue of key worker status (which is only relevant in relation to school closures), the RCVS advice is that only equine veterinary surgeons who are providing emergency care can be considered key workers. This does not apply to all equine vets or nurses and only in exceptional circumstances should vets or nurses in equine practice apply for key worker status.

Finally, we urge all practices to look at ways that they can support the most vulnerable people in society among their clients. Also, see if there is any way that you can support your local NHS Trust – some hospitals are asking for supplies of surgical masks, gloves etc.