COVID-19 Pandemic Underscores the Need to Incorporate One Health into Interprofessional Education
Margaret A. McNulty Feb 11, 2021
I think by now most of us know the origin story of SARS-CoV-2, the coronavirus that causes COVID-19. Originating in bats, the virus initially infected an intermediary species, a pangolin, which then infected humans at an open market in China. SARS-CoV-2 joins several other zoonotic viruses that have caused epidemics or pandemics in the last quarter century: SARS-CoV-1 (SARS, originated in cat-like civets in China), MERS-CoV (MERS, originated in dromedary camel in Saudi Arabia), ebolavirus (originated in either fruit bats or nonhuman primates in what is now the Democratic Republic of Congo), and the H1N1 flu virus (originated in pigs in Mexico that were transported to the U.S. before the virus spread widely).
Aside from its origin, SARS-CoV-2 continues to have a large tie with species other than humans. Following its initial emergence into the human population, it has been found to infect several other species. Big cats (e.g. lions, tigers, and snow leopards) at several zoos have developed COVID symptoms similar to humans and tested positive for the virus after likely coming in contact with SARS-CoV-2-positive caretakers. Signifying transmission into nonhuman primates, two gorillas at the San Diego Zoo tested positive for the virus and displayed symptoms, including a cough. Even our beloved pets aren’t safe; household pets, including cats and dogs, have been naturally and experimentally infected with SARS-CoV-2. And in a direct threat to human health, millions of mink in the Netherlands, and now closer to home in Utah, have been culled after it was discovered that they can contract the virus, spread it to each other, and then spread it to humans with whom they come in contact. And to top it all off, domestic cats that live on the mink farms and feral mink in the area are being blamed, at least in part, for spreading the virus between farms, furthering the spread of the virus. SARS-CoV-2 has clearly demonstrated that we can no longer deny the direct link between human and animal health.
The concept of One Health calls for a worldwide interdisciplinary collaboration between those that care for humans, animals, and the environment with the mission of improving the health and life of our entire planet, and is an overall recognition that the health of humans, animals, and the environment are interconnected and dependent on each other. Those in the veterinary profession are well aware of this link between veterinary and human health, but those in human health professions are perhaps less aware. The Indiana University Infectious Disease Fellowship posted a case to their Twitter feed in October 2020 outlining a case of contagious pustular dermatitis (“orf”). This zoonotic disease is not well known in the broader human medical community, but the word “orf” will strike fear into anyone who works with small ruminants. It’s a common poxvirus found in sheep and goats and it is easily transmitted to humans; therefore, those who work with those species in any context, including veterinarians and veterinary students, have learned to easily recognize the lesions that form on the face of sheep and goats to prevent transmission of the virus to their own skin. There are so many other zoonotic diseases, from severe (e.g. prion diseases) to less emergent (e.g. ringworm) that endanger human health, and the number of these diseases is only going to increase. When you take into consideration studies conducted by environmental researchers that identify how increasing global temperatures will only lead to disease-carrying vectors such as mosquitoes and ticks increasing their range throughout the U.S., the importance of incorporating One Health into interprofessional education (IPE) is only underscored further.
Now, I certainly will not argue that IPE among non-veterinary health professions is not important. In fact, I’d argue that this pandemic has underscored the importance of IPE for all health professions, as we watch nurses, pulmonologists, infectious disease specialists, respiratory therapists, and emergency medicine doctors, among others, work tirelessly together to care for those who fall ill with COVID. However, IPE in the medical field generally excludes veterinary medicine, and focuses only on activities to engage students within the human health professions. Very few schools team up to bridge these gaps so that human and veterinary health care professionals can learn from each other to improve the health of everyone worldwide.
What are some specific ways interprofessional collaboration with veterinarians could benefit our current situation? Veterinarians are incredibly well-versed in infectious disease management. If you want to see an example of incredibly effective disease management, visit a horse barn with a strangles (Streptococcus equi) outbreak. You will find immediate and complete isolation of sick patients as well as rigorous PPE and biosafety protocols, all practiced by laypeople (barn owners, managers, trainers, horse owners, etc.) who were taught these protocols by their local veterinarian. Veterinarians will tell you that the general population is capable of understanding and following these procedures, and those same veterinarians are experts in educating their clients.
Similarly, vaccinations are very common in veterinary medicine. Indeed, my own horses receive vaccinations for at least five different viruses every year. And if we happen to live in a region that is chock-full of virus-carrying mosquitoes or other vectors (e.g. the Gulf Coast), then that number increases to seven or more annually. Immunology forms a foundation for veterinary medicine, as many species live in herds where infectious diseases are easily spread. Even as human medicine ramps up administration of effective vaccines for SARS-CoV-2 across the world, there are still significant hurdles we must jump to effectively distribute the vaccine in order to reach this illusive “herd immunity” (a term also founded in veterinary medicine, if you had not guessed). Veterinarians are fluent in this type of language, and are not only experienced in convincing owners that their beloved pet really does need several vaccines every year, but are also experienced in administering those vaccines. Indeed, there have been increasing calls for veterinarians to assist with the vaccine distribution process alongside emergency medical professionals and students, including by high profile members of Congress, like Senator Mitt Romney. I feel a Tweet by a veterinarian in Chicago, IL sums it up quite nicely: “I’m only half-joking when I say that they should recruit vets to help give the vaccine. On any given vaccine clinic day, I can get 60+ patients done in 2 hours, and that’s patients trying to bite me.”
Outside of infectious disease, those in veterinary and human health care professions share experiences in many other areas of practice, including but not limited to: palliative care and end-of-life decisions, food safety, and patients with similar (if not identical) cancer pathologies and treatments. In addition, students in human and veterinary medical programs share many experiences and professional concerns in areas such as burnout and compassion fatigue and resulting negative impacts, such as high suicide rates and substance abuse.
In short, we can no longer ignore the necessity of including veterinary medicine in interprofessional education, and the benefits of those in each profession learning from each other. While COVID-19 has rocked our world, experts are certain it will not be the last time we are faced with a global pandemic, and One Health is a way we can better educate ourselves and be more prepared for next time.